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Behavioral health managed-care launch generated system configuration costs and early payment problems, department says
Summary
Department officials told lawmakers that Idaho's new Idaho Behavioral Health Plan required larger system changes than previous contracts and that vendor onboarding and payment timing caused early payment problems that are mostly resolved; the department has assessed liquidated damages and placed the vendor on corrective action.
Director Alex Adams and Deputy Director Juliette Sharon answered questions about the launch and early operations of Idaho's behavioral health managed-care contract (IBHP).
Sharon said the new IBHP contract, which began July 1, expanded scope relative to historical contracts: it brought services into managed care that had previously been paid fee-for-service and services previously managed by the Division of Behavioral Health. "The scope of this contract as many of you know was significantly larger than the historical IBHP contract that we've had," she told the committee, and the department needed additional system configurations and interfaces to collect utilization and enrollment data required by federal regulators and for state oversight.
Those configuration and onboarding costs are part of a supplemental request the department presented. Sharon said the department completed system changes at the start of the contract and then identified additional updates necessary to ensure accurate enrollment and utilization reporting.
Senators and representatives raised provider complaints about delayed payments. Sharon and Director Adams said the contractor (Magellan) had initial payment and education problems for providers, including federally qualified health centers; the department said Magellan addressed many issues quickly and that timeliness complied again with contract standards. The department said it has imposed more than $100,000 in liquidated damages, issued management letters and placed the vendor on corrective action plans. "They are back in compliance with timeliness requirements," Sharon said, and department staff monitor monthly reports on payment timeliness and denials.
Committee members pressed whether problems were fully resolved. Sharon said the department had resolved specific FQHC payment issues and corrected mailing/address problems for providers who received paper checks, and that it would continue monitoring payment timeliness and provider concerns.
The department also said it had asked for additional funds to cover actuarial services, CAHPS surveys and to negotiate contracts tied to a resource allocation tool that stems from the KW litigation settlement; one request described ongoing attorney fees tied to the court order. Adams described the KW settlement work as federally directed and part of mandated court compliance.
On other coverage questions, Adams said emergency Medicaid expenses for noncitizens are limited: "in any given year, we spend about $10,000,000 on emergency Medicaid," and that those services are governed by federal law. On postpartum coverage, Adams said the state plan amendment expanding postpartum services is live and that about 2,800 women have benefited; he also said the department had filed an appeal after a federal rejection of a part of Idaho's interpretation tied to abortion law and expected an administrative hearing in April.
Ending note: the department emphasized ongoing monitoring and corrective action for the IBHP vendor and asked legislators to direct policy changes if they want structural cost containment options; officials said they will continue monthly reporting to the legislature on timeliness and other contract metrics.
