I am writing today to announce the closure of the New Mexico Independent. After three and a half years of operation in New Mexico, the board of the American Independent News Network, has decided to shift publication of its news…
While environmental activists played their part yesterday during demonstrations at the capitol building, going so far as to dress up as solar panels and to sing the tune of “You Are My Sunshine,” their counterparts, the anti-cap-and-trade contingency who has…
Roughly one quarter of University of New Mexico students are unimpressed with the state’s flagship public school, according to a survey that questioned college students about their higher education experiences.
Photo by publik15
ALBUQUERQUE — When ValueOptions found out it lost New Mexico’s behavioral health contract, it started cutting back on services to increase profits, charges a lawsuit filed Thursday by the non-profit New Mexico Youth Providers Alliance, a group of organizations that provide services for children with special needs.
In 2005, the New Mexico Behavioral Health Collaborative awarded ValueOptions a four-year contract to manage the state’s publicly funded behavioral health services. In January 2009, the collaborative announced that another company, OptumHealth, had been chosen to receive the next four-year contract estimated at $1 billion and would take over in July. (ValueOptions is suing the state, saying the contract was awarded through a flawed bidding process.)
The lawsuit filed by the New Mexico Youth Providers Alliance (NMYPA) alleges that after the collaborative’s decision, ValueOptions began reducing authorizations for various services, including denying treatment for foster care kids and authorizing a lower level of care with lower reimbursement rates.
“We believe that that the authorizations have been denied improperly and particularly since ValueOptions found out that its contract with the state was not going to be renewed,” said NMYPA’s attorney, Charles Archuleta of Keleher & McLeod.
The lawsuit suggests that ValueOptions was trying to make as much money as possible before July 1, when OptumHealth takes over.
“We are holding on to every penny we’ve got,” the complaint alleges that a ValueOptions case manager told one of the providers.
NMYPA had written to ValueOptions in February, complaining about the change in authorizations and asking that the company revert to the way it used to grant authorizations.
A lawyer for ValueOptions replied with a letter saying, “There have been no changes in VONM’s utilization management policies or practices in this time frame,” and asking for specific examples of the providers’ complaints.
Meanwhile, in response to complaints from providers, the collaborative, which represents 15 state agencies and departments, determined through an audit that despite the company’s denials, ValueOptions had changed the way it was making decisions about which children would receive treatment into foster care, beginning in the fall of 2008.
As a result of those findings, the collaborative issued a Directed Corrective Action Plan (DCAP), outlining measures it expected the company to make to comply with the terms of its contract. In a letter to ValueOptions CEO Eddy Broadway, the New Mexico Secretary of Health and Secretary of the Human Services Department, Alfredo Vigil and Pamela Hyde, wrote that the move was “the only feasible sanction option to ensure that the children of New Mexico receive the behavioral health care they require,” and warned that failure to comply would result in a temporary restraining order against the company.
ValueOptions was ordered to make the changes spelled out in the DCAP by February 27, but the company has not done everything the state asked.
The company has refused to comply with one element of the DCAP regarding treatment foster care services, said Betina Gonzales-McCracken, a spokeswoman for the Human Services Department. The state has not yet decided whether it will pursue a temporary restraining order to compel the company to provide those services until its contract is up at the end of next month.
Patrick Killen, director of public affairs and communications for ValueOptions, declined to comment on the lawsuit or on the collaborative’s charge.
“We do not discuss specific cases that are in litigation. However, in general, it is our policy as a company to authorize care when it is medically necessary,” Killen wrote in an e-mail
