Eliminating administrative burdens is goal of changes to Salud!
Eliminating administrative burdens is goal of changes to Salud!
New Mexico officials announced they plan to require managed care organizations to deliver behavioral health care in the Salud! Medicaid managed care program by contracting directly with individual providers and provider groups.
The change, if implemented, would take effect July 1, 2001, with the next contract cycle. The Salud! program came under fire earlier this year from mental health advocates who charged it had cumbersome administrative procedures that had a negative impact on patient care. (See State Heath Watch, June 2000, p. 1.) State officials angrily denied the charges and claimed that the group leading the protests — Washington, DC-based Bazelon Center for Mental Health Law — did not understand the situation in New Mexico and had a hidden political agenda.
In a written document on contract considerations for 2001, New Mexico officials said that in the proposed new model, all administrative layers between a managed care organization (MCO) and providers would be eliminated.
"Quality oversight, utilization management, grievance/appeals, credentialing, data collection, and claims payment would be retained within the MCO," they wrote.
"This would permit a reduction in the administrative burden, result in consistent application of policy and clinical care criteria within an MCO, bring care coordination functions closer to the clinical and consumer point of service delivery, facilitate timely payment of claims, and free up more funds for direct services," the officials added.
Direct contracting would also permit increased accountability to the state Human Services Department on all matters related to the delivery of behavioral health care, the officials stated.
As the state officials talked with various interest groups about the new contract, they heard recommendations for a separate behavioral health organization.
They said some medical providers expressed concern that research shows that a separate organization would result in a lack of coordination between physical health and behavioral health.
The officials also said a restructured integrated physical and behavioral health model would offer the most advantages for clients in terms of coordination and continuity of care. In addition, the officials say, creating a single statewide behavioral health model would require the state to obtain a new waiver from the Health Care Financing Administration and then issue and award a new request for proposal, a lengthy process that could be disruptive to members and providers.
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