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Behavioral health managed-care launch caused payment problems; state says vendor is addressing issues
Summary
After Idaho launched a larger Idaho Behavioral Health Plan (IBHP) contract July 1, 2024, the new managed‑care vendor experienced provider payment and education issues. The Department of Health and Welfare said problems have been addressed and it has imposed liquidated damages.
The committee heard Feb. 26 that Idaho’s transition to a larger Idaho Behavioral Health Plan contract led to initial provider payment and operational problems but that the department has taken corrective actions.
Deputy Director Juliette Sharon said the IBHP contract that began July 1, 2024, was “significantly larger than the historical IBHP contract” and brought services into managed care that had previously been delivered on a fee-for-service basis. The larger scope required additional system configuration and interfaces in the Medicaid management information system (MMIS) and the department identified extra configuration work during implementation.
Committee members described a pattern of provider-payment complaints to lawmakers after the July 1 go‑live. Sharon and Director Alex Adams testified that many provider issues were addressed quickly in partnership with the contractor (Magellan). Adams said the department imposed over $100,000 in liquidated damages and has management letters and corrective action plans in place. Sharon said Magellan has resolved mailing issues, helped providers enroll for electronic funds transfer, conducted provider education and is back in compliance with timeliness requirements.
Representative Sandra Cook described several provider reports of delayed payments and asked whether the problem was resolved. Juliette Sharon acknowledged early payment challenges and said the department continues monitoring performance through monthly reports, payment‑timeliness metrics and corrective actions. “We have seen them step up and address those issues readily and take it very seriously,” Sharon told the committee.
Why it matters: Provider payment timeliness directly affects small providers’ cash flow and the continuity of services. The department said it is monitoring complaints, assessing denials and imposing contractual remedies when necessary.
Ending: The department said it will continue to report monthly on vendor performance metrics and follow up with legislators on remaining provider concerns.
