Reconciliation and Recoupment Plans for Estimated Claims Payment Period for United Health Group (UHG) / Optum Behavioral Health Providers (Optum)
The Maryland Department of Health (MDH) is preparing to enter into the next phase of reconciliation to resolve the differences in the estimated claims paid from January 1, 2020 through August, 3, 2020, with actual claims submitted for those dates of service.
In contrast to the initial rollout, the UHG/Optum Maryland system has improved dramatically – additional enhancements continue to be made to ensure that providers are accurately and promptly paid for all services provided, and the vast majority of providers are successfully submitting authorizations and claims and are getting paid for the vital services they provide.
UHG/Optum has so far received nearly 17 million claims between January 2020 through August 2021 and has successfully paid nearly $2.9 billion associated with those claims to over 2,600 providers who participate in the Public Behavioral Health System. UHG /Optum is currently paying out an average of $30-$40 million a week to providers based on actual claims for care.
Overall, 98 percent of all provider claims are being adjudicated within 14 days – numbers that are consistent with the experience with the old payment system and are within industry standards.
Beginning on October 24, 2021, MDH anticipates that all of the remaining 835 and Provider Remittance Advice (PRA) reports required for providers to complete any internal reconciliation needed between actual claims submitted and payments from the estimated claims payment period will have been delivered.
The state has a legal and moral responsibility to Maryland taxpayers to recoup these funds, and the time has come to enact a repayment plan that both recognizes this responsibility while making the appropriate allowances to providers. With that in mind, we do not plan to initiate formal recoupment of balances owed until providers have had a reasonable amount of time to reconcile their internal accounting. We estimate that recoupment will begin on or around December 1, 2021.
Moving Forward on Reconciliation
Currently, providers have received approximately $237 million in excess payments during this process, which some have already repaid and many others are working to repay.
In recognition of the challenge caused by repayment, MDH will be forgiving the debt for eligible providers owing $10,000 or less. As a result, more than 42 percent of providers with outstanding balances due will owe nothing. Hopefully, this will eliminate the burden on small, community-based providers. All providers owing $10,000 or less will have their balances cleared with the exception of the following provider types:
Somatic BH Health Providers
Providers who have not yet submitted claims against any of the estimated claims paid.
This plan will have repayment options for those providers owing more than $10,000. They will have one of three options for repayment:
Payment in full at time of notice.
The option to credit current claims paid to off set all or some of the balance sowed over a 12-month period, with final payment to be completed within twelve months.
For providers with outstanding or fully paid balances of between $10,001 and $50,000, we will engage the provider community and will evaluate providing additional relief.
We value our relationship with the Behavioral Health Community and are thankful for the critical services you have continued to provide during this challenging time for all Marylanders in need, especially our most vulnerable populations.
For additional questions please go here:
October 25, 2021
Nicki Drotleff, LCMFT
Board of Professional Counselors
4201 Patterson Avenue, Suite 316
Baltimore, Maryland 21215-2299
Dear Ms. Drotleff:
The Licensed Clinical Professional Counselors of Maryland appreciates the telehealth flexibility extended to health care practitioners during the Governor’s state of emergency. Governor Hogan, the Maryland Department of Health, and the Board of Professional Counselors and Therapists are to be commended for ensuring that Marylanders continued to receive behavioral health services in these difficult times.
Since the State public health emergency has ended, we are reviewing existing regulations and requirements in regards to telehealth practice. We have identified several provisions under COMAR 10.58.06 that are not consistent with the teletherapy laws recently enacted. Since teletherapy has become a primary mode of providing treatment to clients, our members need to be clear about when they are at risk of disciplinary action regarding how they provide teletherapy services. We are asking the Board to offer LCPCs guidance regarding the following:
Location of the Practitioner: Under 10.58.06.03, the regulations state that telehealth requirements apply if either the Maryland licensed practitioner or client is located in Maryland. However, Maryland’s law is structured differently. Under Health Occupations Article §1-1005, Maryland’s telehealth law applies to only when the patient is located in Maryland. We understand when patients are located in another state and the practitioner is in Maryland, the telehealth laws of the patient’s state apply; otherwise, a practitioner could be subject to two conflicting standards. We would appreciate clarification on the issue;
Audio-Only: While Health Occupations Article §1-1001 did not include audio-only in the definition of telehealth, it is our understanding that the law still permits practitioners to provide services to patients through audio-only communications. Those communications are not required to be regulated in the same manner as telehealth services, although a Board could choose to impose similar requirements just as long as those requirements were not inconsistent with the law.
