January 2023 Update from BHAM - Behavioral Health Alliance of Montana

HAPPY NEW YEAR!

We start 2023 with the kick-off of the 68^th Legislative Session! While that may not thrill most Montanans, we who serve the most vulnerable in Montana and try to survive on Medicaid rates, are very excited. Each session, we go hat-in-hand to the session and beg for rates that will at least cover the costs of providing services. Anyone who has ever run a business knows that you can’t keep your doors open if you can’t cover your costs. The same is true for the Medicaid safety net providers and we are coming out of a world of hurt after the worldwide pandemic. Historically high rates of depression and suicidal ideation among children and adults combined with lost income and skyrocketing living costs in this new Made-for-TV Montana have resulted in ever-increasing demands for mental health and substance use disorder treatment.

That rising demand fueled the need for a data-driven, objective Medicaid rate study that the 2021 Legislative spent $2.7M on. For the past two years, behavioral health providers have provided reams of cost reports to the Governor’s administration to show the actual cost of care for providing services. Not the cost plus 2% or 4% or 6% margin, but just the bare minimum cost of providing services to Montana’s most vulnerable.

The 2023 Montana Legislators will get to decide if they finally do something transformative and fund the full continuum of community-based or if 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 Medicaid rate study recommended that adult and children’s mental health and substance use treatment providers receive about $7M per year of the biennium to get the community-based providers up to market and to cover costs of providing the care. The Governor’s budget requests about half of that amount in one-time funding and a third of that amount in ongoing rate increases. We’re incredibly grateful to the Governor’s office and DPHHS for putting that funding in the budget to try and get community-based providers back to work in your communities!

During this legislative session,we’ll be talking with legislators about funding the full recommendations from the Governor’s study. With another $10M in funding, we can get community-based behavioral health providers up to the full recommendation of the Governor’s study.

Advocacy Suggestions:

Thank the Governor and DPHHS for putting rate increases into the Governor’s proposed budget.
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, but not funding community-based care 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/

CSCT Moves Home to DPHHS

The Governor’s budget also moves the Comprehensive School and Community Treatment (CSCT) program back to DPHHS with all the other Medicaid programs. In the 2021 Legislative Session, CSCT was moved to Office of Public Instruction and had a new funding mechanism enacted called an Intergovernmental Transfer (IGT).

There has been a great deal of confusion around this program, and it fell from being a nationally-recognized Montana program to being offered in fewer schools. This program is a wrap-around best practice for children with serious emotional disturbances (SED) so that they can remain in school with the help of a counselor and behavioral health care manager. With the loss of this program in so many schools, children with SEDs and their families have been left without support as they return to post-pandemic schooling.

Advocacy Suggestions:

Thank the Governor’s office and DPHHS for moving this important program back to where it belongs at DPHHS.
Talk with your legislators about funding this program with state funding as most Medicaid programs are funded and removing the IGT program.
Talk with your school district about renewing their CSCT contracts with state-approved mental health providers so that children receive this important service.

HEART Fund Increase

The Governor’s budget requests a change from the original recreational marijuana tax funding for the HEART Fund from $6M to about 11% of net tax amounts. BHAM has advocated for this change to ensure that the Governor’s HEART Fund has a sufficient budget to provide mental health and substance use disorder treatment across Montana.

The HEART Fund can also establish prevention funding for the first time in Montana so that dollars can be spent preventing more expensive treatment in acute settings.

Certified Community Behavioral Health Centers (CCBHCs)

CCBHCs are facilities specifically designed to provide a community with an all-inclusive range of substance use and mental health disorder services, especially for individuals who have the most complex need. Through a generous grant provided by the Murdock Charitable Trust, the Behavioral Health Alliance of Montana has taken the lead on vetting the CCBHC model with providers and state stakeholders.

SAMSHA has been providing short-term planning and implementation grants to agencies throughout the US to help them prepare for their states to implement CCBHCs.

You can view the grant awards here:
https://www.samhsa.gov/grants/awards/2022/SM-22-002?combine=&page=3

Advocacy Suggestions: