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Sheila Hogan

Sheila Hogan, director of Montana's Department of Health and Human Services, speaks during a September legislative committee hearing on the department's budget in Helena.

Thom Bridge, Independent Record

After nine months of Medicaid reimbursement cuts, Montana community health care providers are getting a slight reprieve from the latest round of changes designed to balance the state budget.

Montana chemical dependency providers will see some changes in a “final rule” to be published Friday, according to Sheila Hogan, director of the Montana Department of Public Health and Human Services. Speaking with The Gazette Monday by phone, Hogan said the department listened to concerns expressed at a March 1 hearing and modified the draft rules so that:

  • There won’t be a 12-visit annual limit for patients. Previously, the department proposed that after 12 visits for addiction treatment, the provider would have to get the client certified by an out-of-state “utilization review” company in order for Medicaid to continue coverage. The rule would have required recertification every 12 visits or week and a half for clients in intensive outpatient treatment, which typically requires months of treatment. The recertification would have added considerable operating expenses for Montana providers at a time their reimbursement rates have been reduced.
  • There won’t be an annual limit of 96 units (15-minute units) of targeted case management. That would be good news for anyone who can still get case management, but multiple Montana providers have told The Gazette that Medicaid payments for that service have been cut so low that they can no longer afford to provide this care for mental health clients. Mental health centers already eliminated case manager positions.
  • Instead of limiting addiction treatment groups to eight clients, the limit will be 16. Hogan said providers told the department that eight was too limiting.

Those changes in the final rule don’t stave off the recent and upcoming rate cuts, but would allow providers to avoid new compliance costs and provide more flexibility in treatment group size.

The state’s revenue shortfall hit DPHHS hard. It is a large department with many responsibilities to all Montanans — especially those who are sick, disabled, very young, very old or low-income. The department is required to cut about $60 million in state general fund from its budget during the biennium that ends in the summer of 2019. Because much of DPHHS spending generates federal matching funds, the $60 million general fund cut will result in a $180 million reduction in the department’s total biennial spending, Hogan said.

Montana hospitals, clinics, doctors, counselors and all professionals serving Medicaid clients are feeling the financial pain. Within the department, more than 400 jobs have been cut because of the revenue shortfall, Hogan said.

“The operational corps of the department has been cut,” she said, adding: “We’re not going to cut foster care. We’ve exempted 24/7 facilities for obvious reasons.” The department’s round-the-clock operations include Montana State Hospital at Warm Springs, Montana Chemical Dependency Center in Butte, Montana Developmental Center in Boulder and Montana Mental Health Nursing Home in Lewistown.

“This has been a really difficult time for the community and the department,” Hogan said. “It’s just been awful.”

The latest new Medicaid rules are now scheduled to take effect May 1, although the initial notice cited an April 1 effective date.

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