This past session, the Maryland General Assembly clarified its intent that the Maryland Medicaid Program and State-regulated private insurers reimburse for somatic, behavioral health, and somatic care services delivered through audio-only technology.House Bill 123/Senate 3 is clear that the Maryland General Assembly’s intent is that audio-only services be permitted for behavioral health services.
We ask that the Board communicate with its licensees that audio-only services are permitted through regulation or guidance. Many licensees are confused, especially with all changes in telehealth policies under the state and federal public health emergencies.
Thank you for the opportunity to submit these comments to the Board. If we can be helpful in any other way, please contact our legislative representative, Robyn Elliott, at firstname.lastname@example.org
Susan Roistacher, LCPC
New Minor Consent Law for Mental Health Services in Maryland (Senate Bill 41 - The Mental Health Access Initiative)
LCPCM supported and testified on behalf of Senate Bill 41, which lowers the age of consent from 16 to 12 years of age for those seeking mental health treatment. A child in Maryland may now seek and receive treatment without parental consent in the same capacity as an adult, if the licensed provider has determined that the child is mature and capable of giving informed consent. It is within the professional discretion of the treatment provider to decide if, when, and how to inform parents, unless the provider believes that the disclosure will lead to harm to the minor. This law went into effect on October 1, 2021.
Of course, the goal of all good child psychotherapy is to involve the parents and family, but this new law gives a licensed provider the opportunity to assess the mental health concern of a youth in crisis and in other serious situations. There are two caveats, however: (1) the new law does not apply to medication-based treatment, and (2) when a minor 12-15 offers consent, insurance claims cannot be made without parental permission and the parent is not liable for the treatment fees.
The law is intended to remove unreasonable barriers to mental health services for youth with suicidal ideation and other critical circumstances. Additionally, this law is intended to support special subpopulations of youth, such as those in the LGBTQIA+ community and those needing emergency attention from Mobile Crisis Teams in circumstances where a parent cannot be reached or refuses consent.
You can access the text of SB 41 on the Maryland General Assembly website. You can also view the School Based Health Care's Webinar on the new minor consent law by clicking on the following link: https://vimeo.com/620126737
The list below highlights bills passed by the Maryland General Assembly during the 2020 Legislative Session which was cut short due to the current health crisis. As of this posting date, all bills are currently awaiting the Governor’s signature before becoming law, with the exception of HB 1663/SB 1080, which Governor Hogan signed on March 19, 2020. Due to the current health crisis, the Governor has been unable to attend to bill signings.
As passed by the legislature, the budget includes a 4% Medicaid provider rate increase for behavioral health services, starting July 1, 2020.
The legislature passed three telehealth bills impacting behavioral health services:
Behavioral Health in Schools
By Susan Roistacher LCPC
1. In the Maryland General Assembly:
LCPCM’s lobbyists and Legislative Chair cull through all proposed legislation each year to identify bills that impact our practice and our clients. In 2018, we reviewed almost 80 bills and testified on 15, including bills affecting Medicaid and teletherapy regulations. Most significant this year was our participation in the 10-year Sunset Review of the Board of Professional Counselors and Therapists. The legislative Sunset Review of the Board resulted in 2 years of legislative oversight and 33 mandates for improvements.
2. With the Board of Professional Counselors and Therapists (BOPCT):
LCPCM makes a concerted effort to stay abreast of Board actions and decisions by attending monthly meetings and addressing the Board on specific topics. We provide information and assistance whenever possible. LCPCM shares your requests, complaints, and suggestions for change. This year, we discovered that it is more effective for LCPCM members to contact the Board directly by email, in addition to contacting LCPCM. We encourage you to share your concerns with the Executive Director, Kimberly Link, at: email@example.com. Please be sure to also copy me, Susan Roistacher, Legislative Chair at: firstname.lastname@example.org. I want to know your concerns, so we can offer support when needed and can advocate more effectively. The following is a list of some LCPCM 2017-2018 advocacy projects related to the BOPCT:
3. On state healthcare regulation and planning workgroups:
As representatives of LCPCM, our members and lobbyists monitor and participate on interagency state committees, public advocacy groups and behavioral health coalitions. These groups generate new ideas for legislation and regulations that effect mental health treatment services in Maryland. For example, member Angela Mazer, LCPC serves on the Children’s Behavioral Health Coalition (CBHC). The Children’s Behavioral Health Coalition (CBHC) brings together a range of advocacy groups with a focus on policy issues and concerns specific to children and youth with behavioral health needs and has produced a 2019 Legislative Agenda. Other groups include the MD Health Insurance Protection Commission (Robyn Elliot, lobbyist) and monitoring the MD Medicaid Advisory Committee (Rachel Faulkner, lobbyist).
