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New Mexico speaks, CMS listens

August 29, 2013
by Dennis Grantham, Editor-in-Chief
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Callers refute state's claim of minimal care problems following Medicaid behavioral health payment freeze

In a 90 minute, "open line" listening session conducted by phone on August 28, more than two dozen New Mexicans -- behavioral health consumers, family members, advocates, and others -- spoke up with anger, concern, patience, and frustration and about behavioral health care continuity and service access problems in the aftermath of their state's suspension of payments to 15 of the state's largest behavioral health provider organizations in late June.

They were heard by top officials from the Centers for Medicare and Medicaid Services (CMS), including Barbara Edwards, CMS director of elderly and disabled programs, John O’Brien, Senior Policy Advisor, and Mark Duffy, who heads CMS regional office in Dallas. Also present were New Mexico Human Services Secretary Sidonie Squier, Behavioral Health Collaborative leader Diane McWilliams, and HSD attorney Larry Heyeck.

While New Mexico State officials, including Gov. Susana Martinez and HSD Secretary Sidonie Squier have consistently defended the state's action, saying that it — and the subsequent transitions of many of the provider organizations to new management — were prompted by "credible allegations of fraud" and that service disruptions would be minimized, the examples and stories told by the callers painted a different picture. Callers highlighted numerous problems, including:

·         A disruption of services, due to temporary agency closure, management changes, and staff disruption or losses as some clinical personnel elected not to work for the new management teams.

·         Difficulty getting new appointments with other established providers, some of whom have "closed" practices and others who are overwhelmed with the rush of requests from  patients unsure about the status of the transitioning agencies and providers.

·         Startup delays with the transitional management teams from Arizona whose newly named entities had access to providers and funding, but not to key contracts created by the previous management. Several callers complained that while BSM workers who normally helped their special needs children at schools were unable to work because of the contract situation.  HSD spokesman Larry Heyeck responded that the Department was in communication with school officials to resolve the problem.

·         A breakdown in access to patient records. When a mental health consumer worried that the transition managers would be given access to her confidential patient file, Heyeck assured her that "all patient consents are being honored" and that no records access could occur without a patient consent form being signed with the new provider organization. But the issue of consent has raised other problems. Paul Weeks, a clinician at Valencia Counseling Services in Los Lunas said that nine of 12 counselors left the organization and that, without access to current patient records, the three remaining therapists have to conduct two-hour intake sessions, even with longstanding patients, to get up to date. The three conducted 20 intakes on one day this week, but he explained that with the shorthanded agency’s roster of 2,000 consumers, no return to “normal” treatment can be expected anytime soon.

Several mental health consumers called into report rising anxiety and fears that, without regular access to services, they might soon lose their ability to function. Family members said that unless regular access was restored, they feared having to rehospitalize loved ones, or worried that their children’s escalating behavior problems would lead to arrest and incarceration.

McWilliams responded personally to several of the callers, asking them to call her office line personally for assistance.  She assured callers that “we are following up on all of the calls we receive. We don’t want a disruption of services and we’ve tried to minimize that, but we’re not in denial that this is happening.”

A frontier county official expressed anger on behalf of taxpayers who, in response to significant local substance abuse treatment needs, supported tax increases to invest in public health infrastructure. “This action by HSD sets a precedent that allows for closing local facilities,” she complained. “What does this mean for our hospitals and FQHCs?” 

“This was a unique situation,” Heyeck responded, saying of the payment freeze: “We had to take action.”

CMS officials, who described the session as "a productive start to the discussion," invited other New Mexicans to report examples and concerns about access, continuity of care, and other issues in the New Mexico behavioral health system to the CMS regional office in Dallas at the addresses below. Any submittals should mention the location (community, county), provider of services, and the specific problem. 

Mail to:   E-mail to:

CMS

1301 Young Street, Rm 833

Dallas, Texas 75202

C/O: Bill Brooks

CMSrodaldmch@cms.hhs.gov

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