- Associated Press - Wednesday, April 4, 2018

Montana Standard, April 1, on taking public input before changing Wilderness Study Areas’ status:

Five Montana Wilderness Study Areas have been locked in federal administrative limbo for some 41 years, since Lee Metcalf first proposed them for wilderness designation in 1977.

While that fact irritates those who would like to use them for non-wilderness purposes, the WSAs, as they are known, are intact roadless areas that have been treated like the wildlands they were in 1977. As a result, they are still exactly that.

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Since Sen. Steve Daines introduced S2206, which would strip the areas of their wilderness study status and allow them to be managed for “multiple use,” there’s been a lot of turbulence around the issue across the state, but particularly in southwest Montana.

Daines makes the very valid point that these lands are overdue for a resolution - a permanent status. The differences we have with him lie partly with what that status should be, and greatly in how it should be determined.

Certainly, Daines’ move to remove the wilderness tag on this land makes us uneasy. Take the two WSAs closest to Butte, the West Pioneers and Sapphire WSAs.

The West Pioneers, a sprawling, 151,000-acre area within Beaverhead-Deerlodge National Forest, contains significant parts of the Big Hole’s headwaters.

Land-use decisions made upstream always impact what lies below. That’s played out time and time again in this West we love, in these Northern Rockies with the annual rush of snowmelt. It’s played out from the mines of Butte to Milltown, and from countless streams, degraded by siltation from logging and roading or acid rock drainage from mining, to their larger, vital downstream waters.

For its part, the Sapphire WSA contains many relatively untouched - and fragile - high-altitude lakes.

Of course, multiple use means help for the extractive economy in our state, but our outdoor economy segment is equally crucial to the state’s present and future. Degrading the quality of a fishery like the Big Hole would be disastrous.

But our largest concern is about the need for transparency in the process of change. Such momentous decisions as changing the use and stewardship of 500,000 currently unspoiled acres of public lands should not be made without hearing from Montanans in a highly organized and inclusive fashion.

Before a “solution” is put on paper as federal legislation, affected citizens should have been allowed - nay, encouraged - to speak their piece in public.

Sen. Daines has not only not held any public meetings on this issue - he has actively avoided engaging with opponents of his bill in the state.

This comes at a time when some of the state’s most respected and dependable environmental watchdogs are up in arms. They say we are facing an unprecedented assault on our public lands, and the WSA issue is at the tip of the spear.

So Senator, before moving this bill forward, won’t you set up some public meetings so that all sides can come and discuss these decisions of enormous consequence?

In Montana, we like our government the same way we like our water - clean, clear and public.

Editorial: https://bit.ly/2EeTcGK


Bozeman Daily Chronicle, March 30, on budget cuts affecting people in need:

The closure of the Livingston Mental Health Center is just the latest evidence of the imprudent decisions made by state lawmakers. The closure leaves more than 100 patients scrambling to find mental health care elsewhere. And, to be realistic, some may simply go without. And that’s a dangerous and inhumane prospect.

The center will close its doors at the end of next month as a result of budget cuts enacted by legislators in response to lower than expected fossil fuel and income tax collections and a costly fire season. The Livingston facility comes on the heels of similar closures in other small cities, including Libby and Dillon.

Legislators got into the budget fix by adopting unrealistically rosy estimates in the first place. Then when a $200 million-plus budget shortfall loomed and a special session was called to deal with it, they slashed away at agency budgets with little to no consideration for raising revenue. The Department of Health and Human Services, which funds small town mental health facilities, was among the hardest hit, and now the consequences are being felt in rural communities.

When the Legislature convened last year they were presented with very reasonable options from Gov. Steve Bullock for raising taxes on hotel rooms and rental cars to take care of about a third of the anticipated shortfall. Some budget transfers would have taken care of another third and budget cuts would address the remainder under Bullock’s proposal.

But the legislators were intransigent.

Tax increases that would have primarily impacted tourists from out of state tourists would have been pain-free for most Montanans and a sensible way to help keep the doors open on rural mental health services. Now hundreds of low-income Montanans will be forced to travel onerous distances for mental health care or do without. And this at a time when many are calling for more attention to mental health as part of the response to school gun violence.