4. With National organizations:
1. The LGPC Committee: LCPCM formed a LGPC committee co-chaired by members Robert Castle LCPC and Katy Schaffer PhD. It is creating a guidebook designed to help LGPCs navigate the often confusing and somewhat arduous road to licensure. The guide should be available this Fall. The committee members are LGPCs who provide valuable information to LCPCM, to better serve their needs.
2. Conferences: We offer two full-day conferences a year for CEU’s at a discounted for members. LCPCM works hard to contract with well-known professionals who can provide informative and stimulating trainings. Our networking luncheons are included as a special benefit to our members who continue to support all the work we do.
3. Supervisor Trainings: LCPCM is the main provider of supervisor training for LCPCs and others in Maryland. This 18- hour CEU training is offered 3-4 times a year and fulfills the training requirement for clinicians to be approved by the BOPCT. Marsha Riggio, LPC, PhD teaches the training and consistently gets rave reviews.
4. Committed Professionals: Once an all-volunteer association, today LCPCM has a professional lobbying group (Public Policy Partners) and a webmaster (Debbie Hastings-DesignMe Creative). We also have a business administrator, Sharon Nalley, who has been with us for a year. She is an experienced financial bookkeeper who can professionally handle our increasing volume of diverse activities including registrations and CEU certificates.
5. Supervisor/Supervisee Connection: The LCPCM website has an on-line service to help LGPCs find the supervisor who best meets their needs. It has information about the prospective supervisor’s background, experience, and specialties. The BOPCT’s website lists approved supervisors, but only provides contact information. This service is the brainchild of Robert Castle, LCPC, PhD who designed and implemented the project.
6. BOPCT Nominations: LCPCM nominates members to serve on the BOPCT and submits them to the Governor’s office. We are pleased that over the years, many of our members have been selected and served.
7. Parity: Professional parity is an LCPCM priority. We work toward parity legislatively, but also in the community. If requested, LCPCM will assist members confronted with workplace discrimination based on the LCPC title. Members are encouraged to contact us if you need support or intervention on your behalf.
LCPCM and National Association of Social Workers-Maryland Chapter have joined together to introduce a bill this session of the Maryland General Assembly that would require Medicaid to reimburse Medicaid behavioral health providers for what will be called “telehealth” services. Senator Kathleen Klausmeier will sponsor the bill in the Senate and Delegate Sheree Sample-Hughes will sponsor the bill in the House of Delegates.
Use the link below to view the PowerPoint presentation from the LCPCM Legislative Seminar held on 5/9/17.
HB 245 (SB 310) Support
Child Abuse and Neglect - Failure to Report
Del. Kathleen Dumais et al.
HB 579 (SB 858) Support
Mental Health - Wraparound Services for Children and Youth
Del. Samuel Rosenberg et al.
HB 595 (SB 497) Support
Behavioral Health Community Providers - Keep the Door Open Act
Del. Antonio Hayes et al.
HB 682 (SB 551) Support
Department of Health and Mental Hygiene - Clinical Crisis Walk-In Services and Mobile Crisis Teams - Strategic Plan
HB 802 Support with Amendments
Health Insurance - Provider Panel Lists
Chair, Health and Government Operations Committee et al.
HB 944 Oppose
Criminal Law - Professional Counselors and Therapists - Misconduct (Lynette's Law)
Del. David Vogt et al.
HB 984 (SB 17) Support
Open Meetings Act - Retention of Minutes and Recordings - Revision
Del. Sid Saab et al.
HB 1103 Support with Amendments
Health Care Practitioners - Use of Teletherapy
Del. Kirill Reznik et al.
