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Keeping 'Perspectives': Medicaid payment delays strain mental health services

Waterloo-Cedar Falls Courier (IA) - 5/23/2016

May 23--WATERLOO -- Courtney Gay comes to her downtown Perspectives Behavioral Health office each morning to find a handful of clients with a crisis.

They need help getting their medication. They need to set up a doctor's appointment. They're considering running away from their problems.

Added to those day-to-day emergencies, since April 1, Gay has to worry about how Perspectives can keep its doors open.

Perspectives Behavioral Health, like many of its peers, has seen its Medicaid payments slow since April when the program converted to three private managed-care organizations.

"We're going to provide our services come hell or high water, but we're at zero right now," said Kim Henny, executive director at Perspectives. "We have been without funding for a long time."

Typically funded fully by Medicaid, the nonprofit is turning to fundraising for the first time to try to make up the difference.

They launched a Go Fund Me campaign at www.gofundme.com/perspectives and reached out to various organizations that may be able to help.

Perspectives provides 4.25 hours of day habilitation services to people with a diagnosed mental illness. The faith-based nonprofit sees about 35 people a day. They hope to offer a morning and afternoon session that serves 50 people each, but need the funding first.

They opted for short-term donations, believing their cash-flow problem is temporary. But that doesn't mean things aren't tough right now.

"We never needed fundraisers before, so we didn't do them, because we were always funded on time," said Gay, a case manager. "It's hard. Money's tight for everybody these days."

Mind the gap

Some area mental health providers are being funded -- though not necessarily at levels they were prior to the transition. But Henny said she's hearing Perspectives payments may not begin until the end of June.

But Henny says it's "critical" to keep serving clients.

"The people that come to our program, they do not repeat crimes; they do not get arrested again; they do not go into the hospital unless it's extreme cases," Henny said, adding, "We charge pennies compared to the cost of going in the hospital, for instance."

Iowa Department of Human Services spokeswoman Amy McCoy said Perspectives' experience is atypical of providers filing "clean claims," that is, paperwork without any errors. She pointed to a requirement that the MCOs process 90 percent of "clean claims" within 14 days, 99.5 percent within 21 calendar days and 100 percent of all claims within 90 days.

Henny said her case workers are used to working with the insurance companies to submit claims. Staff also participated in webinars and other training to prepare for the transition. But they have run into problems because the clients are not yet all on file with the new companies and that's what has contributed to the delays in payments.

Denise Malecki, public relations director for Amerigroup, said it's a state issue, not the MCOs, if the clients' names are not yet entered into the Medicaid system.

"They want us to stay in business, but because of the transition and the problems with crunching all this through so fast, they don't have everybody in the system," Henny said. "We're just waiting, with an empty bank account."

McCoy echoed Henny in that sentiment, saying, "We don't want to see any providers have hardship or not be able to serve their patients. We want as many providers as possible to participate in the program."

Peer review

Several providers throughout the Cedar Valley have reported similar delays in payments. Both McCoy and the providers say some of that stems from switching managed care organizations, and from one MCO to three.

Behavioral health providers had been working with Magellan, which they say often provided quick payments. The system now does not have the rapid turnaround, but McCoy said it is designed to be consistent across providers.

"There has been some changes for those providers over the past several months, but all with the goal of having program integrity," McCoy said.

Larger groups like Pathways Behavioral Services and North Star Community Services have more easily weathered the transition, but that doesn't mean it's been easy.

Chris Hoffman, executive director of Pathways, said he "just kind of assumed something like this was going to happen" with delayed payments, so the nonprofit has built up reserves. Pathways provides mental health and substance abuse counseling to about 6,000 people each year in a six-county area including Black Hawk County.

Hoffman said the agency recently started getting paid for services rendered in January through March. "We got a payment, but it was not at the rates that we should have gotten paid, so now we have to appeal everything that we billed for to get paid at the proper rate."

McCoy said there has been a "learning curve" in the new coding required to submit claims to the MCOs, and DHS and the MCOs have been training providers to make the process easier.

Malecki, of Amerigroup, said 89 percent of 10,500 claims have so far been paid. Like McCoy, she acknowledged a "learning curve" with the new coding systems.

She encouraged providers who aren't getting paid to reach out to the MCOs because coding issues can be easily remedied.

Hoffman said he's "optimistic that in the long-run we will manage." But he said it's taking more effort now and distracts from programs and services.

"I'm hoping this dust settles, so that we can get back to those things, which is providing services," Hoffman said.

North Star, likewise, has a contingency plan for fewer gaps in services due to delayed payments. State Sen. Jeff Danielson, D-Waterloo, a board member at North Star, reported during a Thursday night legislative forum that the agency took out a $400,000 line of credit, which would cover two payrolls, to ensure its clients' needs continue to be met.

For perspective, the Perspectives Go Fund Me request is for $35,000.

Hard times

Many of the smaller behavioral health providers are just starting to see money flow, but it's hit them harder.

As Henny summed up, "This is hard right now. It's hard times."

Gail Althaus, of Family Solutions III Inc. which provides outpatient mental health services throughout the region, is at the point of missing payments and payroll.

"I have not been able to meet payroll three times since mid-February; that has never ever happened before ever," Althaus said. "All of my financial obligations, except two, are past due. A very costly situation."

Some of her employees don't have the gas money to travel to see their clients, and Althaus can't help. But Althaus stresses that none of her employees have so far left, such is their dedication.

She said just recently two of the providers have started delivering payments, but the nonprofit still struggles with one.

Like Perspectives, Althaus' staff have gone to training sessions and tried their best to understand the process in order to submit "clean claims." She acknowledges the "learning curve" McCoy referenced, but said the training has not been as helpful as DHS and the MCOs believe they are.

"I am certain that we will eventually level out; however, there are going to be a whole lot more bumps before that happens," Althaus said.

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(c)2016 Waterloo-Cedar Falls Courier (Waterloo, Iowa)

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