April 2023 Update from BHAM

On this, the last day in the month of March, we get ready to turn the page on the calendar and begin the last full month of the 68th Legislative Session in Montana. While our legislators keep jockeying and angling and working the rooms and halls over in Helena, we take a minute to bring you our monthly update with a look at some of the latest topics being worked on. If you have questions or thoughts about anything you read here, we encourage you to get in touch.

Also … like many Montanans, we are desperately craving spring. A dose of warmth, sun, nice weather and general outdoor comfort will do us all some good. It can’t come fast enough!

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: 

  • 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. 
  • 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.

Implementation of Certified Community Behavioral Health Centers (CCBHCs):

What a long, strange trip it’s been. First, HB17, carried by Stafman (D), Bozeman, was tabled by the Joint Appropriation Subcommittee after numerous hearings where only proponents stood in support and there were no opponents. Then a second CCBHC bill, HB939, was carried by Gillette (R), Gallatin. That bill was heard in House Appropriations where only proponents from all across Montana spoke in favor of this program. Minutes after the hearing, Fitzgerald (R), Anaconda, moved to table the bill and that motion was passed 13-10. You can’t make this stuff up. 

States all across the nation are vying for a $1M planning grant to be able to implement this program. Montana received one of the first 15 of these grants in early March and will move forward with the planning for implementation of CCBHCs even though this legislature has killed this, not once but twice! Stay tuned for more shenanigans as we continue to move this national best practice model forward for the seriously mentally ill adults and seriously emotionally disturbed children of Montana.

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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