The Democratic members of the Congressional delegation want to make sure a repeat of the 2013 behavioral health shakeup can’t happen again in New Mexico or anywhere else.
The members introduced legislation that would clarify rules on when Medicaid funding can be taken away from providers by the state.
The legislation is called the “Medicaid Program Integrity Enhancement Act of 2016.”
Currently, federal law allows states to remove Medicaid funding for “credible allegations of fraud.” It also allows for discretion from the state in cutting off funding.
The new legislation would require Medicaid agencies in the state to consult with the state attorney general before payments are cut off, as well as requiring states to look at the impact on beneficiaries before payments are suspended.
The legislation would also require states to stop the payment suspensions after the end of an investigation and provide for an appeal process.
This all comes after the state Human Services Department stripped funding from 15 behavioral health providers in 2013. The state cited “credible allegations of fraud” for doing so; the state Attorney General later announced after an investigation exonerated 13 of the providers of the alleged fraud.
Some of these providers went out of business. The state opted to bring in Arizona providers, some of which have already left.
Critics have said this process removed the rights of due process for the providers, and the state is facing lawsuits from some providers.
HSD said in the past that they still intend to recover funds that were wasted by overbilling from the providers.
The National Council for Behavioral Health endorsed the federal legislation.
Criticism from delegation
The House and Senate Democrats echoed criticism leveled at HSD over the past few years when announcing the new legislation.
“Behavioral health services like substance abuse treatment and mental health care are critical for many of New Mexico’s most vulnerable,” said Sen. Tom Udall in a statement. “The state’s reckless decision to suspend Medicaid payments without notice forced several trusted providers to shut their doors, leaving patients at risk without the services they rely on.”
“Even though one provider after the next has been exonerated of the charges leveled against them by the State, the damage has been done – vulnerable New Mexicans have experienced disruptions in services and providers have been forced to close their doors,” Rep. Ben Ray Luján said. “The legislation we have introduced will guarantee the due process that none of these organizations were provided and ensure there is a process in place that provides additional review while protecting access to vital services and continuity of care.”
“New Mexico’s behavioral health system was turned upside down overnight when the state unilaterally suspended Medicaid payments for vital services,” U.S. Sen. Martin Heinrich said.
Rep. Michelle Lujan Grisham said the legislation was in an attempt to “ensure that this never happens again.”
Calls for investigation
Previously, the Democrats in the delegation asked for an investigation into the behavioral health situation from the U.S. Health and Human Services Department. Later, state Senate Democrats joined in on the call for a federal investigation.
A bill to address the situation on the state level passed the Senate in 2015 but failed to pass the Republican-controlled House.