The Western Montana Mental Health Center has taken recent Medicaid cuts by the state in stride by reorganizing, cutting some salaries, and closing two offices.
But now it could be looking at even deeper cuts, after the Montana Department of Public Health and Human Services proposed revising three codes relating to chemical dependency services that will affect reimbursement rates. And it warns that even without future cuts, the current model may not be sustainable over the long term, or even after six months.
A hearing on the newest proposed changes will be held Thursday in Helena.
Like all Medicaid providers, the center experienced a 2.99 percent reimbursement rate decrease as DPHHS sought to find $8.6 million in savings because of cuts triggered by weak state revenues.
The Mental Health Center closed its offices in Dillon and Libby as a cost-saving measure. But in Ravalli County, despite major cuts to targeted case management, the center transitioned out of providing those services and instead changed to a Program of Assertive Community Treatment, or PACT model.
Kari Auclair, the West House Crisis Facility program manager in Hamilton, said they retrained and moved their case managers onto the 13-person PACT team, whose members currently serve 45 clients and spend about 75 percent of their time in the community instead of in the office.
The team includes a medical provider, two nurses, two therapists, some care coordinators, peer support, an avocation rehabilitation specialist and a licensed addiction counselor. They will be able to serve up to 70 clients.
“We prepared early and got our folks trained so it was a soft landing for us,” Auclair said. “The Bitterroot Valley really stepped up to help out. We readjusted and can really feel it across the board, but we are committed to not closing our doors and helping each person, even if it looks like we’re doing it in a different way.”
The newest proposed revisions in funding 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.
Some mental health care providers say that $19.01 isn’t going to offset all that they lost on the other changes. Auclair said she’s not sure how any additional cuts will impact Ravalli County, and added that the earlier cuts by DPHHS only went into effect three weeks ago, so they’re not sure about the long-term impacts.
“Most of our clients are on Medicaid, so we don’t get reimbursed as much. We have to make adjustments and water our budgets carefully,” Auclair said. “We are in pretty good shape now, but six months down the road we will be at capacity with the PACT team with 70 clients. What happens when client 71 and 72 come along? I don’t know.
“I don’t want to give everyone the false sense that this has been worked out. It hasn’t. What I foresee is our jail will be over capacity. Our ER will be inundated. Our crisis center will be inundated. Those folks who are living on their own, who may be homeless, who don’t have medications or know how to get them — I don’t know what will happen to them.”
Another problem with the new proposed 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.
Barbara Mettler, executive director of the South Central Montana Regional Mental Health Center, said they’ve already had to close its case management unit, affecting both clients and 20 employees. Decreasing the group rate will have additional impacts.
“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.