HB1217 (SB899) Support with Amendments
Maryland Medical Assistance Program-specialty mental health
HB 1318 (SB929) -Support
Network Access Standards and Provider Network Directories
HB 1437 – Support
Education- Individualized Counseling Services-Requirements
HB 334 – Support with Amendments
Access to accurate provider directories
Thus far, LCPCM is supporting the following two bills in the Maryland General Assembly and urge you to contact your Delegates and Senators to do the same. You can find the information you need to make these contacts by going to the Maryland General Assembly website (http://mgaleg.maryland.gov)
1. The Keep the Door Open Act (SB 497 / HB 595), will improve access to care by ensuring that our community behavioral health providers have the resources necessary to treat those in need. The Senate bill was introduced with 27 co-sponsors and is scheduled for a hearing later this month. The House bill will be heard in the Health and Government Operations Committee next week!
2. These bills that were introduced last week (SB 551 / HB 682) will require the Department of Health and Mental Hygiene to work with other stakeholders in developing a plan to ensure that walk-in and mobile behavioral health crisis services are available to Marylanders across the state. This walk-in capacity is critical. In places that have implemented highly efficient crisis response systems – both in Maryland and throughout the United States – a central hub, operating 24/7, where individuals in crisis and their families can go without an appointment, is a key to success.
Dear Maryland Mental Health Counselor Community:
I know that I have bombarded you with pleas and special requests this summer, but this one is my most impassioned plea to you for assistance.
Contrary to what any of us would believe was possible, we now have sister groups of mental health counselors sympathetic to the CACREP only perspective, in different parts of the country, lobbying members of Congress to deny mental health counselors who graduated from non-CACREP and counseling psychology programs (with five years experience) the automatic right to practice in TRICARE, as proposed in a revision to the National Defense Authorization Act (NDAA).
As you can imagine this is a very concerning development, as it gives the false impression that concerned mental health counselors are decrying the practice of unqualified mental counselors, who are identified by their graduation from "unaccredited" or non-CACREP schools. I confess that it is surreal and disconcerting to read these communications to Congress and to see counselors trying to undermine the careers and livelihoods of their fellow counselors. Nothing can be more distressing to witness than this.
Many of these commentators are trying to spin the false narrative that allowing non-CACREP counselors to practice in TRICARE will prevent all counselors from ever practicing in MEDICARE. There is no connection between TRICARE and MEDICARE in current bills before Congress and to suggest this connection is misinformation.
I need every non-CACREP counselor in Maryland to write a short email through the following link (that contacts the entire Maryland Congressional delegation) in order to explain your exceptional competence as a mental health counselor from a non-CACREP school and to ask our Maryland representatives to support the revision in the NDAA that gives all mental health counselors with 5 years experience the right to practice in TRICARE. If you write a sentence, a few sentences, or a paragraph, your email will make a difference, however short or long.
I wish I had the wisdom to explain to you why our sister associations are trying to harm us rather than reaching out in support. However, I believe our kindness and respectful advocacy will inevitably win out over the hurtful behavior that is being directed against us. I believe our greatest enemy is not those who attack us but the indifference of the overwhelming majority who know what is happening is wrong and choose to do nothing. If every counselor in Maryland stands up for what is right, we will prevail against this undeserved threat to our practice rights and mischaracterization of our competency.
Please take a moment to voice your opinion to the Maryland Delegation in Congress by sending your email to the link below:
The distribution list address is:
This is being sent to:
Jean Doyle - Legislative Director for The Honorable Barbara A. Mikulski
Tommy Bredar - Legislative Correspondent for The Honorable Benjamin L. Cardin
Priscilla Ross - Legislative Director for The Honorable Benjamin L. Cardin
Jodi Schwartz - Legislative Assistant for The Honorable Benjamin L. Cardin
John Dutton - Legislative Director for The Honorable Andrew P. Harris
Walter Gonzales - Legislative Director for The Honorable C.A. Ruppersberger
Raymond O'Mara - Legislative Director for The Honorable John P. Sarbanes
Christopher Schloesser - Legislative Director for The Honorable Donna Edwards
Jim Notter - Legislative Director for The Honorable Steny H. Hoyer
Suzanne Owen - Legislative Director for The Honorable Elijah E. Cummings
Sarah Schenning- Legislative Director for The Honorable Christopher Van Hollen
Xan Fishman - Legislative Director for The Honorable John Delaney
McKenzie Haynes - Military LA for The Honorable John Delaney
Thank you again for your assistance.
LCPCM | P.O. Box 7762, Wilmington, NC 28406 • 443-370-1255 • email@example.com