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Senate committee presses Access over delayed Medicaid payments as agency fights behavioral‑health fraud
Summary
Arizona senators pressed Access and its new director on lengthy prepayment reviews and prior‑authorization delays that officials say are a byproduct of combatting a large sober‑living fraud scheme; Access pledged a performance improvement plan, additional staff and external support to speed adjudication and protect providers.
Sen. Warner, chair of the Senate Health and Human Services Committee, opened a hearing focused on the state’s response to a large behavioral‑health billing fraud and its effects on legitimate Medicaid providers.
The committee heard that actions taken after an external forensic audit and law‑enforcement referrals have reduced fraudulent payments but left many providers struggling with payment delays. "Providers are closing," Warner said, noting two recent closures. Marcus Johnson, deputy director at Access, told the committee that the agency has decreased unadjudicated mental‑health claims from roughly 27,000 to about 7,000 and increased behavioral‑health claim approval rates from about 70% to 87%.
Access officials described a three‑checkpoint approach to claims screening: an initial documentation review, statistical outlier flags based on standard deviations, and prepayment review for flagged providers. Lynn Emmons, assistant deputy director, said the agency aims to reduce prior‑authorization turnaround from an average of roughly 23 days toward the statutory targets (five days for urgent admits, 14 days for non‑urgent) and to shorten prepayment review timeframes that legally may take up to a year. "We've reduced review time from around six months to less than 90 days and are working to get it under 30 days before the end of the year," Emmons said.
Committee members pressed Access for specifics: which providers account for most pending claims, the dollar value of unadjudicated claims, and provider lists for those on prepayment review. Access agreed to provide aggregate reports, lists when not constrained by confidentiality, and more granular breakdowns of prior‑authorization averages by provider type. The agency also committed to delivering job descriptions and background information for staff who review claims.
Multiple senators warned that lengthy reviews are forcing ethical providers to operate as unpaid credit lines. "Why should the provider suffer because your department is ill prepared?" Sen. Angus asked. Access officials responded that resource constraints and the need for trained reviewers have limited throughput, and they said they are adding staff and exploring external contractors to accelerate reviews.
Director Virginia Rountree, who took her post in October, told the committee she is pursuing both short‑term surge capacity and long‑term process improvements. "We need to get the backlog resolved, but we also have to be sustainable going forward," Rountree said, describing plans for a project manager, live staff dashboards, and targeted one‑on‑one technical assistance for providers. The committee requested timelines and updated cash‑disbursement figures through October 31.
The hearing closed with the committee demanding periodic updates and asking Access to keep legislators informed as improvements are implemented and as providers are paid or transitioned so member care is not interrupted.
