This tumultuous year has proven the essential nature of nonpartisan local news. Every day we bring you news critical to staying informed and active in the community. Join us with a tax-deductible donation.
A contract dispute between Magellan Healthcare and CalOptima, the county’s health plan for low-income and elderly residents, may have left some of CalOptima’s 710,000 patients without mental health care when, for nine days in July, Magellan refused to process Medi-Cal payment claims.
CalOptima spokeswoman Bridget Kelly said the agency has “no evidence that anyone’s care was impacted” and that the few providers who said they might cancel their appointments were “reassured” they would be paid and should continue to see CalOptima members.
But the state’s Department of Managed Health Care wrote in a settlement it brokered with Magellan that “CalOptima received notice regarding providers refusing mental health services to CalOptima Medi-Cal enrollees,” although it doesn’t say how many providers were refusing services.
A department spokesman Friday did not provide the number of those refusing, instead requiring a reporter to file a Public Records Act request.
“Magellan’s actions in purporting to rescind the contract on extremely short notice posed a serious concern for the approximately 710,000 CalOptima Medi-Cal members whose access to behavioral health services had the potential to be interrupted.”
-Settlement document from the California Department of Managed Health Care
Magellan’s contract is worth $41 million a year, according to a September 2016 CalOptima staff report.
On average, Magellan administers the mental health care services of 6,700 patients a month, Kelly said.
The issue began when Magellan asked CalOptima to change the rate at which the company is reimbursed for applied behavioral analysis (ABA) services, a therapy for patients with a range of symptoms associated with autism, according to a staff report.
It said CalOptima couldn’t reach a rate agreement with Magellan, which has had a contract since January to administer the mental health care of nearly 710,000 CalOptima patients.
On June 28, the company notified CalOptima it would rescind its three-year contract effective July 1, according to the staff report.
According to the state Department of Managed Health Care, between July 1 and July 9, when Medi-Cal enrollees called Magellan, the company referred them to CalOptima’s customer service call center. When providers tried to submit claims to be reimbursed by Medi-Cal, the company blocked the submission and told providers to send all their claims directly to CalOptima.
The state, which regulates Magellan, stepped in on the grounds that Magellan could be disciplined for unfair business practices, and brokered a contract on July 14 that would require Magellan to retroactively process all Medi-Cal claims and continue to provide services through the end of August.
Colleen Flanagan Johnson, a representative for Magellan Health, did not comment on the company’s decision to rescind the contract, but said “Magellan has been and remains deeply committed to its work on behalf of CalOptima and to the service provided to their members.”
At its August 3 Board of Directors meeting, CalOptima CEO Michael Schrader declined to answer any questions about why Magellan rescinded its contract, saying he did not want to divulge any legally sensitive information.
Late Thursday afternoon, Voice of OC asked Kelly how long CalOptima and Magellan had been in dispute over the contract; what exactly Magellan is demanding; how many providers said they might cancel appointments and other questions, including requesting a copy of the disputed contract between CalOptima and Magellan.
Kelly, the communications director, had not responded to those questions by Sunday evening.
At its August 3rd meeting, the board voted in closed session, under an item to consider initiating litigation, to approve a transition plan for Magellan to provide services until the end of the calendar year.
The board now has three options for what to do next. It could continue working with Magellan, pick a new company to manage behavioral health care services, or take all of the work in-house.
Magellan currently manages more than 530 contracts on behalf of CalOptima, which includes 800 different mental health providers and 300 ABA providers.
CalOptima staff is recommending the board bring administration of mental health care in-house, which likely would require hiring additional staff and cost up to $6.6 million this fiscal year, according to a staff report.
The board will discuss its next steps at the September 7 meeting.
Contact Thy Vo at email@example.com or follow her on Twitter @thyanhvo.