July 7, 2017

Feds to look into behavioral health services in NM

Capitol Hill in Washington D.C.

The federal government will take a look into New Mexico’s behavioral health services, according to the four Democratic members of the state’s congressional delegation.

In a letter last month to Sens. Tom Udall and Martin Heinrich and Reps. Michelle Lujan Grisham and Ben Ray Luján, the federal Department of Health and Human Services Inspector General Daniel Levinson confirmed the upcoming review.

“OIG will review the extent to which behavioral health providers are included in the States’ managed care plans and the types of care offered by these providers,” Levinson wrote in the June 28 letter. “We will also assess the extent to which behavioral health providers have available appointments for new patients, the extent to which behavioral health providers have waiting lists, and the extent to which behavioral health providers are able to make referrals to other behavioral health providers for needed care.”[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The state’s best environmental coverage.

[/perfectpullquote]The federal review will begin this fall, Levinson added.

The review comes in response to a formal request for the review from the Democratic delegation members. It also comes four years after the administration of Gov. Susana Martinez controversially cut off all state funding from 15 behavioral health providers amid allegations of “credible fraud” in Medicaid of $36 million worth of overbilling.

The $36 million figure came from an extrapolation in an audit from Public Consulting Group, the methods of which were heavily criticized when they were made public. For example, one of the accused providers originally accused of overbilling $2.8 million recently settled with the state to pay back just $484.87.

The state Attorney General also eventually cleared all 15 providers of legal wrongdoing. But by then, most had ceased operations for lack of resources, while the Martinez administration selected Arizona-based providers to fill the void. Many of those Arizona providers have since left New Mexico. Meanwhile, critics say the aftermath caused a “behavioral health crisis” that resulted in dropped services for vulnerable New Mexicans.

In prepared statements, each of the Democratic congressional delegation members criticized Martinez’s administration for the 2013 decision and praised the federal government review of behavioral health services.

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“This was a manufactured crisis that has had tragic consequences for children and families struggling with mental illness, behavioral health issues and substance abuse, who lost access to care altogether or haven’t been able to find steady care,” Udall said. “Our fragile network of behavioral health providers is still struggling to meet the needs of these patients. I look forward to the results of this study and will continue fighting for improved behavioral health access in New Mexico.”

Heinrich said he was “glad” the federal government “agreed to review whether the state is still failing to provide New Mexicans with mental health services they need.” He also called the Martinez shakeup a “manufactured crisis” that “dangerously left patients without the care they deserved and had come to rely on, caused hundreds of New Mexicans to lose their jobs, and wasted tens of millions of taxpayer dollars.”

Luján said he was hopeful the review will help prevent another similar crisis from happening again.

“While we cannot undo all the damage that was done, we can take steps to protect continuity of care for those who need it, provide due process for providers, and prevent such a crisis from happening in the future,” Luján said. “Hopefully, the results of this study will help us improve the behavioral health situation in our state in both the short and long term.”

Lujan Grisham, who herself is running for governor in 2018, criticized Martinez’s administration for refusing to “ensure vulnerable New Mexicans have access to services.”

“I pushed the federal Office of Inspector General since the beginning of this crisis, and we finally succeeded in convincing investigators to conduct a thorough review of those services,” she sais. “I want the OIG to determine where the state continues to fail its mission of providing mental health services.”

In early 2016, Lujan Grisham called for an investigation into the behavioral health situation.

State legislators had called for a Department of Justice investigation into the shakeup.