Eye On Boise

Mental health care providers blast private manager; H&W may impose penalties

Click below for a full report from AP reporter John Miller on the concerns raised at a Statehouse public hearing today about Optum, the private contractor that the state Department of Health & Welfare is paying $10.5 million a month to administer outpatient behavioral health services for Idaho's Medicaid program. Numerous mental health care providers told of waiting hours and hours on the phone for response from Optum to pre-authorize services for clients, with disastrous results. After Friday's meeting, Health & Welfare spokesman Tom Shanahan said Optum's contract requires it to respond to phone calls from providers within only two minutes; the agency has given the company until the end of the first week in February to start performing. If it falls short, Shanahan said, penalties could ensue.

Mental health care providers blast private manager
By JOHN MILLER, Associated Press

BOISE, Idaho (AP) — Mental health professionals blasted a private company now managing behavioral health care for low-income Idaho residents, saying the contract is plagued with problems and hours-long delays that not only make the process more difficult but could put their clients at risk.

A joint House and Senate Health and Welfare Committee meeting Friday provided a venue to criticize Optum, a Minnesota-based health care services management company whose parent company is UnitedHealth Group.

Since September, it's being paid $10.5 million monthly to administer outpatient behavioral health services for Idaho's Medicaid program as the state seeks to as it seeks to control costs, boost efficiency and give incentives to providers to offer appropriate services when they're needed. However, private providers in Idaho say the transition has been fraught with poor communication, including spending hours on hold with the company's representatives as they seek to authorize services for people suffering from mental illnesses.

Nikki Tangen, of Boise-based Access Behavioral Health Services, contends Optum has exacerbated a bottleneck in getting care to clients in crisis. One prospective patient barred from getting help is now in a psychiatric hospital, another committed a felony offense and another burned his house down, Tangen said, complaining she currently has 16 new clients on hold because nobody will tell her if services will be covered.

"Their promises that it's going to get fixed aren't going to help," said Tangen, among more than three dozen people at the Capitol meeting with concerns about Optum's performance. "Our request is Optum immediately lift the requirement they have prior authorizations" necessary to ensure that providers like her company will be paid.

Paul Hymas, of Upper Valley Resource & Counseling Center in Sugar City, told the committees Optum's arrival has been accompanied by "a complete lack of communication," including his company and others spending hours and hours on hold while trying to get questions answered about what services will be remunerated.

"We are concerned that if we continue on our current path we will continue to see the high suicide rates in Idaho, we will see the adverse effects not only on the mentally ill population, but also on the citizens of the state," Hymas said.

After Friday's meeting, Idaho Department of Health and Welfare spokesman Tom Shanahan said Optum's contract requires it to respond to phone calls from providers like Hymas within only two minutes.

The agency has given the company until the end of the first week in February to start performing.

If it falls short, Shanahan said, "We probably would look at taking possible penalties."

Optum, which manages Medicaid health services for other states, too, says it's trying to fix problems.

"We understand that some providers are experiencing unacceptable wait times when they call for authorizations for some patients," it said in a statement. "We are taking action by adding staff, implementing additional ways to obtain authorizations and working more closely with individual providers to simplify the process."

Sen. Lee Heider, the Republican committee chairman, acknowledged Idaho has been deluged with complaints and pledged "to try and get to the bottom of that."

"We've gotten promises from Optum," Heider said. "We're trying to resolve those issues, for your knowledge."

Rep. Fred Wood, a medical doctor and chairman of the House Health and Welfare Committee, said Idaho's Medicaid traditionally has had high rates of utilization for mental health services, compared to the rest of the country.

Consequently, as the state attempts to manage those services, he said, there are bound to be concerns among the companies providing those services.

"Idaho has the highest rate of utilization of psychosocial rehabilitation services in the United States — period. That had to end, and I agree with that," Wood said. "It's not going to be without significant issues."

However, Sen. Dan Schmidt, a family doctor and Democratic member of the committee, is concerned problems with Optum documented Friday go far deeper than the "stress of change."

"Optum is not being responsive to providers, and therefore, making services unavailable," said Schmidt, a Moscow Democrat. "That's what everybody said. C'mon, how long can you be on hold, waiting for prior authorization, so you will get paid for what you do."


Copyright 2014 The Associated Press




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Betsy Z. Russell
Betsy Russell covers Idaho news from the state capitol in Boise and writes the Eye on Boise blog.

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