Already grappling with cuts to Medicaid reimbursement rates, the South Central Montana Regional Mental Health Center now fears it could be looking at even deeper cuts.

The Montana Department of Public Health and Human Services is proposing revising three codes relating to chemical dependency services that will affect the center’s reimbursement rates. A hearing on the changes will be held Thursday in Helena.

The Mental Health Center offers mental health and chemical dependency treatment in an 11-county area. It has offices in Billings, Hardin, Red Lodge, Columbus, Big Timber, Roundup and Lewistown.

Like all Medicaid providers, it experienced a 2.99 percent reimbursement rate decrease as DPHHS sought to find $8.6 million in state dollar savings because of cuts triggered by weak state revenues.

Because of major cuts to targeted case management, the Mental Health Center was forced to close its case management unit, affecting both clients and 20 employees.

“Between October and last week we were working on transitioning case managers into other jobs or laying them off,” said Executive Director Barbara Mettler. “They had about 200 open clients, and you can’t just dump them. We’ve been working to transition them into other programs.”

What’s significant about the loss of case management is its link to the mission of the center, Mettler said. Community mental health centers came into being in the early 1970s when mental hospital patients were being released into local communities.

“What kept them in the community was case management, helping them to do things they didn’t know how because they were in a hospital,” Mettler said. “Now we have to pretty much do away with that.”

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She is now confronting more changes in funding that would:

  • Decrease reimbursement for substance use disorder assessments from $282.50 to $89.71, a decrease of $192.79 per assessment.
  • Decrease the group counseling rate from $24.27 per hour to $17.55 per event, regardless of the number of hours.
  • Boost the rate for individual counseling from $16.99 per each 15 minutes to $87.07 per hour, an increase of $19.01 per hour.

“But that $19.01 isn’t going to offset all that we lost on the other ones,” Mettler said. “We’re finding ourselves having to go back and look at the budget and see what we’re going to have to do to balance it.”

The burgeoning cuts could even force leadership to look at whether it can continue maintain all of the center’s satellite programs, she said.

Another problem with the rate revision has to do with what experts have determined are best practices regarding chemical dependency treatment. Evidence-based practice, which the state expects, calls for group therapy, which frequently lasts two or more hours.

“With them cutting this rate back, we’re seriously going to have to look at if we can even afford groups,” Mettler said.

She plans to attend the Feb. 1 hearing. She’d like to see a less severe cut to the assessment reimbursement. Mettler will also ask that DPHHS base the group rate on the number of hours, not per event.

“For this cohort of folks, group therapy is the best intervention,” she said.

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