Earlier this week Salt Lake County Mayor Ben McAdams (Democrat) convened a press conference to announce results of the county-commissioned audit dealing with recent changes in behavioral healthcare delivery. The report describes what the administrative landscape now looks like in the era of managed healthcare systems with government participation. Joining Mayor McAdams was County Councilman Arlyn Bradshaw (Democrat) who represented the council’s interests in this process. Additionally, Brian Miller, Executive Director of the National Alliance for Mental Illness in Utah, was on hand to make a plea for the best direction the various players could take.
The entire report can be found here, commissioned by the county at a cost to taxpayers of over $28,000 and was completed by TAP International at the county’s request.
Stakeholders had a chance to review the materials ahead of the Mayor’s press conference and the reviews were generally good, but Utah Political Capitol uncovered some dissent among the providers and the way that insurer OptumHealth was holding authorizations for payment to healthcare professionals and providers in Salt Lake County.
Some of the current snags include Optum claims personnel denying patients admittance to inpatient care after an acute behavioral health matter has been initiated by crisis intervention personnel, first responders and then emergency room professionals.
Denials seem to occur when an individual has been assessed by qualified crisis intervention professionals, but because the patient has drugs or alcohol in their system, Optum personnel deny benefits in behavioral health claims based on anecdotal situations. It appears that Optum uses this strategy to reduce costs and increase profits as a claim moves forward.
McAdams has promised that his point person, Tim Whelan, and the county staff responsible for the County’s oversight of the process, would get to the bottom of any discrepancies, complaints or wrongful denial of benefits, and cases of managed healthcare as the county adjusts to the realities of the new healthcare marketplace. County personnel are proceeding by closely monitoring all of the problems that are brought to their attention and may intervene where appropriate.
The mayor deferred any discussion about how this portion of county services would work as the debate about expanding Medicaid to include those who are presently not covered; indicating that discussion was beyond the scope of the day’s press briefing.
Because it is close on the heels of the revision in behavioral healthcare delivery in Salt Lake County, and because researchers from the University of Utah released their findings that far more people are involved in the so-called “donut-hole” or “Medicaid gap,” this part of the public policy discussion may come up sooner rather than later.
CORRECTION: In the original headline, Utah Political Capitol incorrectly stated that McAdams called for an investigation. As stated in the article, McAdams was releasing the findings of an investigation which had already been commissioned.