MT Medicaid patients to see greater access to substance use disorder treatment

MM Curator summary

[MM Curator Summary]: CMS is waiving the bed cap for another state (Montana).


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Montana this week received federal approval for substance-use disorder treatment providers with 17 or more beds to bill Medicaid, an expansion providers called a “game changer” for combating addiction across the state.

“Until now, we’ve been limited in the number of Medicaid members that we’ve been able to serve, despite an increased demand for treatment,” said Lenette Kosovich, CEO at Rimrock Foundation, the state’s largest provider of treatment for substance-use and co-occurring disorders.

The governor’s office and the Montana Department of Public Health and Human Services announced the approval Wednesday. Federal law prohibits Medicaid payment to any institution for mental disease with 17 or more beds that provide substance-use or mental-health treatment. Last year, DPHHS applied for a waiver to expand the number of services not typically covered for Medicaid recipients. A DPHHS spokesperson said Wednesday during those negotiations, the department decided to ask the Centers for Medicare and Medicaid Services to specifically waive the 17-bed exclusion in order to get that piece in place sooner while negotiations continue.

That exclusion waiver granted this week allows larger treatment providers to receive Medicaid reimbursement for short-term acute inpatient and residential stays at facilities serving patients with mental disease.

“There’s more work ahead, but we’re certainly excited to announce this achievement today,” DPHHS spokesperson Jon Ebelt said in an email.

letter dated July 1 specifically does not approve substance use disorder services at the Montana State Hospital, citing the agency’s decision in April to terminate its reimbursement agreement at the facility due to repeated failures to maintain health and safety levels there.

The state is leveraging its new Healing and Ending Addiction through Recovery Treatment (HEART) Fund, proposed by Gov. Greg Gianforte and approved by the state Legislature in 2021, which draws $7 million from new marijuana tax revenues. That money will generate federal matching dollars to bring that to a new total of $25 million in annual spending, according to the governor’s office.

“Our HEART Fund fills gaps to provide for a full continuum of substance use prevention and treatment programs for communities,” Gianforte said in a press release. “For too long, Montanans have struggled to receive timely access to treatment due in large part to the limited number of beds. With this approval, more people will have access to treatment when they need it most.”


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Department of Public Health and Human Services Director Adam Meier.

THOM BRIDGE, Independent Record

Adam Meier, director of DPHHS, said the waiver addresses the ongoing challenge of wait times for this level of care due to an insufficient number of beds available for Medicaid patients.

“Access to treatment is vital, and now hundreds more Medicaid recipients will be able to receive this critical service,” Meier said in the release.

The statewide impact will be realized over time, the governor’s office said in Wednesday’s press release. The Rimrock Foundation, meanwhile, estimates the waiver will allow the organization to scale up to serve an additional 350 Medicaid members annually.

In whole, the waiver application asked for federal approval of Medicaid coverage for additional community-based treatment and recovery services, including evidence-based stimulant use disorder treatment models, housing supports and pre-release care management for individuals in the 30 days prior to their release from a correctional setting. The state health department and CMS continue to negotiate toward the approval of these components of the waiver application, Ebelt said Wednesday.


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