Karen Pence

Karen Pence greets Rimrock CEO Lenette Kosovich during a visit to the Willow Way addiction recovery group home operated by Rimrock in Billings on June 12, 2019.

Montanans who need addiction treatment and mental health counseling won't be able to get both services if changes in the state's Medicaid provider manual take effect as proposed on July 1.

This change — denying Medicaid coverage for mental illness while an individual is in addiction treatment — is contrary to best professional practices. It's like trying to treat illness that affects the entire body by treating just one part at a time.

Last month, Billings addiction treatment and mental health care providers told The Gazette they were hopeful of restoring some services curtailed by the state budget cuts of 2017 and 2018. Providers have been meeting regularly with the Montana Department of Public Health and Human Services leadership, and it appeared that their concerns about unsustainably low payment rates were going to be addressed in July. Community service providers were hopeful. They told The Gazette that DPHHS was listening to their concerns.

But last week at a Helena hearing, community service providers learned that the department is proposing changes that had not been discussed with them, changes that would effectively deny the best care to the majority of addiction treatment clients who have a co-occurring mental illness, such as depression, anxiety or bipolar disorder.

Rimrock, a private, nonprofit addiction treatment center in Billings, issued this statement Tuesday:

“DPHHS has published a new Medicaid Services Provider Manual for substance use disorders. The overarching concern is that anyone with Medicaid seeking substance use treatment whether inpatient or outpatient, will no longer be allowed to have concurrent mental health treatment covered by Medicaid. Over 80% of the clients seeking treatment for a substance use disorder have a co-occurring illness and integrated treatment is the best practice in addiction treatment across the country. Disallowing Medicaid clients coverage for therapy such as, marriage and family therapy, trauma therapy, grief counseling or any other therapeutic intervention while also treating their addiction puts them at a disadvantage to achieving whole-person recovery. If mental illness and substance use disorders are not treated concurrently the risk of relapse increases, leading to an ongoing cycle of detox and treatment, creating further strain on the community and resources."

Effective addiction treatment can require several weeks or months of intensive work by the client and licensed addiction counselors. The proposed change would deny Medicaid clients needed mental health counseling during that period, either interrupting their counseling or delaying it unnecessarily.

"It takes Montana back 30 years to say we cannot provide integrated care," Coralee Schmitz, Rimrock chief operating officer, told The Gazette.

We call on DPHHS leadership to reconsider the restrictions on concurrent mental health and addiction treatment. Don't damage the health care safety net the department is trying to strengthen. As noted in the June 2 Gazette opinion, the resources restored by the 2019 Legislature and Gov. Steve Bullock must be administered through DPHHS rules. Let's get those rules right.

The deadline for DPHHS to receive public comments is Friday. If you are concerned about how the prohibition against paying for concurrent mental health counseling could affect you or someone you know, please speak up immediately. Check the contact information in "Comment on rules" above.

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