Presbyterian fills in for Agave health

April 30--Presbyterian Medical Services, one of the 15 mental health care providers that Gov. Susana Martinez had accused of Medicaid fraud that later settled with the state for $4 million, will take over most of the Santa Fe services for Agave Health Inc., which recently announced its exit from New Mexico, according to an email sent from Agave's chief executive officer to his employees this week.

Agave is one of five Arizona providers that the Martinez administration brought into the state to replace 15 New Mexico firms accused of overbilling Medicaid for a total of about $36 million.

The Arizona firm announced earlier this month it would stop serving about 3,000 low-income patients in Northern New Mexico, including Albuquerque and Rio Rancho, citing financial losses. Since then, the state has been looking for providers to take over its 11 locations. It was the third Arizona firm to announce it was leaving the state.

Heath Kilgore, Agave's chief executive officer, sent an email Thursday to employees detailing the different providers that will take over their current locations and the type of services they will provide.

The email was obtained by The New Mexican.

Presbyterian will take over the Santa Fe location but won't provide the intensive outpatient program, which treats patients with drug dependency or other serious mental illnesses, according to the email.

Presbyterian also will provide most of the services for three of Agave's locations in Española, Grants and Rio Rancho. Valle del Sol, another Arizona provider, will be supporting Presbyterian with services in Española and Grants.

Valle del Sol will take over Agave's locations in Los Lunas, Taos and Raton.

New Mexico Solutions will take over the Albuquerque location and La Familia Medical Center will take over the Las Vegas location, but won't be able to provide key mental health programs that Agave currently does, according to the email.

The state still needs to find providers for Agave's Clayton and Santa Rosa locations, the email says.

"I am expecting calls from each of them to discuss some of the logistics by location," Kilgore wrote in the email to employees.

It has been nearly three years since Presbyterian settled with the Martinez administration even though firm officials believe they were innocent of Medicaid fraud. Presbyterian officials have said that they settled in order to keep offering services and prevent it from complete collapse. Another firm, Youth Development Inc., also paid the state $240,000 as part of a settlement.

In the time since the companies settled, the state Attorney General's Office cleared all 15 firms of any criminal wrongdoing.

Presbyterian officials didn't return a phone message from The New Mexican seeking comment Friday.

The state also tapped Presbyterian last year to take over services in the southwestern part of the state in the wake of Arizona-based provider La Frontera's decision to depart.

Officials from the state Human Services Department have said they are working with four managed care organizations, which are insurance companies that contract with the state to oversee the Medicaid cash, to find a new provider. The providers act as direct contractors with the managed care companies, which negotiate the rates Medicaid pays the providers for treating low-income patients on the program.

Kyler Nerison, a spokesman for the department, didn't confirm Presbyterian will be one of the providers in this recent transition. But he did say in an email that Presbyterian "will likely be one of several providers that will be involved in the transition to ensure that services are maintained."

"The Department continues to remain vigilant in ensuring that Medicaid dollars go toward providing care and services to those who need it the most," he added.

The news that Presbyterian is taking over Agave's services comes as Human Services Department data shows the number of New Mexicans accessing behavioral health services in 2015 doubled from the previous year to 153,000. State officials attributed the increase to Gov. Martinez's 2014 expansion of Medicaid.

As the numbers climb, advocates are concerned about the ability of the state to keep pace given a lack of providers in the wake of the shake-up of New Mexico's mental health care system, The Associated Press reported.

Shannon Freedle, chief executive officer of Santa Fe-based Teambuilders Counseling Services Inc., which Agave replaced during the shake-up, said recently he asked the state Human Services Department about the possibility of getting his business back. But the department wouldn't entertain his inquiries, he said, and subsequently sent Teambuilders a letter demanding it repay what the state claims were millions of dollars in Medicaid overpayments.

Contact Uriel Garcia at 505-986-3062 or [email protected]. New Mexican reporter Justin Horwath contributed to this story.

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