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Some Medicaid providers in Maryland still going unpaid for drug and mental health treatment

Baltimore Sun - 2/7/2020

Payments are finally going out to those providing addiction and mental health treatment in Maryland following the botched roll-out of the state’s new Medicaid management system. But some practitioners in the program used by more than a quarter of a million low-income residents say the funds are insufficient and others remain unpaid since December.

Those providers say the result is straining their offices financially. And while treatment for existing patients is largely uninterrupted, an unknown number of new clients are being turned away as the state grapples with an intractable drug overdose epidemic and growing demand for mental health care.

“I’m still seeing my clients because obviously this is not their fault,” said Aviva Kovacs, a practitioner in Pikesville who has not been paid. “However, I know that many providers are no longer taking new Medicaid clients. I can’t imagine the impact on those who need substance abuse help. This is having a very real impact on both providers and on those who need mental health services.”

The state Department of Health has not explained what went wrong with the new system after Optum Behavioral Health won a multi-year, $188 million contract to manage the state’s program last year. And officials said in a message to providers this week it could be the end of April before the system is fixed -- nearly four months into the contract.

In the meantime, officials have begun sending $32 million in “estimated” payments a week to thousands of individual providers, clinics and hospitals based on billing from last year. By Friday afternoon, 2,752 had been paid. Officials couldn’t say how many more are owed payments or how much.

About one in five Maryland residents, or more than 1.2 million people, are enrolled in the state’s Medicaid program and about 260,000 to 280,000 tap behavioral health services.

"Since instituting the estimated payment process, we are continually monitoring and improving the process with Optum to address providers who may not have received payments as planned,” said Dennis Schrader, the state’s Medicaid director, in a statement. “Those providers will be included in getting estimated payments going forward.”

Christine Hauser, an Optum spokeswoman, said officials there “understand the frustration of providers who are at the front lines of helping patients.” She said the company is processing claims now, has made close to $83 million in estimated payments and is making progress on the system.

Practioners say they’ve needed to borrow money, stop some off-site visits and turn away patients to cope with the delays.

The state’s biggest provider of behavioral health services, Sheppard Pratt Health System, said it is still taking new patients in its 160 programs.

"We have not allowed challenges in the [Administrative Service Organization] to impact the ability of those we serve to access care in any of our programs across the state,” said Tamara Chumley, a Sheppard Pratt spokeswoman.

But others say they can’t. Clara Bobo, director of administrative services for the Fallston practice of Alyssa Taylor, said her office has not received a payment, though she’s hopeful the state and Optum are working on a remedy.

“It is no fault of their own, and we will not be jeopardizing any continuity of care,” she said of existing patients. “Unfortunately we are unable to submit for authorizations for new clients so that has come to a halt for the time being. We hope to see this resolved soon, but we are not holding our breath.”

Some say the system has been unable to recognize patients and practitioners, complicating authorizations for care, as well as payment.

Adriane Brooks, who owns Brooks Behavioral Health Services in Frederick with her husband, said they have “spent countless hours at work trying to find out how they want us to bill claims in order to get paid.”

Brooks Behavioral Health received one payment for less than two-weeks of normal revenue and has racked up bills as they continue to pay employees and see patients.

“We see clients daily not knowing if we will get paid, but we would never turn away anyone in need,” Brooks said.

Dan Martin, director of public policy for the Mental Health Association of Maryland, and Shannon Hall, executive director of the Community Behavioral Health Association of Maryland, represent many of the practitioners and said they recognize the hardship but believe the state is making progress.

Despite the “bumpy start,” Martin said, “I understand that everyone is working together to smooth the process. Providers are starting to get those estimated payments, and I’m hopeful things are turning the corner.”

Said Hall: “Everyone is struggling, and there is a lot of stress around this. … But I’m optimistic the checks are giving them some breathing room.”

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