February 2023 Update from BHAM - Behavioral Health Alliance of Montana

We’re knee deep into the 2023 Montana Legislature and focusing on trying to get transformative change to the behavioral healthcare system. Will the legislators fund the full continuum of community-based services or will they choose to close most or all their community-based services in their towns and counties, including nursing homes, assisted living facilities, children’s group homes, disability group homes, substance use disorder treatment programs, and mental health programs?

Here are some of our priorities for the coming session:

Governor’s Medicaid Provider Rate Increase

The Governor’s proposed budget has come out and includes increases for the four sectors studied in the Medicaid Provider Rate Study: senior and long-term care, developmentally delayed, and adult and children’s mental health and substance use disorder treatment providers.

The comprehensive and objective Governor’s Medicaid rate study found that adult and children’s mental health and substance use treatment providers receive less than 85% on average of the cost of delivering that care. Obviously, a business can’t remain open if they are reimbursed less than their costs. That’s just basic Business 101.

During this legislative session, we’ll be talking with legislators about funding the full recommendations from the Governor’s study.

Advocacy Suggestions:

Advocate to your representatives and senators across the state to fund the full recommendations for community-based behavioral health in your communities.
Educate your legislators that funding one silo of the healthcare continuum, i.e., the Montana State Hospital at $118M, but not funding community-based care is throwing good money after bad as it condemns the patients to a revolving door at the MSH since there is nowhere to treat them in the community.
Advocate for both Republican and Democratic Representatives and Senators to support the rate increases as this was a legislatively-funded $2.7M study proposed by DPHHS under this administration.
Advocate for an annual Medicaid cost-of-living increase for mental health and substance use providers similar to the one that physicians receive. Once we get the rates up to market, we want to make sure that another expensive rate study isn’t required in the future.
To learn more go to: https://bhamt.org/advocacy/

Certified Community Behavioral Health Centers (CCBHCs)

DPHHS, National Council for Mental Wellbeing, BHAM, NAMI MT and others have been educating the legislators on the Health and Human Services Committee and the Part B Budget Committee on CCBHCs. Unfortunately, some of the legislators are still struggling with understanding the model.

In an attempt to boil it down as simply as possible, we’ve come up with this description:

The Certified Community Behavioral Health Centers (CCBHC) would begin the transformational change of the behavioral health system to a comprehensive value-based reimbursement system. That means that the siloed organizations that currently receive fee-for-service would be able to work together in a continuum of care and provide wrap-around services for seriously mentally ill adults and seriously emotionally disturbed children. This is the model that FQHCs and hospitals use so we’re just asking that behavioral health providers also be able to provide care this way.

Advocacy Suggestions:

You can learn more about the CCBHC model here: https://www.thenationalcouncil.org/program/ccbhc-success-center/ccbhc-overview/
Educate your legislators on how CCBHCs can help enhance community-based behavioral health services in your communities.
CCBHC advocacy talking points are available on the BHAM website at https://bhamt.org/advocacy/

Bills To Watch

HB 17, Provide for implementation of Certified Community Behavioral Health Centers: HB0017.pdf (mt.gov)
This bill remains in the Health and Human Services Committee. The sponsor has changed to Sen. Ed Buttrey. Please see our talking points above and engage your legislators in advocating for this very important behavioral health system model.
HB311, Establish a behavioral health voucher system. HB0311.pdf (mt.gov)
This bill is carried by freshman representative, Mike Yakawich, out of Billings. While it seems like a good idea, the problem isn’t with enough people seeking substance use treatment, but with enough SUD treatment providers. It doesn’t matter if it’s Medicaid, a voucher, or a block grant, the low Medicaid reimbursement has caused a workplace crisis in people providing care. This bill doesn’t solve the problem.
SB 198, Revise laws related to behavioral health peer support specialists SB0198.pdf (mt.gov)
This bill is carried by a number of sponsors. While it’s intention seems to be to raise the professionalism of the peer support career, it’s unintentional consequences would make it impossible to hire peer supporters by Medicaid state approved agencies. The bill has been delayed in hearing until Feb. 10^th in front of the Public Health, Welfare and Safety Committee. BHAM remains willing to help craft amendments that would make this bill more effective but currently, we will oppose it.
SB 196, Require payment parity in insurance coverage of telehealth services (https://leg.mt.gov/bills/2023/billpdf/SB0196.pdf)
This bill is carried by Sen. Walt Sales and would require parity in payment of telehealth services with in person services. With the huge explosion of telehealth services since COVID and the number of people who are now treated effectively with telehealth, this bill is a no-brainer. No hearing is currently scheduled for this bill.