Commentary: (Santa Fe, NM) –The New Mexico Senate today passed by a vote of 31 – 9 and with huge bipartisan support legislation to protect providers of health care who are falsely accused of fraud by the State. The measure, sponsored by Senate President Pro Tem, Mary Kay Papen(D-38-Dona Ana), establishes strong new procedures for due process. SB 217, ‘Medicaid Access, Disputes & Fraud’, will guarantee that providers who stand accused of fraud will receive the opportunity to review the allegations made against them, and the chance to respond to allegations in an administrative hearing, and also in district court. That opportunity did not exist by law in 2013 when 15 non-profits and firms were mostly put out of business, only subsequently to be cleared of any wrongdoing by the Attorney General.
“I am grateful to my colleagues for helping to make sure that a tragedy affecting vulnerable children and adults in need of critical mental health and substance abuse treatment never happens again. Before people with mental health disorders are forced to go without treatment for their conditions because of disruption of services, due process is needed. I am confident SB 217 will accomplish the transparency and independent analysis in these situations that is needed. Let’s never have what happened during the last four years in behavioral health in New Mexico ever occur again. If this bill makes it to her desk, I am calling on the Governor to sign it,” Said Sen. Papen.
SB 217 responds to the disruption in care which began in 2013 when Governor Susana Martinez’s administration leveled charges of overbilling and fraud against the state’s long-standing treatment providers under Medicaid. Even though the Attorney General’s Office subsequently cleared all of them of the allegations, there are still large gaps in accessible coverage across the state, and the State has never returned more than $11 million in payments owed to the providers from that time. Many went out of business as a result.
“This legislation is critical to ensure that all healthcare providers who deliver services to Medicaid beneficiaries are protected. New Mexico has the highest per capita Medicaid-eligible population in the whole U.S. 42% of New Mexicans currently qualify for access to Medicaid healthcare. This bill is critical to ensure that we have professional healthcare capacity in the future,” said Patricia Romero, CEO of Easter Seals El Mirador.
The provision of behavioral health services in New Mexico has never recovered. The companies from Arizona brought in to replace pre-2013 providers now all have left, except for one.