There are still a lot of questions about the New Mexico Human Services Department's to 15 behavioral health providers and the state's contracts with Arizona firms to take over provider management.
Here's some of what we do know.
1. The Human Services Department (HSD) halted funding for 15 behavioral health providers who provide services to 30,000 clients in New Mexico in response to allegations of . The managed care organization that oversees behavioral health services in New Mexico, installed a new software system to detect fraud. When that system sent up red flags, the state ordered an audit.
2. The set off alarm bells that the providers had . The details of the audit have but has been provided to at least .
3. The performed the $3.2-million audit through an with the state. PCG has also contracted with the state to manage the . That contract is for almost $4-million.
4. Behavioral health, or , is achieved when people experience a state of well-being and are free of depression and anxiety disorders. include things like , medication, and various forms of one-on-one and group . Patients experiencing things like addiction, schizophrenia, autism, sexual abuse, and a wide range of other issues and conditions can seek behavioral health services.
5. Fifteen behavioral health providers were audited. At least by Arizona firms.
- - 22 counties
- Partners In Wellness, Inc. - Los Lunas
- - 9 counties
- - 5 counties
- - Albuquerque
- - Albuquerque metro area
- - Silver City
- - Roswell
- - Las Cruces
- Southwest Counseling Center - Las Cruces
- The Counseling Center - Alamogordo
- - Los Lunas
- - Anthony and Sunland Park
- - Santa Fe and Alcalde
- - Raton
6. Five Arizona nonprofits who have to take over management of local providers.
- Agave Health, Inc. - $7.1 million
- - $2 million
- - $4 million
- - $2 million
- - $2 million
7. The Arizona providers will continue to manage organizations in New Mexico. Contracts go through the end of 2013, but an official of Governor Susana Martinez said earlier this month that the .
8. Many of the New Mexico providers say they have not been given details about what fraud they are accused of committing. The say the funding freeze and new management constitute a . They argue the are and, in some cases, to the financial solvency of entire organizations.
9. Several of the local providers who were and did not have any of their funding restored . So far, they have been at getting their funding restored.
10. Officials in Governor Susana Martinez's administration say they have a responsibility under the Affordable Care Act to find and prevent Medicaid fraud. Many of the are egregious.
11. Lawmakers have from the state of New Mexico to the Arizona contractors. A hearing was held August 21st in Chama at which legislators voted not to endorse the transfer. The vote did not halt the transfer.
12. Members of that officials from the US Health and Human Services Department hold a public hearing in New Mexico. Senators Tom Udall (D) and Martin Heinrich (D) and Representatives Ben Ray Lujan (D) and Michelle Lujan Grisham (D) wrote a letter to HHS Secretary Kathleen Sebelius on August 14th asking that she set up the public forum within two weeks. No date has yet been set.
