HARRISBURG, Pennsylvania – A top executive with the company some Oregon families blame for serious harm to loved ones with mental illness said she’s empathetic to their concerns but defended the company’s work.
“Any time there’s disruption or change, there’s going to be turmoil,” said Meghan Harris, chief operating officer for Kepro, a national company that reviews Medicaid eligibility. “Kepro is clearly a part of that system and is facing pressure to get it right.”
The Oregon Health Authority hired Kepro in 2016 to determine which Oregonians with mental illness could be moved into lower levels of care as part of its effort with the U.S. Department of Justice to transform the state’s mental health system.
Advocates, families and healthcare providers have accused Kepro of being too aggressive in disqualifying people Medicaid coverage to stay in specialized facilities for people with severe mental illness. The newsroom found three cases of serious harm to people after they moved out of a facility.
The health authority has many concerns of its own with the program, most of which center on the design and implementation of its contract with Kepro. The state pays the company to determine which people with mental illness were eligible for Medicaid to pay for their stay in a specialized facility.
Among the health authority’s concerns is a contract provision that offers Kepro a $1,000 bonus for people moved out of locked residential facilities following a Kepro denial of care.
In an interview at the company’s headquarters this week, Harris said the company’s efforts are entirely in line with what the health authority asked it to do.
She said the company follows state guidelines and its medical experts are in no way motivated by the bonus when deciding who needs what level of care. Harris said she feels for the families who need to transition out of a facility they’re used to. But it’s up to Oregon to ensure that transition goes smoothly, she said.
“We trust that the state has the services to support them,” Harris said. “I’m sure there’s different opinions on that.”
The health authority found in January that there wasn’t enough housing to accommodate the people being told they didn’t qualify for care in a facility, state records show. The state has opted to pay out of pocket to keep many in facilities.
The troubles facing the health authority stem from a years-long effort to move people out of facilities and into more independent settings. A 1999 Supreme Court ruling ruled that to comply with the Americans with Disabilities Act, states had to ensure people weren’t locked up unnecessarily. Seventeen years later, the U.S. Department of Justice came to an agreement with Oregon on a slew of targets to help the state achieve that.
To help it get there, the health authority hired Kepro.
The company has comparable contracts in 20 states, Harris said, about five of which involve behavioral health. Kepro also contracts with the federal government to determine what care people on Medicare need in 33 states and the District of Columbia.
Oregon’s efforts have run into numerous problems, some unrelated Kepro’s work.
The health authority recently found that hundreds of notices it sent out, informing people they didn’t qualify for their existing level of care, violated federal law because they didn’t have enough information about why a person was being denied care. And the agency also found that some of those notices were going to the mentally ill people themselves, not their guardians.
A key health authority employee, who managed the state’s contract with Kepro, is under investigation and is on administrative leave. That employee, in turn, is claiming the state is retaliating against him for repeatedly bringing up concerns about the program.
Advocates and the state have zeroed in on a provision in the Kepro contract that promises the company $1,000 in performance pay per person who is moved out of a locked residential facility. Advocates have said it could create an incentive for the company to make medically inappropriate decisions. The health authority’s director Patrick Allen said his agency is revisiting the wisdom of that provision.
Harris said the incentive has no impact whatsoever on the company’s decisions, and said her company has no qualms should the state decide to remove the performance pay.
“They can take it out of the contract,” Harris said. “It’s not a motivator for us.”
Kepro has made at least $215,000 so far in performance pay. Its contract is worth $27 million.
Harris also defended the company’s role in a case in Illinois, where the state used Kepro’s determinations to tell 175 children they didn’t qualify for all the in-home nursing care they were getting. A federal judge ordered the state to reinstate all of the hours Kepro had found unnecessary. The company was not a defendant in the suit.
As in Oregon, Harris said, Kepro was following state guidelines and a state tool to determine medical necessity when making decisions about patients in Illinois.
Have a tip about Oregon’s mental health services? Get in touch.
— Fedor Zarkhin
desk: 503-294-7674|cell: 971-373-2905|@fedorzarkhin
To block caller ID, first dial *67
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