Senate Pro Tem Mary Kay Papen, D-Las Cruces, sponsored HB 55, which she said will improve the way the state deals with healthcare providers. Responding to questions from Sen. Gay Kernan, R-Hobbs, Papen said the primary differences between her proposal and the paradigm in which the state’s been operating boil down to a few key words: transparency and due process.
Current law, said Papen, “is tilted in favor of state, and it’s calculated to make providers’ responses onerous.”
For example, when the state Human Services Department conducted an audit of 15 behavioral health providers back in February 2013, the results pointed to problems including Medicaid overbilling and possible fraud. The state’s response was to immediately freeze payments to all 15 affected agencies.
The agencies had no opportunity to respond to the allegations or even see the evidence of fraud indicated in the audit. Some of have since been forced to cease operations.
The Human Services Department, then under the leadership of former Secretary Sidonie Squier, brought in five behavioral health providers from Arizona to fill in gaps in service. However, that transition has also seen its share of problems.
State officials have said the suspension of payments was in line with federal Medicaid regulations. Papen said her bill “addresses the unfortunate consequences of federal law that gives HSD too much leeway to decide” whether Medicaid payments should be withheld.
She said the proposal also sets new procedures for determining whether allegations of fraud are truly credible and “gives the accused an opportunity to respond.”
Sen. Jerry Ortiz y Pino, D-Albuquerque, said he supported the measure in part because the funding freeze the struck behavioral health agencies could happen to any other service provider that receives Medicaid money.
“This sets up a way for there to be some … right to face your accusers, hear what you’re accused of and respond,” said Ortiz y Pino. “That’s missing now.”
Sen. Sue Wilson Beffort, R-Sandia Park, said “there was fault to go around” when it came to the state’s behavioral health shakedown. The Medicaid freeze was tied to unintended consequences of the Affordable Care Act, she said.
“The problem is you have such an enormous federal act … and the next thing you know, the state is trying to interpret it.”
However, Beffort said she was confident that Brent Earnest, Gov. Susana Martinez’s pick for the new head of HSD, would act “much more professionally and without some of the apparent glaring errors that occurred.”
There was little debate before the chamber voted 32 to 8 to ratify Papen’s bill and send it on to the House for final approval.