The Louisiana Department of Health recently implemented new processes to ensure that managed care organizations are providing accurate and adequate provider information to the state and to individuals seeking specialized behavioral health services.
A recent audit completed by the Louisiana Legislative Auditor reviewed information and data from October 2016 through December 2016 and found examples of inaccurate listings of licensed mental health providers in the managed care organizations’ provider directories. These listings are important for patients to be properly referred to licensed mental health providers.
A review by the Office of Behavioral Health discovered the actual numbers of unlicensed providers are far less than stated by the Legislative Auditor. For example, the audit indicated that 1,539 mental health providers reported by the managed care organizations were not properly licensed. The Office of Behavioral Health verified licensure for 862 of those identified and confirmed that the majority of the remaining providers had already been corrected in the managed care organizations’ most recent reports.
“Ensuring that individuals understand their options for care and are receiving the appropriate services from the appropriate, licensed providers is a priority for the Louisiana Department of Health,” said Michelle Alletto, deputy secretary, Louisiana Department of Health. “This is why, even before this audit took place, our agency identified processes to strengthen provider information shared by the managed care organizations to their members and to the state.”
Alletto added that making these necessary improvements is difficult due, in part, to past staffing reductions that left the Department with only four staff members dedicated to monitoring behavioral health networks which includes thousands of providers.
In July of 2017, the Louisiana Department of Health enhanced its oversight of the managed care organizations and the accuracy of the available information about licensed behavioral health providers. This oversight includes desk audits, on-site reviews and targeted secret-shopper calls to behavioral health providers in order to verify provider qualifications, licensure and whether or not providers are accepting new patients; technical assistance provided on-site to the managed care organizations to improve reporting; notices of non-compliance from the state to the managed care organizations; and monetary penalties.
Under the guidelines set forth in the current contracts between the state and the managed care organizations, the Department of Health has issued $44,000 in fines for failure to accurately report information concerning specialized behavioral health.
“Since this work began, we have already noticed that the information shared by the managed care organizations has improved, and we will continue to move forward with further improvements,” said Dr. James Hussey, assistant secretary Office of Behavioral Health, Louisiana Department of Health.
The Department has proposed amendments to the current managed care contracts to strengthen existing oversight and monitoring, including an amendment that will require the organizations to maintain 90 percent accuracy in their provider directories and possibly face stricter monetary penalties for noncompliance.
Alletto said the Department relies on audits to help identify weaknesses and follows up on the findings.
“We welcome audits such as this one because they help us to identify opportunities to further adjust our processes and ensure the best data and resources are available for Louisiana residents to make informed decisions about their health care.”