Officials say Nevada is underbilling for Medicaid, losing federal money

Health and Human Services officials told lawmakers Thursday that Nevada’s Mental Health and Developmental Services Division is losing Medicaid money because of the way it offers and bills for services.“We’re currently underbilling Medicaid,” said Richard Whitley, Health Division director. “Historically, MHDS has not done the best possible job of billing and getting reimbursed for Medicaid.”According to documentation presented to the joint subcommittee of Ways and Means and Senate Finance, 27 percent of MHDS clients are Medicaid-eligible. But the division only recouped 13.5 percent of costs from Medicaid.That means the state should have collected $5.88 million more in revenue that, instead, had to be covered by the general fund in 2012 alone, officials say.The system needs to not only identify eligible people it can bill the federal government to provide services for, but to “provide services that are billable,” Whitley said. He and State Health Officer Tracey Green said the system also is providing services that aren’t Medicaid-reimbursable.Nevada “needs to make sure we are providing services that are covered by Medicaid,” Green said.“Medicaid can only pay when there is an eligible individual,” said Mike Willden, HHS director. “Once you have an eligible person, you have to have eligible services.”The testimony came during discussion of the Health Division’s Behavioral Services budgets. Willden told the committee that, because of the federal health care law, eligibility criteria will be replaced by 2015 by the simple test of whether a client is making more or less than 138 percent of the federal poverty level.“Disability doesn’t matter,” Willden said. “Once you have an eligible person, you have to have eligible services.”


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