Montana behavioral health providers consider overhaul

When it comes to fixing Montana’s behavioral health care system, policy pundits often say there is no silver bullet. The second-best option, however, may be a jargon-filled phrase that gives hope to many stakeholders: Certified Community Behavioral Health Clinicsor CCBHC, a Medicaid program and funding mechanism designed to make essential mental health and addictions treatment available to communities in need.

This clinical model is being studied as part of an ongoing legislative study on the adult mental health care system by the Interim Committee on Children, Families, Health and Social Services. Proponents of the CCBHC model say it could be a boon for Montana’s currently strained and underfunded system for treating mental health and addictions disorders — if it gains traction with state lawmakers and lawmakers. the administration of Governor Greg Gianforte.

Speaking to lawmakers on Friday, Department of Public Health and Human Services Director Adam Meier signaled some openness about the model.

“We’re now at the point where we’re kind of exploring it alongside the vendors and you guys,” Meier told committee lawmakers. “Once we have more information, [and] we have feedback on whether vendors want to go that route, I think that lets us know if there’s interest on our end as well.

Even this evasive response has sparked enthusiasm from some proponents of the program.

“It’s tempting to see the administration circling around CCBHCs,” said Matt Kuntz, director of nonprofit mental health advocacy group NAMI Montana, adding that the model could critically expand treatment and services. .

National CCBHC supporters tout the model’s potential. In a 2020 report titled “Hope for the Future,” the National Behavioral Health Council said it aimed to make CCBHCs available in every state.

“When that happens,” the report says, “we will have created the greatest opportunity to improve the health and well-being of the entire nation.”

WHERE DO CCBHC COME FROM?

As of 2017, a handful of states launched CCBHCs as part of a Medicaid Demonstration Program designed to make treatments for mental health and substance use disorders more widely available. While 10 states have begun implementing statewide CCBHC programs, many other organizations have received federal grants to build infrastructure to support CCBHC services, including three providers in Montana: Rimrock Foundation in Billings, Center for Mental Health in Great Falls, and Western Montana Mental Health Center.

CCBHC care providers are expected to offer a range of services to complete the spectrum of mental health and addictions treatment, as well as address certain reporting requirements set by the federal government. In return, participating providers receive enhanced federal funding for treating Medicaid patients – a key incentive for behavioral health providers and practitioners.

ANOTHER WAY TO PAY FOR BEHAVIORAL HEALTH CARE

CCBHC advocates say the key difference between this model and Montana’s current behavioral health system is how Medicaid services are funded. If a statewide CCBHC program were implemented in Montana, the state would transition from its current fee-for-service model to what is called a prospective payment system.

Under fee-for-service, “if a supplier charges [Medicaid] for a 50-minute therapy session, they get paid for that 50-minute session,” said Mary Windecker, executive director of the Behavioral Health Alliance of Montana (BHAM), a group of providers currently studying the CCBHC model.

Alternatively, said Windecker, a prospective payment system would guarantee providers a fee “that takes into account the true costs of providing that care,” such as time spent on documentation, administrative staff and case managers. “This is especially important for community behavioral health care, where so many services go unreimbursed” under the current Medicaid billing system, she said.

Montana’s behavioral health providers have long said that the state’s Medicaid reimbursement rates are insufficient. While some providers may stay financially afloat by accepting private insurance, organizations that work primarily with Medicaid-enrolled or uninsured patients may not be able to retain staff or expand services. As a result, Montana struggles to provide robust and widespread treatments that meet the needs of the state’s population. By using a forward-looking payment system with a stronger federal counterpart, advocates say, CCBHCs can reliably deliver essential services to communities in need.

The Medicaid rate for CCBHCs “covers the true costs of delivering improved services to an increased number of patients and represents a significant transformation in clinic sustainability,” the report from the National Council for Behavioral Health said.

Participating clinics can still provide services to patients with private insurance or no insurance at all — federal requirements state that an organization must provide treatment regardless of a person’s ability to pay. The higher reimbursement rate associated with licensure as a CCBHC applies only to patients on Medicaid.

DO CCBHCs REALLY WORK?

After about five years of implementing the CCBHC model, state officials generally praised the program to investigators from the National Council for Mental Wellbeing.

Of the eight states surveyed, CCBHCs “have reduced costs, improved outcomes, helped build capacity and critical infrastructure in the mental health and addictions care system needed to meet growing levels of need,” the report wrote. organization in a 2021 report. In some states, people receiving treatment at CCBHCs saw fewer emergency room visits, fewer interactions with law enforcement, and lower readmission rates.

In a presentation to Montana lawmakers last week, a representative from the National Council for Mental Wellness said that 100% of existing CCHBCs offer crisis response services such as a 24-hour mobile crisis team. on 24, a type of emergency protocol for people in mental health crisis. which is inconsistently available in Montana. The presentation specifically highlighted positive results in Missouri and Texas, with the latter country expected to save $10 billion by 2030 through the implementation of the CCBHC model.

“HOPE” FOR MONTANA

In an often struggling industry facing growing demand for services, Montana providers widely agree that stabilizing and strengthening behavioral health care is essential. NAMI Montana’s Kuntz said implementing a CCBHC model could be a game-changer for patients and providers.

“The hope is that we have a long-term solution to fund our mental health centers… so we actually have a model that works for things like the crisis [care], where our therapists are fully funded at their expense,” Kuntz said. “If you get the payment model right, it’s possible to deliver care to underserved communities.”

But implementing a CCBHC program would be a big undertaking for Montana officials, who would have to either modify the current state Medicaid plan, join the federal demonstration project with 10 other states, or file a special waiver. with the Centers for Medicare and Medicaid to get the green light for a state program.

Windecker said becoming a licensed CCBHC could also be a hurdle for individual facilities, which would have to comply with federal data collection requirements.

“There are 21 evidence-based outcome measures that need to be collected” by CCBHCs, she said. “It would be a heavy burden on providers and the state, but would assure the state that CCBHCs are providing the care they are licensed to provide.”

Windecker said his organization’s study of transitioning to a CCBHC model, funded by a grant from the Murdock Charitable Trust, will not be concluded for six months. By then, BHAM providers will have a clearer picture of whether to advocate for statewide CCBHC implementation.

“The last thing any of us want is to implement a model that won’t work for Montana,” Windecker said, noting the state’s unique rural characteristics. “[W]We need to look at its applicability to the great outdoors of Montana to make sure it would work here.

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