Mental health cuts

More than 40 people testified in Helena on Thursday for a Department of Public Health and Human Services hearing to oppose proposed rule changes that will further cut back on substance abuse disorder treatment and other mental health services.

Montanans with substance addictions could be limited on how many counseling sessions they get a year as the state health department continues to make budget cuts. Patients and providers gathered in the capitol Thursday and said that would lead to more crises, hospitalizations and suicide attempts statewide.

The proposed rules, set to begin April 1, would move Montana’s addiction counseling system from a needs-based assessment to a cap. People who ask for help beyond 12 individual and 12 group sessions a year would need a professional evaluation and state approval to continue therapy.

Livingston resident Kris Ingwell said those restrictions won’t work well.

Ingwell sometimes relies on his counselors at Southwest Chemical Dependency twice a day. He spent the last few years in Montana State Prison after he was caught repeatedly driving drunk. He was released eight days ago and wants to stay sober.

“Drinking has always been my forte,” he said. “The services I got in Livingston the last week were better than the last years. They’re a lifesaver.”

He held a sign outside the health department asking for fair funding. Inside, a hearing began on the Department of Public Health and Human Services’ proposed changes.

The meeting took place the same day Montana treatment agencies saw more Medicaid reimbursement cuts. April 1 is set to come with another round of rollbacks.

Shelly Johnson of the Bozeman-based Alcohol and Drug Services said at least one vacant position will stay unfilled. She also cut administrators’ hours and curbed travel to rural areas.

“That’s just to start,” Johnson said. “I think some agencies will be closing.”

Johnson said with the new rules, she’s not sure how centers can follow national standards that are also state mandated. She said the center won’t be able to provide its three-hour intensive outpatient group for high-needs clients. That includes treatment court clients who enter an 18-month program.

Because counseling limits are new to Montana, the health department doesn’t know whether the change will save money, according to its statement outlining the need to try.

As it stands, the rules include that people in therapeutic group homes will now need prior authorization and periodic reviews. They also propose how many hours case managers and other mental health professionals can spend with clients.

“I can promise you that we will make changes where we can in order to minimize any proposed impact to the people we serve,” said health department Director Sheila Hogan at the start of Thursday’s meeting.

More than 40 people testified over three hours. Many said they wanted the state’s proposed changes redone, saying it hadn’t been done well or with enough feedback from health professionals.

The hearing was Johnson’s fifth trip to Helena since lawmakers and officials began trying to fix the state’s out-of-balance budget.

“We don’t feel heard,” she said. “We have always hoped that something will change, someone will ask us to be part of the decisions that affect our clients.”

Lisa Dilley said for some patients, it’s truly an issue of life or death. She said roughly a year ago she planned to kill herself. At the time, she couldn’t imagine living without adderall or marijuana. She said a balance of medication and counseling means that’s not the case anymore.

“A diabetic will die if they don’t get help. I may have died too,” Dilley said, adding that she still needs help to stay healthy.

After the meeting, Hogan said she hasn’t looked at the manual that outlines the changes yet, but plans to do her own evaluations.

She said drafting proposals then putting them through public comment is how the state gets people’s input. And she said that’s not where she’s left it. Since September, Hogan has traveled to 32 places in Montana to meet with people impacted by cuts.

“I feel I went over and above to make sure I went out to communities,” Hogan said.

Thursday’s hearing was a week after Hogan met with Gallatin County health advocates. When people said it was difficult to reach the health department, Hogan’s response was that they should call her.

Johnson said when it came to her question at the meeting, “[Hogan] got my phone number and said she would call me when she knew more.”

As of Thursday, Johnson was still waiting for that call and Hogan said she was still working on it.

People have until March 9 at 5 p.m. to comment on the proposed changes.

People can email dphhslegal@mt.gov with their comments. Written views can go to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana 59604-4210.

Katheryn Houghton can be reached at khoughton@dailychronicle.com or at 406-582-2628. Follow her on Twitter @K_Hought.

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