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La Clinica launches takeover of mental health services

Las Cruces Sun-News (NM) - 8/3/2015

Aug. 02--LAS CRUCES -- Starting today, an estimated 1,900 behavioral health clients across Doña Ana County begin to receive their Medicaid-funded services from a new provider.

At 11:59 p.m. Friday, a much-discussed switch occurred between outgoing nonprofit La Frontera, which has been the main provider in Las Cruces the past two years, and La Clinica de Familia, a longtime low-income health care provider that was recruited to replace La Frontera after that organization announced its departure in April.

La Clinica planned to spend the weekend setting up its computer network, phone lines, copy machines and doing other IT work needed to start business this morning. In all, the organization is taking over more than a dozen adult and youth mental health services, ranging from outpatient therapy to group home services, at several facilities in Anthony and Las Cruces.

While there will be a few differences -- clients, for instance, will be asked to fill out the type of paperwork they would if they were visiting a new doctor -- La Clinica officials said they're hoping that months of planning will pay off in the form of few disruptions to clients.

"Business should continue uninterrupted," said La Clinica CEO Suzan Martinez de Gonzales. "We've put in a lot of work, and I think it's going to show."

Over the weekend, workers removed a La Frontera sign from the organization's main building at 100 W. Griggs Ave. in Las Cruces. A La Clinica de Familia sign was installed last week.

Another difference is that clients will have access to eligibility specialists -- who help enroll clients in Medicaid or insurance, said Virgil Medina, LCDF chief operations officer. That's something they didn't have under La Frontera.

The transition becomes the second in two years for the state after a mid-2013 shake-up. Funding was abruptly cut off to a 15 former providers after a controversial audit yielded allegations of overbilling and possible fraud. Several former Medicaid behavioral health providers have been cleared of wrongdoing; others remain under investigation.

Client switchover

Of the estimated 1,900 clients, some 500 were already receiving primary health care services from La Clinica, according to Martinez de Gonzales. The 1,400 entirely new clients will amount to about a roughly 6 percent increase in the size of La Clinica's client load.

Notable about the switch is that phone numbers to each of the facilities will remain the same as they were under La Frontera, according to LCDF officials.

Also, after the final leases were signed last week, LCDF will offer most of the services from the same locations as La Frontera. However, a few of the services are being rearranged among those facilities.

Friday, furniture from some of the organization's new office space on the south side of Griggs Avenue in Las Cruces was being loaded into trucks. Medina said that was partly to prepare for some services that needed to operate over the weekend. Also, LCDF was relocating services to entirely separate youth clients from adult clients.

Martinez de Gonzales said LCDF will maintain an appointment schedule for clients from before the transition. She said the organization has had trouble getting solid client counts, as well as other information, from La Frontera, something noted to lawmakers during a hearing last month.

"It's been challenging," she said.

Medina said data entry specialists in recent days were wrapping up the creation of client profiles to allow for scanned documentation from Frontera to be attached. But a more sophisticated software will have to be developed down the road to create a more efficient mental health case management system, LCDF officials said.

One service formerly overseen by La Frontera -- a safe house program -- isn't being taken over by LCDF. Rather, La Piñon, a sexual assault recovery nonprofit, will be the new provider. Also, La Frontera will continue providing a foster care service, likely through October, until LCDF becomes certified to run the program, according to LCDF officials.

Staff transition

In all, LCDF officials have said they expect to have 184 positions, which include 60 vacancies and some newly created positions, to run its new Medicaid mental health services division. Of those, about 66 are clinicians or, in some cases, lay people who are service providers, according to La Clinica officials.

About 85 percent of La Frontera's staff decided to transfer to La Clinica, according to Martinez de Gonzales.

Las Crucen Ricardo De Leon, who has been a client of Medicaid behavioral health care in Las Cruces for about five years, said one of his biggest concerns with the recent transition was changeover in personnel, with whom clients often have a good rapport.

"We were just worried about losing staff," he said.

But De Leon said he was relieved to know most staff would be staying.

"Everything is going smoothly," he said.

On Saturdays for the last month, transitioning staff have gone through La Clinica's new employee orientation and training, such as CPR, that's required, officials said. Also, personnel had to have their vaccinations updated.

Resident Jack Eakman, who was part of a county behavioral health task force that aimed to review the transition between La Frontera and La Clinica, said he was "impressed" by La Clinica's decision to hire La Frontera's staff, and the way the nonprofit has addressed the uncertainties that go along with expanding its services, which is a "huge change of its mission."

"I am very, very impressed with the new leadership for behavioral health care at La Clinica de Familia," said Eakman, a retired hospital administrator. "They really seem to have things under control."

Martinez de Gonzales said a key step in the transition will be the credentialing of all the new personnel with each of the four major health plans -- called Managed Care Organizations -- that administer Medicaid claims and funding on behalf of the state. Though the clinicians may have been credentialed with the MCOs previously, the health plans require recredentialing because of the change in providers, she said. LCDF can't bill the Medicaid plans for services provided by a given clinician until that process has finished. But it could take several months.

Authorization pending

In addition to credentialing, LCDF is still waiting for what's known as a "change of scope" authorization from the federal Health Resources and Services Administration, part of the U.S. Department of Health and Human Services, according to Martinez de Gonzales. Without that, LCDF also can't bill the MCOs.

"That's why the MCOs have given us (funding for) start up costs," she said. "We wouldn't have been able to do this without their help."

Liz Lacouture, executive director for Behavioral Health, Presbyterian Health Plan said in a statement that organization has "spent the past few months working closely with multiple state agencies including the New Mexico Human Services Department; the Children, Youth and Families Department; the Department of Health; other Managed Care Organizations; community providers and other stakeholders to ensure that La Clinica could assume La Frontera's operations and deliver the high-quality services that our members need."

"We fully anticipate this smooth transition to continue," she said.

The three other health plans are BlueCross BlueShield, Molina Healthcare and UnitedHealthcare. Reimbursement for certain types of behavioral health services stems directly from the state, providers have said.

HSD spokesman Matt Kennicott said in a statement Friday the agency's "top priority is to ensure that patients get the quality care they need, which is why we are working with everyone involved to ensure the smoothest transition possible."

The mid-2013 transition to La Frontera was rocky, with clients and staff reporting disruptions in service. But it was more abrupt and with less planning and coordination among all the entities involved than last week's transition.

Over the past two years, La Frontera dropped a number of services, according to La Clinica officials. And its caseload declined.

La Clinica officials said they've hired health "promotoras" to try to track down those lost clients to find out if they plugged into services elsewhere or stopped getting services altogether.

LCDF is planning an "open house" at noon Sept. 16 at the 100 W. Griggs Ave. location that's open to the public, Martinez de Gonzales said.

Eakman said he's hopeful LCDF will continue to be supported during the transition.

"I think the community should do everything they can to back La Clinica de Familia through this change," he said.

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

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