Idaho mental health providers worry pay could lapse amid Medicaid contractor change

Magellan of Idaho is set to take over managing mental health benefits for around 400,000 Idahoans on Medicaid on July 1. (Getty Images)

Editor’s note: This is the first story in a two-part series on the Idaho Behavioral Health Plan contract. The second story will focus on how the new contractor, Magellan of Idaho, hired three former state employees — which officials say isn’t against state law.

Some Idaho mental health providers worry their payments could be delayed as Idaho switches to a new Medicaid mental health contractor.

Magellan of Idaho is set to take over managing mental health benefits for around 400,000 Idahoans on Medicaid on July 1, when it takes over the contract for the Idaho Behavioral Health Plan, or IBHP. 

Some providers worry Magellan might be delayed in sending payments — like Optum’s delayed payments after the company first took over the contract a decade ago — citing technical issues accessing its test billing system.

When Optum took over in 2013, Idaho providers had better cash flow to weather delayed payments, said Laura Scuri, co-chair of the behavioral health subgroup in the Idaho Association of Community Providers. But if payment is delayed again now — as other insurance companies struggle to pay providers — Scuri worries it could push providers to close.

If Medicaid mental health contractor payments are delayed again, Access Behavioral Health Services co-owner Laura Scuri worries it could push providers out of business. (Courtesy of Access Behavioral Health Services)

“I don’t think that a lot of the providers have the resiliency to make it through any big glitches with payment, let alone operations,” said Scuri, co-owner of Access Behavioral Health Services in Boise.

Scuri said she doesn’t know a provider that has been able to test the payment system yet, saying Magellan’s testing is only partial. Scuri said she’s especially worried about small providers, which don’t process as many payments or have access to more intricate technologies.

But officials with Magellan and the Idaho Department of Health and Welfare have tried to reassure providers worried about the possibility of delayed payments.

Magellan spokesperson Lilly Ackley told the Idaho Capital Sun in a statement that Magellan’s systems, including claims payment, are on track for the contract’s launch.

“Magellan Healthcare follows a consistent readiness protocol, which includes provider participation throughout the testing process,” Ackley said in a May 28 statement.

The Idaho Department of Health and Welfare “does not have reason to believe that providers will be unpaid after the contract transition,” agency spokesperson AJ McWhorter told the Sun in a May 24 email.

Officials and leaders at the state health department and Magellan “have been in constant contact with providers and provider associations” on concerns and questions, he said. “Providers have shared their appreciation with both the Department and Magellan through this transition and the availability of staff to quickly problem solve.”

“We know this transition will not be without some bumps in the road and are confident that both (the Idaho Department of Health and Welfare) and Magellan are prepared to quickly address any issues and mitigate impacts to providers and participants,” McWhorter said.

“Magellan has been testing claims for several weeks with the goal of identifying issues before (the contract starts). Providers have successfully tested claims and Magellan will continue to support providers through the transition,” McWhorter said in June.

The new $1.2 billion Idaho Behavioral Health Plan — Idaho’s largest state contract — was pushed back from taking effect March 1 of this year. In December, McWhorter told the Sun the contract’s July launch date reflected an industry-standard 12-month implementation period, and stakeholders collaborated on that date “to prioritize doing this right over doing this fast.”

Magellan and the state health department have been “hyper responsive” to concerns by providers recently, said Idaho Association of Community Providers lobbyist David Lehman. 

“There has been a significant amount of resources put into getting things caught up over the last two months, than the previous six months. So, they have heard our concerns, I think, pretty clearly and have made the effort and put the resources in place to address them,” Lehman told the Sun in an interview this month.

At STARR Family Behavioral Health in Boise, Program Director Jessica Trent’s billing employee has played around with the new test system.

But Trent says she hasn’t been able to actually test it. Trent said she’s sent emails to Magellan seeking help but hasn’t gotten answers. 

“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 is through providing services, getting paid and paying our employees. If we’re not paid, we can’t pay them.”

In Idaho Falls, Children’s Supportive Services President Kelly Keele told the Sun in an interview that he isn’t concerned about delayed payment. He said he suspects there will be some delays, but that’s what businesses plan for, noting that he’s still getting payments from Optum for services his clinic provided weeks ago.

“There’s only so much they can do in terms of testing systems with a sampling of providers, until the system actually goes live. And realistically, all of us who’ve been in business have payment in the pipeline from services we’ve provided in the past three to four weeks that’ll continue to be coming in during that first couple of weeks,” Keele said. “It’s not expected that you provide a service and you get paid that week.”

Kelly Keele testifies before the Idaho House and Senate Health & Welfare committees on March 8, 2011. (Betsy Russell/The Spokesman-Review)

And while he said there’s still a lot of information to learn before July 1, he said Magellan has built in grace periods of 90 days and longer to get up to speed with its new systems.

“I feel like we’ve got complete information to contract with them to provide the services,” Keele said. “There’s going to be a learning curve. There always is with a new managed care organization. But the information is out there. And they’re being, I believe, very helpful in guiding us to find the information we need.”

Magellan is often holding trainings with providers, Scuri said, such as how to access a system to upload documents to care for patients. But Scuri said providers don’t have all of those documents yet.

“We still are lacking that fine detail that tells us what’s acceptable and what’s not when we deliver a service,” she said.

Providers are used to developing a plan for the treatment services that they think will help patients most, she said. But the assessment document they’d use “doesn’t exist,” she said. 

She said she doesn’t know what information Magellan needs to determine medical necessity — like in requests for prior authorizations — or Magellan’s process of denying services.

McWhorter pointed toward Magellan of Idaho’s website for providers seeking more contract information. Amid the transition, provisional contract arrangements are allowed, he said.

“If providers are feeling strained while trying to balance operating their business and treating their clients, and getting credentialed and contracted with Magellan, we recommend they reach out to the Magellan network team at IdahoProvider@magellanhealth.com,” McWhorter told the Sun in a June 12 email. “The department has worked with Magellan to allow for provisional contract arrangements for providers during the transition.”

To Magellan’s credit, the company is expanding services, Scuri said, but “before they really identify what existing services are allowed to do.”

“We can do that for a little while,” Scuri said. “But what we risk is an increase in fraud. Can’t be fraud if you didn’t know what you were doing, and … they just told you to go.”

Providers, she said, will get frustrated and quit.

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