HELENA — Department of Public Health and Human Services (DPHHS) Director Adam Meier announced the agency is seeking public comment on its federal application to expand mental health and substance use treatment services through the Healing and Ending Addiction through Recovery and Treatment (HEART) Initiative.

Governor Greg Gianforte recently signed the HEART Initiative into law through HB 701 that was sponsored by Rep. Mike Hopkins of Missoula. Now, DPHHS must begin the federally-required process of submitting a Medicaid Section 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS) for approval to expand services. The first step in the process is a 60-day public comment period that begins on Friday, July 9, 2021.

“The HEART Initiative will help to address the State’s drug epidemic that is devastating our communities by expanding access to mental health and substance use disorder treatment across the full spectrum of care,” Meier said. “The waiver application is a critical step to delivering on Governor Gianforte’s commitment to filling the gaps that currently exist.” 

Additional details about the HEART waiver application, instructions for submitting public comment, and information about the virtual public hearings on July 20 and 21 are available at https://dphhs.mt.gov/heartwaiver.

The deadline to submit public comments is by 11:59 p.m. on September 7, 2021.

The HEART Initiative directs state and federal funding to expand the State’s behavioral health continuum. The proposal will allow DPHHS to leverage state dollars to draw down increased federal funding for treatment services, to ultimately provide up to $25 million per year of services to fund a full Medicaid continuum of care.

In its waiver application, DPHHS seeks federal funding approval for broader efforts to strengthen Montana’s evidence-based behavioral health continuum of care for individuals with substance use disorder and serious mental health needs.

A Medicaid waiver is a provision in federal law which allows the federal government to waive rules that usually apply to the state-administered programs. Through waivers, states can provide services to their residents that wouldn’t usually be covered by Medicaid. Over the years, DPHHS has been successful in submitting several other waivers to CMS to improve service delivery in Montana.

Meier explains that current gaps in the behavioral health treatment system leave Montanans unable to access the appropriate level of care at the right time, which can lead to poor health outcomes and increased costs. Through the waiver, DPHHS aims to expand access to inpatient, residential and community-based treatment and recovery services for individuals with substance use disorder and serious mental illness, and to improve transitions of care across treatment levels.

The application requests CMS to allow Medicaid coverage for short-term inpatient and residential treatment in larger community treatment facilities with more than 16 beds and for other complementary community-based treatment and recovery services.

“The waiver to allow inpatient treatment in facilities with more than 16 beds is a way to break down another barrier to care by reducing wait times and allowing people to enter the level of care they need sooner,” said Lenette Kosovich, CEO of Rimrock, which provides treatment for individuals with substance use disorders. “As a provider, we frequently see patients who are forced to delay the treatment they so desperately need because of current barriers. This proposed change would put patients on the path to a healthier life.”

In order to receive federal approval for Medicaid coverage of short-term inpatient and residential stays in larger community treatment facilities, the State must commit to improving community-based outpatient mental health and substance use disorder treatment.

As part of this commitment, the waiver also asks 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 inmates in the 30 days prior to their discharge.

“This is a game-changer for Montana,” said Matt Kuntz, Executive Director of NAMI Montana, an organization that advocates for Montanans with severe mental illness and their families. “This will help Montanans at all stages of recovery. It will end the discrimination against patients needing inpatient care for mental health and substance use disorder conditions. It also wraps support around families through expanding community-based services, like housing support services. It’s almost impossible to recover from mental health struggles without secure housing, and this waiver will support that. We are very excited about this opportunity.”

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