Gianforte, DPHHS secure federal approval to increase treatment through HEART Fund

Together with Department of Public Health and Human Services Director Adam Meier, Gov. Greg Gianforte announced Wednesday the state is significantly increasing access to substance use disorder treatment for Montana Medicaid members through the Healing and Ending Addiction through Recovery and Treatment, or HEART Fund, according to a news release.

“Our HEART Fund fills gaps to provide for a full continuum of substance use prevention and treatment programs for communities,” Gov. Gianforte said in a statement. “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.”

The federal approval, made possible through the governor’s HEART Fund, allows larger licensed substance use treatment providers to receive Medicaid reimbursement for short-term acute inpatient and residential stays at facilities that meet the definition of an institution for mental disease, the news release said.

Introduced by the governor during his first week in office as a central component of his budget, the HEART Fund invests $25 million per year to provide for a full continuum of behavioral health and treatment programs for communities, the news release said. Until now, Medicaid patients have had to wait to receive treatment until a Medicaid-eligible bed at a smaller facility became available.

Federal law prohibits Medicaid payment to any IMD facility with 17 or more beds that provide substance use or mental health treatment, according to the news release. However, at the direction of the governor, DPHHS applied for and secured a waiver from the Centers for Medicare & Medicaid Services to drop this prohibition, the news release said.

“The ability to bill Medicaid will increase capacity for substance use disorder treatment in Montana,” Meier said in a statement. “Access to treatment is vital, and now hundreds more Medicaid recipients will be able to receive this critical service.”

The Governor’s Office said the approval is a major step forward in helping the state address its serious public health crisis in substance use disorders, including alcohol abuse, methamphetamine use, and opioid abuse and overdose.

In the release, Meier said there were several reasons why DPHHS sought permission from CMS to fill this critical gap in the state’s system. The primary reasons include the ongoing challenge of waitlists for this level of care due to an insufficient number of beds available for patients covered by Medicaid, Montana’s current SUD crisis, and the need for increased capacity to help stabilize patients prior to receiving community-based treatment, the news release said.

Rimrock Foundation CEO Lenette Kosovich said this approval opens a needed pathway to treatment, according to the news release.

“This is a game changer,” Kosovich said in a statement. “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.”

Rimrock estimates it will be able to scale up to serve an additional 350 Medicaid members annually, the news release said.

Kosovich said these services are focused on stabilizing a person with a SUD in a structured 24-hour setting, according to the news release. Once stabilized, the patient is then able to step down to community treatment where they continue to receive support services to aid in their ongoing recovery.

As part of the conditions for federal approval of this waiver, the state must commit to improving community-based outpatient mental health and SUD treatment, including transitions to community-based care following inpatient treatment, the news release said.

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 individuals in the 30 days prior to their release from a correctional setting, according to the news release. DPHHS and CMS continue to work toward approval of these components of the waiver application.

If any Medicaid members have questions about this particular service, please call Isaac Coy of DPHHS Behavioral Health and Developmental Disabilities Division at 406-444-7922.