Maryland’s mental health and addiction treatment providers need their claims paid, not clawed back by contractor

This commentary was submitted by Community Behavioral Health Association of Maryland, Maryland Association for the Treatment of Opioid Dependence and the Maryland Addiction Directors Council

In 2019, Maryland selected a new vendor to pay health care claims for the public behavioral health system. The new vendor – Optum, a division of United HealthCare – was selected based on a bid that was over $70 million less than the incumbent.

When Optum went live with claims processing in 2020, it failed, and it continues to fail today. The repercussions of that failure – during an opioid epidemic, a global pandemic, and now a workforce crisis – have severe consequences that must be addressed.

In hearings over the past month, mental health and addiction providers have described how the pandemic, the workforce crisis, and underpayments from Optum have shrunk their treatment capacity, causing many individuals needing care to sit on waitlists.

Now, the Maryland Department of Health is beginning a process to recoup over $200 million in alleged “overpayments” from providers – an amount that providers report is largely made of claims that Optum failed to process correctly for services that were delivered during the pandemic’s initial months.

Let that sink in:

At a time when many other health care providers were receiving subsidies and retainer payments to preserve treatment capacity while it was being underutilized in the pandemic’s early days, Maryland’s behavioral health providers are being required to return funds for services that they actually delivered. Over a quarter of our members report that they have already laid off staff and reduced capacity, and the looming recoupment will rapidly shrink capacity further.

Optum’s failure to pay claims submitted during the pandemic’s early months and effort now to recoup funds will close the door to many Maryland residents who seeks mental health and addiction treatment services in the coming months. This alarming result needs to be prevented. Since the pandemic began, the Maryland Department of Health reports that suicide attempts by Maryland children have increased over 46%, and overdose death have climbed 18%.

At a time when the need for mental health and addiction treatment is greater than ever, Optum’s flawed recoupment will draw $200 million out of Maryland’s behavioral health system and reduce providers’ ability to meet their community needs.

Legislators must act on what they have learned in numerous briefings and hearings: offer COVID debt relief to Maryland’s mental health and addiction treatment providers, and mitigate the harms caused by Optum. Emergency legislation (SB 549/ HB 715) and budget actions are needed to ensure that access to critical services remains available.