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DHS defends new independent-assessment process for behavioral-health Medicaid services as lawmakers press for fixes
Summary
DHS officials told the committee that independent functional assessments for behavioral-health Medicaid beneficiaries began in 2017 and that challenges have arisen from referral workflows, reassessment timing and contractor performance; DHS said it is refining processes and working with Optum and other vendors.
Department of Human Services staff briefed the committee on the process and performance of independent functional assessments for Medicaid behavioral-health services and described steps to remedy workflow and timeliness problems.
Paula Stone of Arkansas Medicaid said independent assessments—used to determine eligibility for home- and community-based behavioral-health services—have been in place since August 2017. She described a multi-party process in which behavioral-health providers refer clients to EQ Health for prior-authorization workflows, and Optum conducts independent assessments and care coordinators help manage reassessments and service transitions.
DHS said the most common issue is premature or inappropriate referrals: many behavioral-health providers request independent-assessment services before attempting available counseling or outpatient treatment options, causing an increase in referrals that the PAS (prior-authorization) process must triage. Stone said an annual reassessment is required to determine continued need and that the department is working to focus assessors on acute settings (for example, crisis units) so patients leave the hospital with an appropriate plan and, when eligible, rapid access to services.
Committee members raised contract-performance concerns, citing prior penalties assessed against Optum. DHS said penalties were considered and that, at the time of the hearing, there had been no announced reduction in the assessed penalty; members asked for follow-up reporting on enforcement and corrective steps.
DHS told the committee it is working with providers, Optum and EQ Health to clarify workflows, educate referring clinicians and prioritize assessments in crisis settings; the department emphasized that the assessment program applies to a subset of the Medicaid population—estimates presented in the hearing suggested approximately 25,000 people might need the full array of home- and community-based services out of a larger population of Medicaid beneficiaries who receive any behavioral-health service.
The committee requested ongoing engagement with providers and updates on Optum performance and penalty outcomes; no new statutory changes were enacted at the hearing.
