Concerns raised about VDS patients
Two area counselors who made the transition from Valencia Counseling Services to Valle del Sol New Mexico earlier this year say the situation at the Los Lunas mental health facility is short-changing clients and delivering poor care.
Eleanor Van Inwegen and Ed Church were with the now defunct VCS for six and three years, respectively. They were among the staff who stayed on after Valle del Sol took over operations in late August.
The company, along with four other mental health management companies from Arizona, contracted with the New Mexico Human Services Department after a third-party audit alleged Medicaid fraud and abuse at 13 New Mexico mental health nonprofits.
The state froze Medicaid funds going to those companies, and the audit was sealed and turned over to the Attorney General’s office for a criminal investigation.
Both Van Iwegen and Church were laid off in late October, due to financial reasons, Van Iwegen said. And after two months of watching Valle del Sol operate, the two counselors say they have concerns about the future of the company and worry about their former clients.
When Valle del Sol took over operations, the counselors say there were around 1,000 clients receiving services at the Los Lunas location. VCS had services in Grants, Bernalillo and Estancia that VDS is now overseeing.
Van Iwegen and Church say now there are between 300 and 400 clients, and the number of full-time therapists has dropped from 13 to just 2 1/2.
If you do the math, Church says, that comes out to a caseload of about 140 clients each. He argues that there is no way the remaining therapists can see clients on anything approaching a regular basis.
“You could see them once every five weeks and that’s not therapy. For those who are in crisis, they need to be seen weekly,” Church said. “My caseload was in the 90s and I couldn’t fit in the people who needed to be seen weekly on a weekly basis. There was just not enough room.”
Van Iwegen said she was very frustrated and worried that Valle del Sol didn’t do more to inform clients of the change. She wondered what happened when clients called Valencia Counseling Services and were instead greeted with, “Valle del Sol. How can I help you?”
“I’m sure some hung up and that was it. Some called back, but what happened when clients came back and their therapist wasn’t there?” Van Iwegen said.
The day before she was laid off, Van Inwegen saw a female client and scheduled another visit with her for two weeks later.
“When she comes in, I’m just not going to be there,” she said. “There was no chance to talk to her, let her know and help transition her to another counselor.”
Valle del Sol New Mexico CEO Kurt Sheppard said the amount of clients his company received for the Los Lunas site from Optum, the managed care organization contracted with the state to oversee Medicaid for mental health services, didn’t support Church and Van Iwegen’s claims.
“The challenge for us at Los Lunas was that VCS had a lot of contracts besides the Medicaid contract with a lot of other health plans and parts of the justice system,” Sheppard said. “When we came in, our agreement with HSD was only for the Medicaid contract.”
When patients began coming in, presenting for services for other agencies, Sheppard said VDS had to start the process of contracting with those agencies itself.
“We just hired five staff people to fill positions to fulfill some of those contracts. VCS was doing a lot down here,” Sheppard said. “But if we don’t have the contracts, we can’t provide the services.”
Sheppard said according to the latest numbers, there are 962 clients between all four sites, 491 of which are at Los Lunas.
While there are three counselors at Los Lunas, Sheppard said he felt the staffing level was adequate for the client numbers.
“If you look at just the number of counselors, the number may look low, but other staff — psychiatrists, nurse practitioners, and non-licensed professionals and para-professionals — provide much of the care for a large number of the consumers receiving other services. We will be adding direct care positions as the (number of clients) grows,” he said.
This week Sheppard approved adding a counselor position in Los Lunas and one in Grants.
“We will continue to recruit and hire staff to ensure communities have a full spectrum of services,” he said.
As far as the client-to-counselor ratio is concerned, Sheppard said caseloads and frequency of visits cannot be determined strictly on a straight-line ratio.
“Factors such as diagnosis, acuity and other services must be considered. For example, a person on medication management primarily receives services from a psychiatrist or nurse practitioner and will only see a counselor once a year for a treatment-plan update,” he said.
One-to-one sessions once a week or every two weeks is common for new consumers and/or consumers with high acuity, Sheppard said.
“In either case, we should be working with those consumers toward completion of treatment goals and wrapping other services around the consumer to reduce the number of one-to-one counselors sessions,” he said. “In turn, moving the consumer to group sessions with wrap services with the goal of helping the individual reach their highest level of functioning and integrate them back into the community.”
When VCS took over, while all but the top administrators were eligible for rehire, only about 80 percent of the staff stayed, Sheppard said. One staffer who didn’t stay was the intensive outpatient substance abuse counselor. Sheppard said VDS advertised for the position and hired a new counselor about three weeks ago.
“So was there a disruption in service there? Yes. But things are getting better. I will be the first to admit that this process has not been without road blocks and bumps,” Sheppard said. “It’s a complicated process and we are committed to providing services.
“If people have concerns, tell me. If someone has been mistreated by the staff, tell me and I will take action. We are just here because we thought we could help. If New Mexico exonerates (the 13 companies) we will gladly transition back. We are just here to help.”
Sheppard said the October layoffs were mostly of administrative staff, since VDS had taken over both VCS and Easter Seals el Mirador in Santa Fe, to consolidate administrative services, but did acknowledge some direct-care positions were cut.
“One was more a personnel issue. We’d had two complaints and if not for the layoffs, we probably would have taken action to terminate,” he said.
Van Iwegen questions the layoff of herself and others for what she was told were financial reasons.
“The state put aside $17 million for these contracts. And now there’s no money? I just don’t understand that,” she said.
The counselor also wondered why the company wasn’t accepting and billing other insurances.
The contract between HSD and Valle del Sol was for $2 million, and Sheppard said his company saw about half of that.
“A lot of the money from the HSD agreement went to the previous providers to cover payroll during the transition period,” he said. “We didn’t see a lot of that money directly.”
Another issue VDS encountered was the wait time while the company contracted with the various insurance companies.
“You have to get a contract with each plan and it’s not a quick process. Once you get the contract, each plan has to certify your staff,” Sheppard said. “Any organization with a new contract goes through the same thing. It just so happens as we came in, there was a multitude of plans we had to coordinate at the same time, somewhere in the neighborhood of ten. It’s just a process and it doesn’t happen overnight. It takes about six to eight weeks.”
Both Church and Van Iwengen say the handling of the audit and the secrecy surrounding it have damaged the trust the community had.
“These companies were accused of fraud and run out of business by the state,” Church said. “My concern is who’s going to pick up the pieces if this company doesn’t come back? Before Thanksgiving, we had a dinner — alumni and current employees — and they are all saying how frustrated and angry they are. How many times have they been lied to? Is this company going to pull out at the end of the year? The basis of mental health is trust, and that was broken when the accusations of fraud were made. And this company has done nothing but destroy that trust.”
Van Iwengen said she is angry over the lack of accountability and transparency from the governor’s office.
“An edited version of the audit was given to the state auditor. When the conclusion was there were serious issues, the governor took it and ran,” she said. “But when the audit company actually said there wasn’t evidence, well they’re not supposed to come to a conclusion. If that was edited, what else was taken out?”
The HSD contract with Valle del Sol ends on Dec. 31. Services will continue, Sheppard said, and the company is working to finish contract negotiations with the four New Mexico Centennial Care managed care organizations. The contract with HSD was always a short-term measure, he said.
“We knew it was our responsibility to negotiate with the four MCOs after that,” he said.
Medicaid funding for mental health care will be administered by the four organizations, creating an integrated health system that has a statewide network of providers, Sheppard said, and Optum will handle non-Medicaid funding through March 31, when the state goes out for a request for proposals for services.
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