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BOISE, Idaho (AP) — State auditors say the contractor managing mental health and substance treatment for Idaho's poor has helped reduced the use of costly Medicaid reimbursement rehabilitation services, but doing so has caused confusion and negative consequence among some providers unclear of the state's motives.
Lance McCleve from Idaho's Office of Performance Evaluations told state lawmakers Monday that Medicaid spending for community-based rehabilitation, also known as psychosocial rehabilitation, ballooned from $8.3 million in 2001 to $76.1 million in 2012.
Community-based rehab involves trained professional helping individuals with mental illnesses or substance abuse integrate back into society.
Yet the high jump in Medicaid spending for community-based rehab led state health officials and lawmakers to raise concerns that providers were overusing costly rehabilitation in order to receive higher Medicaid reimbursements. According to the state's report though the Department of Health and Welfare failed to communicate its transition plan to providers when it moved forward with contracting with Optum — a unit of UnitedHealth Group.
"The department believed these changes were necessary," McCleve said. "The department had a communication strategy, but its communication strategy wasn't effective in making this change."
Idaho has been paying Optum $10.5 million a month to administer Medicaid's outpatient behavioral health services since 2013. Optum also manages Medicaid health services for other states.
Less than two years after the state began using Optum, Medicaid spending had dropped to $44.1 million as of 2015.
"When I look at the past trend, I am horrified," said Rep. Maxine Bell, R-Jerome, and co-chair of the state's powerful budget setting committee. "I am comforted we are getting those spending trends under control."
Auditors say the three-year contract has been successful in lowering Medicaid costs and encouraging providers to focus on appropriate services for patients. However, getting there took a rocky start.
A few months after the contract was signed, providers began complaining that Optum was putting them on hold for hours when they phoned in a request for reimbursements. Others complained of delayed payments, while others said that Optum was specifically targeting to eliminate community-based rehab.
Optum officials have maintained that science does not back community-based rehab as an effective tool for treating mental illnesses like ADHD — particularly among children and adolescents. Instead, Optum says that it's seen an 87 percent increase in the use of parenting skills through family therapy.
"This indicates more families are engaged in helping their loved ones reach recovery, and families are now taking a more active role in that journey," wrote Optum Idaho Executive Director Becky diVittorio in her response to the state's report.
Additionally, response times to providers have improved after Optum brought on more resources to handle the unexpected high demand.
"The plan was designed to reduce psychosocial rehabilitation," said House Minority Leader John Rusche of Lewiston, who participated by phone. "And Optum basically did what we asked."
"That's correct," McCleve said.
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