La Clinica prepares for July 31 takeover of mental health services from La Frontera

June 14--LAS CRUCES -- Officials involved in the coming transition in Medicaid-funded behavioral health care providers say they're making steps toward the hand-off as a July 31 deadline crawls ever closer.

Tucson-based La Frontera, the main provider of Medicaid mental health care and addiction treatment services in the county, is pulling out of New Mexico entirely. And taking over nearly all of its services is La Clinica de Familia, a low-income medical clinic system that has served Las Cruces and southern Doña Ana County for decades.

"Things are still progressing, not without bumps, but everybody is working so hard to make sure that anything that does come up is dealt with," said Suzan Martinez de Gonzales, executive director for La Clinica.

Weekly meetings about the impending transition continue to take place involving both providers, the state Health and Human Services Department and Managed Care Organizations -- health plans that administer behavioral health funding claims.

In all, an estimated 2,000 clients must be transferred from La Frontera to La Clinica, according to Martinez de Gonzales. But it's still unclear how many of those will be entirely new clients to La Clinica, she said, because the organization already serves at least a portion of the population's primary care needs.

Most services to move

A few weeks ago, one of the matters still up in the air regarding the upcoming transition was how many of La Frontera's services LCDF would take over.

While La Clinica de Familia has been committed from the start to taking over as the provider for the "core" services now offered by La Frontera, whether to take on the specialty services hinged upon how many staff would commit to switching agencies, Martinez de Gonzales said. To offer the "anciliary" services, at least 85 percent of the staff from those services would have to transfer. And so far, nearly everyone is, she said.

"For the most part, we're getting 100 percent," she said. "People are willing to transition."

So, LCDF plans to take on both the core and the more-specialized services, which include treatment foster care for youth and Assertive Community Treatment, an intensive service for people with severe mental illness, LCDF officials said.

In addition, LCDF will take over as the provider of Multi-systemic Therapy -- or MST -- program for youth, which is "highly used by the juvenile justice system and the schools," said Rosario E. Olivera, LCDF director of behavioral health. She said a number of people had been wondering whether LCDF would take on that service.

"We are definitely absorbing that, as well," she said. "It's going to be covering Sunland Park to Cruces like it is now."

Martinez de Gonzales said there is one program now offered by La Frontera that may go to La Piñon, a sexual assault recovery nonprofit. Also, LCDF is attempting to get funding for local youth shelter and group-home services -- the status of which have been uncertain under La Frontera.

"We do have the opportunity and are applying for that shelter grant," she said.

But otherwise, La Clinica is set to take over all La Frontera's programs, LCDF officials said.

Doña Ana County Commissioner Wayne Hancock formed the local Mental Health Oversight Committee in response to the impending transition among behavioral health providers. The panel has met twice since late April, but Hancock has been out of town recently.

"There were a couple of areas of concern, but I'm sure those have been addressed," he said. "When I get back, we'll have another meeting and see if there's any additional action that needs to be taken."

Staffing numbers

LCDF officials said they're expecting to start Aug. 1 with about 185 positions, a number that includes most all of La Frontera's existing personnel; about 35 vacancies from a series of layoffs La Frontera did in December; and a few newly created positions.

Even with all those -- included the newly created jobs -- filled, the total positions will still be less than the 313 believed to have existed among several former nonprofits that La Frontera took over services for in mid-2013, LCDF officials said.

The new jobs will include a corporate compliance manager and a risk manager "to make sure everything runs smoothly and there are no issues," Martinez de Gonzales said. Also, there will be promotoras, care coordinators and Medicaid/ insurance eligibility specialists.

Martinez de Gonzales said her goal is still to boost staffing numbers up to pre-La Frontera levels. But discussions with the state about that won't start until January 2016.

"Because the demand for service has not diminished, but what has diminished is the staff and the ability to provide the service," she said. "If I want to be accountable to the community, I need to make sure that we at least -- within the next year -- come up to" previous staffing levels.

Numbers of staffing are a key factor in a proposed budget LCDF is submitting to the state and health plans regarding costs for taking over the Medicaid behavioral health services, LCDF officials said. And, for a while, La Clinica had trouble getting a final number from La Frontera about how many current staff that organization had. But LCDF got the numbers and recently submitted a proposed budget. Martinez de Gonzales said the document was set to be reviewed for the first time during last week's meeting with the health plans.

HSD spokesman Matt Kennicott said La Clinica is "doing an excellent job of project planning that extends across all pieces of the transition, such as provisional licensing and certification, facilities, staffing, equipment and other areas."

"Financial support is still under negotiation with the Managed Care Organizations," he said in an email.

When La Frontera and other replacement providers were ushered into the state in 2013, the state gave them one-time start up funding. La Frontera got a payment of several million dollars.

Asked if La Clinica is slated to get start-up dollars, Martinez de Gonzales said that's being negotiated through the MCOs, not the state directly.

Clients

Olivera said an estimated 2,000 clients are set to transfer as part of the transition, but LCDF is still awaiting a final number from La Frontera.

There hasn't been a push yet to notify La Frontera clients about the impending switch via letters or during their visits, Martinez de Gonzales said. That will start in early July. Even without notices having gone out, she said many clients are aware about the transition through news media. Still, La Clinica can't formally take them on until Aug. 1.

"We're getting a lot of requests, but we have to tell them: 'No, we're not doing that yet," she said. "It's kind of 'hurry up and wait.'"

La Frontera client Luis Camacho of Chaparral said he's heard about the upcoming switch in providers in Las Cruces, but he didn't learn about it from clinic staff. Camacho said he hopes the transition will be smooth.

Overall, Martinez de Gonzales said she's hoping clients don't notice much difference at all between July 31 and Aug. 1, unless it's improved service.

"Hopefully we'll be able to provide a little bit more access," she said.

Facilities

La Clinica de Familia officials said their goal is to get leases for the current buildings being used by La Frontera in an attempt to avoid disrupting Doña Ana County clients.

Martinez de Gonzales said the facilities, the staff and the programs offered entail various licensing and certifications, another major aspect of the transition. A positive, she said, is that La Frontera has agreed to "stay in the community until some of those licenses and certifications are secured for there not to be any service disruptions." Plus, "La Frontera has agreed to leave a lot of equipment and furniture behind," she said.

Long-term, Martinez de Gonzales said La Clinica has a goal to own all its buildings. She said she doesn't envision the services now offered by La Frontera being housed in a proposed downtown Las Cruces medical clinic that La Clinica has in the works because the two are separate projects.

Overall, Martinez de Gonzales said state agencies have been cooperative in working toward the transition. She credited HSD Secretary Brent Earnst with helping the clinic get over the hurdles that come up. Also, Sen. Martin Heinrich, D-N.M., has met with a key federal agency that will have to give an approval to expand La Clinica's scope of service.

"It's not without bumps, like I said, but when we come to them, everybody is really willing to work and make sure the services remain in the community -- local," Martinez de Gonzales said.

Other transitions

Behavioral health services run by La Frontera in Grant and Hidalgo counties were turned over to Presbyterian Medical Services on June 1, according to Kennicott.

"The transitions for Otero and Lincoln counties will be completed at the end of the month and are still on target and smooth," he said.

Kennicott said that "overall, the transitions are moving very well."

Diana Alba Soular may be reached at 575-541-5443.

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