Office of Behavioral Health Not Adequately Monitoring Mental Health Services for Medicaid Recipients

The state Office of Behavioral Health (OBH) does not monitor managed care organizations well enough to make sure they have an adequate network of licensed and qualified specialized behavioral health providers, the Legislative Auditor said in a report released today.

Specialized behavioral health providers offer such services as psychosocial rehabilitation, therapy, and crisis intervention for those suffering from mental health or substance abuse problems. The managed care organizations (MCOs) oversee the provision of the state’s Medicaid services and are responsible for contracting with specialized behavioral health service providers.

Under the MCO contracts, OBH staff members are required to review plans and reports, check provider information for accuracy, make announced and unannounced visits to ensure providers meet qualification requirements, and make “secret shopper” calls to verify provider availability.

Auditors found that OBH does not adequately ensure the MCOs contract with licensed specialized behavioral health providers, the state auditor said. For example, out of 3,438 providers listed as Licensed Mental Health Professionals, 1,539 (44.8 percent) did not meet state licensure requirements. Auditors noted that could be a result of inaccurate data from the MCOs, or it could mean the providers are offering services they are not licensed to perform.

In addition, auditors found that OBH does not use Medicaid data to determine whether the MCOs report accurate information about the specialized behavioral health providers. Specifically, auditors determined that almost 5 million services were performed by providers not coded as specialized behavioral health providers in the Medicaid data. Approximately $14 million of these services were coded as being provided by physicians who do not offer them.

Auditors also found that OBH has not made secret shopper calls to all specialized behavioral health provider types to ensure the MCOs are not overstating the number of providers in their networks. OBH staff did call 1,529 psychiatrists and found 940 (61.5 percent) either did not accept Medicaid or did not provide services at the location listed by the MCO. Of the 589 psychiatrists who said they accepted Medicaid recipients, 119 (20.2 percent) said they did not accept new Medicaid patients, meaning access is more limited for new Medicaid recipients.