Editor’s note: This is the first of a two-part series on the Idaho Behavioral Health Plan contract. Part two will focus on how the new contractor, Magellan of Idaho, hired three former state employees, a move that officials say does not violate state law.
Some Idaho mental health providers worry that the state’s switch to a new Medicaid mental health contractor could lead to payment delays.
Idaho’s Magellan is set to take over administration of mental health benefits for about 400,000 Idaho residents who are on Medicaid on July 1. Idaho Behavioral Health Planor IBHP.
Some providers are concerned that Magellan will delay sending payments, as Optum has done. Late payments The company first took over the contract 10 years ago, but then backed out due to technical issues with accessing the test billing system.
When Optum acquired it in 2013, Idaho health care providers have good cash flow to weather a delay in payments, said Laura Scully, co-chair of the behavioral health subgroup for the Idaho Association of Community Healthcare Providers. But if payments are delayed again now that other insurers are struggling to pay providers, Scully said. They fear that providers could be forced to close.
“I don’t think there are many providers that are resilient enough to weather major challenges around payment, let alone operations,” said Scully, co-owner of Access Behavioral Health Services in Boise.
Mr. Scri said Magellan’s testing is still partial and he is not yet aware of any providers that have been able to test the payment system. He said he is particularly concerned about smaller providers that don’t process as many payments and don’t have access to more complex technology.
Officials from the Magellan Department of Health and Human Services say testing of the payment system is going well.
But officials with Magellan and the Idaho Department of Health and Welfare are trying to reassure providers concerned about possible delays in payments.
Magellan spokeswoman Lily Ackley said in a statement to the Idaho Capital Sun that Magellan’s systems, including claims processing, are on track to begin the contract.
“Magellan Healthcare has followed a consistent readiness protocol, which includes the participation of health care providers throughout the testing process,” Ackley said in a May 28 statement.
The Idaho Department of Health and Welfare “has no reason to believe that providers will be unpaid following the contract transition,” department spokesman AJ McWhorter told The Sun in a May 24 email.
He said state health department and Magellan staff and leaders “have been in constant communication with health care providers and provider associations” about concerns and questions. “Providers have expressed their gratitude to the health department and Magellan for working through this transition and having staff available to quickly problem-solve.”
“We know this transition will come with some challenges and we are confident that both the (Idaho Department of Health and Welfare) and Magellan are prepared to rapidly address any issues and mitigate the impact to providers and participants,” McWhorter said.
“Magellan has been testing the claims for several weeks with the goal of identifying any issues prior to the start of the contract. The providers have been successful in testing the claims and Magellan will continue to support the providers during the transition period,” McWhorter said in June.
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The new $1.2 billion Idaho Behavioral Health Plan is Idaho’s largest state contract. Pushed back It goes into effect March 1 of this year. McWhorter told The Sun in December that the contract’s July start date reflected the industry standard 12-month implementation period, and that parties worked together on that date “to prioritise doing it right over doing it fast”.
Magellan and Idaho Department of Health and Welfare ‘very sensitive’ to health care provider concerns
David Lehman, a lobbyist for the Idaho Community Providers Association, said Magellan and the state health department have been “very responsive” to provider concerns in recent days.
“There’s been significantly more resources put into trying to get this under control in the last two months compared to the six months prior to that, so I think they’ve pretty clearly heard our concerns and made an effort and put resources into addressing them,” Lehman told The Sun in an interview this month.
What’s new in the Idaho Behavioral Health Plan Contract?
Under the previous contract, Optum was responsible for managing outpatient care such as therapy visits. The New Covenant Magellan is also tasked with managing the mental health care of inpatients, including hospitalization.
“This partnership will deliver a transformative behavioral health program for Idaho, ensuring approximately 400,000 Medicaid enrollees and other Idaho residents have access to the care and support they need. IBHP will consolidate services under one managed care organization, improving care coordination and reducing fragmentation for enrollees,” Magellan spokesperson Kristen Durocher told The Sun in an April 29 statement.
At STARR Family Behavioral Health in Boise, Program Director Jessica Trent’s billing employees tried out the new testing system.
But Trent said he hasn’t been able to actually test it yet, and that he emailed Magellan for help but didn’t receive a response.
“How do we know if it’s going to work?,” Trent told The Sun in an interview this month. “And that’s how we run our company: We provide a service, we get paid, we pay our employees. If we don’t get paid, we can’t pay them.”
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Late payment plans are commonplace, providers say
In Idaho Falls, Child Support Services Director Kelly Keel told The Sun in an interview that she wasn’t worried about delayed payments. There will be some delays, she said, but that’s what the companies expect, she said, noting that she still has received payment from Optum for services her clinic provided a few weeks ago.
“There’s only so much we can do in terms of testing the system with a sample of providers until it goes live. And realistically, all of us in the business have payments in the pipeline from services we’ve provided over the past three to four weeks, and payments will continue to come in for the first two to three weeks,” Keel said. “You’re not expected to get paid the same week you provide services.”
He also said that while there is still a lot of information to be learned before July 1, Magellan is allowing a grace period of at least 90 days for people to get used to the new system.
“I think we have the full information we need to contract with them to provide services,” Keel said. “There’s a learning curve — there always is with any new managed care organization — but the information is there, and I think they’ve been very helpful in helping us find the information we need.”
Providers say they still lack “finer details” about what will be permissible
Magellan frequently trains providers on how to access the system to upload the paperwork they need to care for patients, Scurri said, but providers don’t always have all of that paperwork ready.
“We are still missing finer details that indicate what is and is not acceptable when providing services,” she said.
Providers are used to drawing up plans of treatment services they think will best serve patients, she said, but the assessment documents they use are “nonexistent.”
She said she doesn’t know what information Magellan needs to determine medical necessity, such as a request for prior authorization, or what Magellan’s process is for denying services.
McWhorter pointed to Magellan in Idaho. Website For providers seeking more contracting information, interim contracting procedures will be allowed during the transition period, he said.
“If providers are feeling stressed while trying to balance running their business, treating clients and their credentialing and contract with Magellan, we encourage them to reach out to the Magellan Network team. [email protected]“The agency has been working with Magellan to allow for an interim contracting process with providers during the transition period,” McWhorter told The Sun in a June 12 email.
To Magellan’s credit, the company is expanding its services “before it has really identified what it can do with its existing services,” Scully said.
“They can do that for a while,” Scurri said, “but there’s a risk that fraud will increase. If you don’t know what you’re doing and they just tell you to go away, that’s not fraud.”
Providers will become dissatisfied and quit, she said.
How to learn more about contracts
Information for providers about the Idaho Behavioral Health Plan can be found at Magellan of Idaho Website“We’re pleased to announce that we have received the vaccine,” said AJ McWhorter, a spokesman for the Idaho Department of Health and Welfare.
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