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The Salt Lake County Council on Tuesday unanimously approved an audit of its mental health care system in the wake of a decision from a key provider that cut services to as many as 2,000 clients, some of whom now claim they're struggling to find care.
Valley Mental Health in June announced its decision to shrink patient rolls and focus only on clients with serious mental illness, citing cuts in the rates it gets paid for its services.
Lobbied by mental health advocates and patients, Mayor Ben McAdams called for an audit last month, saying the scope of the investigation should include both Valley and Optum, the managed care company contracted by the county two years ago to run the Medicaid-funded system. County officials decided to make the pay rate cuts after what they said was a drop in Medicaid funding for fiscal year 2014.
The council's approval allocates up to $50,000 for an audit, the scope of which will be determined by a committee of staff and stakeholders, including community groups that work with the mentally ill and consumers of mental health services.
A request for proposal will be drafted by that committee and the audit sent out to bid under the county's usual process, said Tim Whalen, the county's director of mental health. That process could take up to 90 days.
Council members expressed frustration with Valley Mental Health's cuts and by the private nonprofit's use of staff letters and the news media to announce the changes ahead of direct conversations with the county, Optum or clients.
"I felt ambushed. It was really uncool," Chairman Steve Debry of South Jordan said. "I think we need to figure this out because this is too important for people's lives. And when you negatively affect people's lives, it affects the whole community."
The county's proposed audit also includes a directive to identify two or three county representatives, from the ranks of either staff or elected officials, that could be suggested to Valley as potential board members something that occurred in the past.
"This would have never happened if we were still on the board. There would have been some serious hell to pay," said Councilman Randy Horiuchi, who previously sat on Valley's board. "We need, as a group from this council or the mayor's office, to get on the board and provide some leadership."
Since the cuts, Optum has been providing Valley's former clients with referrals to possible new physicians and therapists and has pledged to ensure that no one falls through the cracks.
It's not clear how well patients are faring, however.
Some have told The Salt Lake Tribune they have struggled to find providers willing to see them, while others say local sources for crisis help are swamped with calls from former Valley clients feeling emotionally unstable.
Kent Strock, who suffers from bipolar disorder, said he called each of the three provider names he got from an Optum consultant. Two told him it could be up to three months before he could see a psychiatrist who then would only decide whether to see him after evaluating his Valley records. A third provider, based at Pioneer Valley Hospital, said the earliest available appointment was in December.
Strock said none of the providers he talked to had full-time staff to absorb an influx of new patients, nor could they help him with his monthly prescription needs.
"I don't see how they can make this work," said Strock, 45, of South Salt Lake. "The demand [in the past] was met by Valley, but now you're pushing that volume out into a system that's not set up to handle it."
Weekly reports to the county from both Optum and Valley suggest otherwise, Whalen said after the meeting. To date, 730 Valley clients have been cut and 75 percent have already been successfully connected with a new provider, he said. Another 58 clients have appealed Valley's decision to cut their services, and one third of those decisions were overturned, according to data provided to the county.
County officials contend they had to cut the rates they pay to mental health and substance abuse service providers by 5.5 percent after learning in May that they would have less state and federal funding for Medicaid programs. The county opted to ask providers to absorb the cuts rather than cancel programs or services, officials have said.
Valley took a smaller rate cut 4.9 percent because some of the services it provides are tied to specific Medicaid rules, Whalen has said. Without the cuts, the county may have had to seek a tax increase.
Whalen said Valley has also had an additional $4 million cut from its contract in recent years, money the county rerouted to fund other programs because the agency had failed to spend it on client services.
Both Valley Executive Director Gary Larcenaire and Richard Elorreaga, Optum's executive director of public sector solutions, have said they welcome an audit.