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.
Hundreds of behavioral health providers soon will be able to tap into a $1 million fund to help them recover financially from a crisis last year in the state’s behavioral health system, a state agency announced Thursday.
In addition to the $1 million, another $500,000 will be deposited into a separate fund by Optum Health New Mexico to pay a monitor to keep tabs on its performance. Optum won a four-year, $1 billion contract last year to manage how mental health and substance abuse services are administered and paid across New Mexico.
The $1.5 million in the two funds was part of an agreement between the state and Optum following the discovery in October that the firm had failed to pay millions of dollars, sometimes for months, to providers for work they already had completed.
The agreement was announced during a meeting of the New Mexico Behavioral Health Collaborative, which hired Optum.
Reached Thursday, the agreement does not technically assess a penalty against Optum — as sanctions levied against the firm this fall would have done. Optum appealed the sanctions, and the agreement was the result of negotiations between Optum and New Mexico.
Optum will underwrite the two funds instead of paying a $1.2 million base penalty, with the potential for additional costs tacked on, officials said.
“We’re on board with this,” said Sandy Forquer, president of Optum Health New Mexico. “We’re on target.”
Many providers across the state found themselves dipping into cash reserves to survive from July through October as they waited for Optum to pay for services rendered. Optum acts effectively as one-stop shop, approving or rejecting claims submitted by providers and then paying the approved claims with government money.
The trouble was with Optum Health’s electronic claims management system, touted as a way to promptly pay nonprofits and others working with the mentally ill and those struggling with substance abuse. The system failed under the crush of real-world use after it went live July 1, as the volume of invoices and claims that flooded the system were much greater than the test sample of claims the state used to conduct its readiness review.
At the same time that providers dipped into cash reserves, some re-directed front-line employees — those who work with clients — to the task of making sure their claims were paid, adding costs to administration and taking much-needed expenses away from other priorities.
The agreement does not preclude future action against Optum if the state finds the firm is not living up to its contractual obligations, Mark Reynolds of the state’s Human Services Department told the New Mexico Behavioral Health Collaborative.
The Collaborative hired Optum earlier this year to a four-year, $1 billion contract to administrate the state’s behavioral health system.
There were signs Thursday that Optum has not safely navigated through its problems.
When asked if she were satisfied with the progress Optum has made in resolving problems, the state monitor, Alicia Smith, hesitated before answering.
“I still feel still that we are getting our arms around what happened in the past,” Smith told the collaborative. “Some issues are beginning to move in the right direction. There is still a lot of ground to cover.”
The state has not worked out a system to funnel the $1 million to providers yet, but figuring that out will happen in coming days, collaborative director Linda Roebuck Homer said Thursday. According to the agreement, the payments will start going out to providers as soon as Jan. 11.
“We just reached this agreement today,” she said.
