New Mexico losing fourth behavioral health provider; has Taos office

Valle del Sol and the four other Arizona nonprofits began contracting with the Human Services Department in the summer of 2013 to provide treatment services for Medicaid patients after the department accused 15 New Mexico-based behavioral health contractors of fraudulent billing practices. The state froze Medicaid reimbursements to most of those organizations, and many were forced to shut down amid investigations and legal battles that continue, even after the state attorney general cleared all 15 of criminal wrongdoing.

Three of the Arizona nonprofits — Agave Health, La Frontera Center and Turquoise Health and Wellness — have already left the state. The planned departure of Valle del Sol raises further questions about how extensively the behavioral health shake-up has affected the publicly funded system that provides low-income residents with mental health and addiction services — particularly in a state with some of the highest rates of poverty, suicide, drug overdoses and alcohol-related deaths.

Valle del Sol is one of the few behavioral health service providers in Española, where opioid overdose rates have ranked among the highest in the nation. In addition to Taos, the organization also has offices in Bernalillo, Los Lunas, Grants, Moriarty and Raton, Florez said. She declined to say how many patients and employees it has in the state or whether workers can expect layoffs.

Kyler Nerison, a spokesman for the Human Services Department, on Thursday said the agency “will work with Valle del Sol, one of dozens of behavioral health agencies in New Mexico, and hope they maintain their operations here, which account for less than 2 percent of behavioral health services.”

If the nonprofit does follow through with the departure, he said, the department will coordinate with managed care organizations that contract with the state’s Medicaid program — Blue Cross Blue Shield, Molina Health Care, Presbyterian Health Plan and UnitedHealthcare Community Plan — “to ensure access to care is not interrupted.”

Nerison said access to behavioral health services has increased by 75 percent in the past two years.

But state lawmakers have questioned the Human Services Department’s behavioral health figures. A performance report card completed in July by the department’s Behavioral Health Services Division cites financial and workforce constraints as barriers to improving Medicaid-funded behavioral health services.

A state government financial crisis, largely triggered by a downturn in oil and gas revenues, led officials to make deep cuts to the Medicaid program earlier this year.

Nerison said the Human Services Department “largely exempted behavioral health agencies from the Legislature’s forced Medicaid cuts.” Medicaid reimbursement rates to providers for some mental health treatments, however, were cut by as much as 5 percent.

Valle del Sol took over many of the services in Northern New Mexico that had been provided by Easter Seals El Mirador, one of the nonprofits whose Medicaid funding was frozen. Easter Seals is one of the few providers involved in the shake-up that is still in business. But it no longer provides Medicaid-funded treatment.

Easter Seals has agreed to pay the state $691 for Medicaid billing errors — far below what state officials initially alleged.

CEO Patsy Romero on Thursday said Easter Seals has no plans to seek state credentials to provide Medicaid care anytime soon. With the recent reductions in reimbursement rates, she said, participating in the Medicaid program doesn’t make sense.

She’s also leery of working with Gov. Susana Martinez’s administration. “We really can’t afford to trust that the administration is going to do the right thing for the vulnerable people of New Mexico,” she said.

New Mexico spent at least $24 million bringing in Valle del Sol and the other Arizona providers in 2013, according to reporting by The New Mexican. The nonprofits began receiving payments even before the completion of an audit citing possible Medicaid overbilling by the New Mexico-based organizations.

Valle del Sol was paid some $2 million during the transition, and its leader, Kurt Sheppard, was billing the state $300 an hour for his work, records show. Months after it arrived in the state, Valle del Sol began laying off employees.

Easter Seals officials on Thursday said Valle del Sol also got a windfall when Easter Seals held a “fire sale” of its buildings for just over $1 million, including an Española campus formerly known as Casa de Corazon.

Southwest Network is the only remaining Arizona-based provider that has not departed New Mexico or publicly announced a pending departure. Under the name Open Skies Healthcare, Southwest Network operates in Albuquerque, Rio Rancho, Grants and Los Lunas.

Two officials at Open Skies’ Albuquerque location on Thursday hung up on a reporter after questions about whether the organization had any plans to leave the state. Management in Arizona could not be reached for comment.

The Santa Fe New Mexican is a sister-paper of The Taos News. Contact Justin Horwath 505-986-3017 or jhorwath@sfnewmexican.com.