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Medicaid slowdown hurts, providers say

For one, backlogged claims hit $5M by Andy Davis | April 11, 2019 at 4:30 a.m.

A Hot Springs mental health and substance abuse treatment provider told state lawmakers on Wednesday that the slow process for becoming enrolled in the state Medicaid program forced it to lay off 100 employees and close 13 of the more than 40 clinics it took over from another organization last year.

Quapaw House Chief Executive Officer Casey Bright was one of several providers who told members of the Senate Committee on State Agencies and Governmental Affairs that delays in payment from the program are putting a financial strain on their businesses.

At one point, Bright told legislators, the state owed his nonprofit about $5 million in backlogged claims.

The delays stem from multiple sources, including the enrollment process and a shift to managed care that took effect March 1 for about 40,000 Medicaid recipients with significant mental illness or developmental disabilities, Bright and other providers said.

"Everybody's in transition at once -- that's going to be a recipe for disaster," Bright said after the meeting.

Lawmakers on the committee repeatedly questioned Department of Human Services officials about the reason for the delays. Another meeting on the issue was set for April 24.

"All the people sitting behind you are telling us that you're not working hard enough to help them," Sen. Bill Sample, R-Hot Springs, who requested the meeting, told department Director Cindy Gillespie, referring to providers who filled the seats of the Old Supreme Court chamber in the state Capitol where the committee met.

Gillespie said the department has been working to speed up its process for enrolling providers, which she acknowledged is "way too slow, way too cumbersome."

She said other delays result from the billing systems used by the Medicaid program, providers or the managed care companies.

"There are different problems," she said. "There is no one silver bullet."

Quapaw House bought the assets of Preferred Family Healthcare in October after the Springfield, Mo.-based organization decided to leave Arkansas. Preferred Family's move followed the state's decision to cancel 16 of its contracts after an organization executive was charged with Medicaid fraud.

Within a month of taking over Preferred Family's operations on Oct. 15, Bright said he was able to obtain licenses for the clinics to provide substance abuse and mental health treatment. But securing their approval as Medicaid providers was a different matter.

Eight of the clinics were enrolled within 30 days, he said.

But for 22 other clinics, the process wasn't finished until Feb. 22.

By that time, he said, he wasn't able to submit claims because of the approaching start of the managed care program.

EQHealth Solutions had taken over processing requests for approval for Medicaid services because the previous vendor, Beacon Health Options, has an ownership stake in one of the managed care companies providing health benefits to mentally ill and developmentally disabled Medicaid recipients.

But EQHealth Solutions didn't begin processing the requests for approval of mental health and substance abuse services until March 1, resulting in another week of delay before Quapaw House could start submitting its backlog of claims, Bright said.

He said some of the claims were processed last week, reducing the backlog from $5.2 million to about $3 million.

Gillespie said the remaining amount will be paid Friday.

Once the backlog is cleared out, Bright said he hopes to eventually reopen all of the closed clinics.

Gillespie said the Human Services Department tries to enroll providers within 30 days, but doesn't always meet that goal.

The slow process "has been a real problem point for DHS, apparently for many years," she said.

The issue was one reason for recent management changes within the department, she said, including the hiring in January of Janet Mann as director of the department's Division of Medical Services.

Mann took over from Tami Harlan, who was moved to a lower-paying position within the department.

"It's a complex one to fix, and it became something we were really focused on ensuring we could put a team in there that could dig into this and get it fixed," Gillespie said. "It is not an easy set of changes to make."

Medicaid Director Dawn Stehle said the changes the department is working on include processing more of the documents electronically and combining some of the tasks involved with licensing and enrolling providers.

Providers said the managed care companies are another source of delayed payments. The three companies' contracts require them to pay 70 percent of properly submitted claims within seven days and 95 percent of such claims within 30 days.

In a March 22 email to the companies and the Human Services Department, Joel Lanfreneau, director of the Behavioral Health Private Providers Association of Arkansas, said "it has become clear that this is universally not happening across the state."

"I have a variety of clients that are in various degrees of distress, some from just being able to make payroll from reserve to others metaphorically being on their knees in banker's offices, asking for for extensions of lines of credit," Lanfreneau, who is also an attorney for an association of Arkansas substance abuse treatment providers, told lawmakers Wednesday.

Human Services Department spokesman Amy Webb said in an email that the companies, known as Provider-led Arkansas Shared Savings Entities, or PASSEs, have 45 days to pay claims during a "transition period."

"It's my understanding that there is a small group of providers that have had some difficulties, but those issues have been isolated and have been forwarded to the PASSE team to handle on a case-by-case basis," Webb said.

A Section on 04/11/2019

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