News Article Details

R.I. treatment centers raise alarm over delayed Medicaid reimbursement

Providence Journal - 3/11/2019

March 11-- Mar. 11--PROVIDENCE -- A statewide coalition of nonprofit behavioral healthcare and substance-abuse treatment centers has gone public with concerns about delays in receiving state Medicaid reimbursement for services they provide.

Delays in cash flow affect staff and management operations, thus imperiling vital care for thousands of vulnerable Rhode Islanders, providers said. In response, the state acknowledged concerns but asserted they are being properly and promptly addressed.

In a letter to Gov. Gina Raimondo, Lynda A. Stein, chairwoman of Woonsocket-based Community Care Alliance, wrote of "the negative impact to our workforce and ultimately to the persons we serve who have severe and persistent mental illness" or are battling addiction. Problems, she wrote, "are growing exponentially greater by the week."

Others joining in a plea for remedy include addiction-treatment organization CODAC; Thrive Behavioral Health, formerly Warwick's Kent Center and Warren's Riverwood Mental Health Services; Discovery House Comprehensive Treatment Center of Providence; and Newport Mental Health.

"We have been reluctant to go public with this problem but now know unless something is done now, many of these critical providers will start reducing services or worse," Newport Mental Health president and CEO Jamie Lehane told The Journal. "This is a widespread system issue, not [for] just a few providers."

Speaking on behalf of the governor, state Medicaid director Patrick Tigue said in an interview Monday that the Executive Office of Health and Human Services is "completely committed" to addressing the reimbursement issues and already has taken steps toward that end.

"These are complex, nuanced issues," Tigue said, ones that do not have an instant solution. But he said they have commanded the attention of the governor's office, his office, and the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, which plays a central role, along with private agencies, in providing services.

Stein, a University of Rhode Island psychology professor who holds an adjunct faculty position at Brown University, said in her letter that a root of the problem was the state's decision three years ago to transition Medicaid funding to managed-care organizations United HealthCare, Tufts Health Plan and Neighborhood Health Plan of RI.

"Where Community Care Alliance is concerned, shifting from a state-managed approach to a managed-care model has had dire consequences resulting in short-term salary reductions, delayed payrolls and raises, as well as staff attrition," Stein wrote. "Moreover, as a local non-profit business with over 500 employees, CCA has multiple other payment obligations such as healthcare, liability insurance, building maintenance, mortgages, payroll taxes and more."

"Rhode Island is committed to providing a broad array of high-quality services to Rhode Islanders in need of mental or behavioral-health treatment," Tigue told The Journal. "We are committed to ensuring the success of the system as a whole. Working closely with our managed-care and provider partners, we continue to make significant strides in streamlining billing and payment process.

"Medicaid maintains close oversight of its managed-care organizations as well as provides ongoing technical assistance to both managed-care organizations and providers. Furthermore, Medicaid makes available contingency payments to help meet urgent provider needs, if necessary. I strongly believe, together, we have made consistent and significant progress solving short- and long-term concerns."

Said Community Care Alliance president and CEO Ben Lessing: "While there has been short-term intervention in the form of Medicaid advances to providers, the underlying structural and policy problems have not been resolved. The result is a fragile behavioral health system that cannot be sustained given the current circumstances."

"At the end of the day, the workforce that supports Rhode Islanders with some of the most complex psychiatric and addiction needs is tired, frustrated and asking the state to provide the necessary leadership to immediately stabilize the behavioral-health system while we still have one."

The cash-flow issue is the latest affecting a community behavioral health system that once was held as a national model, but has suffered in recent years due to underfunding, lack of strong political support and other factors, a 2015 Journal investigation disclosed. Improvements since then have been marginal or non-existent, critics today maintain.

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(c)2019 The Providence Journal (Providence, R.I.)

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