Sneak Preview: Md. Crafts Mental Health Eligibility Procedures

October 24, 2014 | By Jerry Ashworth | Post a Comment

xsass_bookshot(The following was excerpted from an article in the Single Audit Information Service.) The Maryland Mental Hygiene Administration, in response to recent audit findings, has established new procedures to ensure that statewide mental health service providers obtain required documentation identifying whether patients are eligible to receive treatment for mental health services paid by the state’s general fund.

The Mental Hygiene Administration (MHA) is part of the Maryland Department of Health and Mental Hygiene. The Maryland Office of Legislative Audits (OLA) recently reviewed MHA’s oversight of the mental health program. MHA contracts with an administrative service organization (ASO) to provide benefit management services (e.g., ensuring patient eligibility, paying provider claims).

During fiscal years 2011 through 2013, ASO paid about $2 million in provider claims for mental health services, most of which related to patients covered by Medicaid. In addition, needy individuals that do not qualify for Medicaid still may be eligible for mental health services paid by the state’s general fund, known as “uninsured coverage,” if they meet certain eligibility criteria (e.g., verifiable social security number, proof of state residency) and qualifying conditions.

OLA found that although MHA provided guidance to providers regarding documentation requirements for uninsured coverage, it did not always have on file the eligibility documentation for these patients. For example, OLA reviewed documentation on 25 patients who received claims paid in 2013 and found that a verifiable social security number was not available in 14 cases and proof of residency was not available in 13 cases.

The ASO also is “required to periodically examine selected providers and related claims for propriety, including a review of supporting eligibility documentation,” OLA added. “However, the ASO’s reviews of selected providers and related claims for propriety did not specifically target claims paid as uninsured coverage. Rather, the claims reviewed were chosen randomly and no statistics were kept on the number of claims paid as uninsured coverage that were audited.”

(The full version of this story has now been made available to all for a limited time on Thompson’s Grants Compliance Expert site).

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