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Department seeks external quality‑review funding; behavioral health managed‑care launch prompted system fixes and vendor issues
Summary
Analysts requested federal and state funding for external quality review and for additional system configuration tied to the Idaho Behavioral Health Plan (IBHP) contract; department staff acknowledged initial provider payment problems with the new managed‑care vendor but said major issues have been resolved.
House and Senate appropriators were asked to approve funding to meet federal external quality review requirements for Idaho’s managed care programs and to cover system configuration costs arising from the state’s new Idaho Behavioral Health Plan (IBHP) managed‑care contract.
Alex Williamson told the committee a $1.35 million request would allow the department to complete system configuration changes and onboarding of a new vendor for the Idaho Behavioral Health Plan, and that earlier RFPs for the external quality review failed to attract responses because market prices have risen since the state’s historical payments. Williamson also described a capitation rate increase request for the behavioral health plan that would be split across Medicaid plans.
Director Alex Adams and Deputy Director Juliette Sharon responded to member questions about the IBHP launch. Sharon said the IBHP contract, which went live July 1, covered a broader scope than prior behavioral‑health contracts and included services historically delivered through fee‑for‑service and through the Division of Behavioral Health. The scope required additional Medicaid Management Information System (MMIS) interfaces and adjustments.
Senator Sandra Cook and other members raised concerns about provider payments after the contract began. Sharon said the managed‑care vendor (Magellan) and the department addressed early payment delays, took corrective action, and the department has assessed more than $100,000 in liquidated damages and issued management letters and corrective action plans. Sharon said Magellan is back in compliance with timeliness standards and that some payment and mailing issues were resolved; she cautioned that occasional provider problems may persist but that the department monitors timeliness and denials monthly.
Williamson also described a separate funding request to pay for the federally required Managed Care External Quality Review (EQR); the department said the procurement environment had changed and the higher request aligns Idaho with other states of similar size.
Committee members asked the department for additional follow‑up on vendor performance metrics and on the RFP process for the EQR. No formal votes were recorded during the hearing.
