Behavioral Health Shakeup Bill Lands in GOP House

A bill that seeks to give providers of Medicaid services more protections when the state accuses them of defrauding the federal insurance program for the low-income cleared the state Senate and awaits passage by the Republican-controlled House Judiciary Committee.

The

, introduced by Sen.

, D-Las Cruces, seeks to clarify the definition of Medicaid as well as give providers more rights to appeal determinations made by the state to withhold Medicaid payments.

In late June 2013, Gov. Susana Martinez' Human Services Department

Medicaid payments to 15 mental health

based on an audit by Boston-based Public Consulting Group that accused the nonprofits of over-billing for Medicaid reimbursement claims over a three-year period by $36 million.

Seeking to recover Medicaid overpayments and save money for the federal program, the Affordable Care Act gave states more leeway in freezing payments to providers of Medicaid.

But the Martinez administration took that new freedom to the extreme, accusing providers that care for more than 80 percent of the state's behavioral health population receiving Medicaid-funded behavioral healthcare services of defrauding the program without even giving them a chance to see the audit that served as the basis of the accusations. Many of the agencies closed down as the state brought in Arizona providers to take them over, pending criminal probes by the attorney general that, so far, have either cleared the providers of committing fraud or have not yet been completed.

In cases of the cleared providers, the attorney general only found that they had overbilled a fraction of what the audit, which state officials altered, had alleged.

Santa Fe Reporter