photo is of a long road ahead, with the yellow line in the middle of the frame.

April 2023 Directors Report

Cognitive Behavioral Health Therapy 3-day Intensive Course:

Cognitive Behavioral Health Therapy 3-day Intensive Course with Dr. Galen Cole will be in Billings May 17-19. This training is free to attendees but has a capped enrollment. It will be hosted by Yellowstone Boys & Girls Ranch and held at the Ranch Chapel. Please register at this link.

Provider Rate Increases for Medicaid:

The 2021 Legislature appropriated $2.7M for a Medicaid provider rate study of four sectors deemed most in need of substantial increases to rates: senior and long term care, developmentally disabled, mental health and substance use disorder programs.

There are now two bills for the provider rate study increases:

  1. HB2 with recommendations close to benchmarks that were set by the Part B Subcommittee. Those rates provide about 90% of the rate recommendations for most programs but remain $25M below covering the full recommended benchmarks. HB2 has moved to the Senate.
  2. HB649, carried by Mary Caferro (D), Helena, and others, that would raise Medicaid rates to the full benchmarks recommended by the Guidehouse study and include a cost-of-living adjustment (COLA). The COLA amount is yet to be determined but could be similar to what is in statute for the Medicaid physician COLA, the consumer price index (CPI) percentage annually. Today, the bill was amended to provide $5M to DPHHS for discretion in provider rate increases and the COLA was removed.

HB872: An Act Revising Behavioral Health Systems:

This bill, sponsored by Keenan (R), Big Fork, is a request for unprecedented funding for the behavioral health system, including the developmentally delayed programs, that would:

  • Create a Behavioral health system for future generations advisory commission, and;
  • Behavioral health system for future generations’ fund.

This fund would appropriate $70M in the next biennium for DPHHS to work on fixing our collapsing behavioral health system and appropriate $75M for the 2024-2025 biennium for capital projects to shore up the crumbling Montana State Hospital as well as potentially create two regional crisis behavioral health facilities. Any money left over from the coming biennium would go back to the fund. Overall, $300M would be placed in this fund for spending in coming years to fund both an acute and community- based behavioral health continuum of care.

If this fund is used to reopen and create community-based programs, decimated by the 2017 budget cuts and the worldwide pandemic, it would be money very well spent. If it is used only for facilities, it will be a waste of $300M as the facilities will need revolving doors since there will be no one to treat clients to prevent admission or after discharge. A continuum of care for behavioral health is something that has never existed in Montana and it’s time for one.

We’re less concerned that there aren’t blueprints and a detailed strategic plan on how this money will be spent. Anyone who works in healthcare knows that you can’t plan much beyond 1-2 years since the landscape is constantly shifting. Who would have predicted COVID shutting down the country in 2019?

HB822 Generally revised school-based mental health:

HB822, sponsored by Keenan (R) Big Fork, appropriates $1M for each year of the coming biennium to create a continuum of school-based mental health programs, including screening and reinvigorating Comprehensive School and Community Treatment (CSCT). CSCT has been badly abused over the few years and the number school districts participating has fallen by about 50 percent.

BHAM has long suggested that CSCT be moved from OPI back to DPHHS (a move that is happening this session) and then getting rid of the Intergovernmental Transfer (IGT), and funding this important program as all other Medicaid programs are funded – out of the state general fund.

HB147 An act creating an enhanced Medicaid reimbursement rate for providers of certain children’s mental health service:

This well-intentioned bill, carried by Gillette (R), Gallatin, came out of the Children’s, Families Health and Human Services Interim Committee and appropriated a fund for placing children at risk of being sent out of state into an in-state psychiatric residential treatment facility (PRTF) or a Therapeutic Group Home (TGH). For reasons unknown, this bill was amended to remove TGHs thereby rendering it pretty much useless. PRTFs are slated to receive almost 100% of the recommended provider rate increases, but TGHs are still well below benchmarks and were the programs that really needed an enhanced rate.

Please reach out to me if there is anything you need. When we work together, we can solve all the problems out there!

Stay safe. Stay healthy.

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