When they meet again in January, lawmakers would do well to ease off the anti-tax fervor and give some help to Montanans who need it most.

Editorial: https://bit.ly/2GTRvnQ


Billings Gazette, Mach 30, on less service and more Medicaid providers:

Two Billings Gazette headlines published 11 days apart in March present conflicting views on the effects of changes in Montana’s Medicaid system since the 2017 Legislature adjourned.

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Which is correct? That state spending reductions will force mental health and chemical dependency treatment providers to cut services? Or that a change in state law may increase the number of Medicaid-eligible addiction treatment programs from 32 to 57 by year’s end?

As with most things in the U.S. health care system, the answer is complicated. To understand this complexity, let’s look at Eastern Montana Community Mental Health Center. With headquarters in Miles City, EMCMHC serves a vast 17-county, 48,000-square-mile region. Last year (before state revenue shortfalls resulted in decreases in Medicaid rates), the center applied to add chemical dependency treatment in five counties where it already provides mental health services.

By using existing staff, telehealth technology and hiring just 1.5 additional full-time-equivalent staff, the center plans to extend addiction treatment to Dawson, Richland, Prairie, McCone and Wibaux counties. Only after the service expansion was ready to start did CEO Brenda Kneeland learn of further proposed changes in Medicaid that will reduce reimbursement to her nonprofit organization and other Montana addiction treatment providers.

The Eastern Montana center is moving forward with addiction treatment expansion while leaving other staff positions vacant, Kneeland told The Gazette.

New service limits

“We are trying to find our footing in regards to the proposed rate cuts (taking effect April 1) and we plan to do our very best to not cut services, but we will not be able to provide what we cannot pay for so time will tell,” Kneeland said. “At this point, we are more concerned with the systemic changes the state is proposing that limit the number of services an individual can receive, require ongoing authorizations and that require precious state dollars being given to a managed care company rather than supporting providers throughout the state who provide direct chemical dependency treatment services to Montanans.”

Like Kneeland, Barbara Mettler, executive director for the Mental Health Center in Billings, sees financial uncertainty for community behavioral health services. Between July and September 2017, the state Medicaid program effectively eliminated mental health case management by reducing the rate below the cost of service. South Central Montana Mental Health Center, which serves Yellowstone and 10 neighboring counties, lost $200,000 in 2016, it eliminated 20 jobs last year, mostly case managers. Revenues and expenses came back into balance for 2017, but after 2.99 percent Medicaid rate cut showed up in February receipts, the center was back the red for the month. In March, DPHHS announced significant changes in addiction treatment payments.

Although the state is processing applications for new addiction treatment programs, some existing services have shut down. For example, in Billings the Center for Children and Families closed last month, shutting down outpatient addiction treatment and safe housing for up to 40 children and mothers in treatment. Western Montana Mental Health Center has closed its offices in Livingston, Libby and Dillon.

Proposed changes in state Medicaid policy have already prompted change in the Billings center’s intensive outpatient addiction treatment regimen so that clients will have less time in group treatment, even though “best practice for drug and alcohol treatment is group, not individual therapy,” Mettler said. Intensive outpatient treatment will be reduced from four eight-client groups to one.

Most people participating in Billings drug treatment courts need that intensive level of treatment to get off drugs and stay in recovery. With fewer slots available, waiting lists will grow and court cases will be delayed.

Rainbow House

Mettler is concerned about the future of Rainbow House, a daytime treatment program for seriously mentally ill adults, some of whom live in a Mental Health Center group home. A new state provider manual proposes that only one service per day can be billed to Medicaid. Mettler wonders if that means people who are receiving shelter can’t also be served at Rainbow House.

“No stakeholders were invited to help revise the provider manual,” Mettler said. “We’re still in the dark till we read it in the newspaper.”

Montanans are seeing Medicaid service reductions along with new addiction treatment programs. Health care providers are painfully aware that their reimbursement is less than expected and will stay that way at least through this biennium. They deserve seats at the table to help write the rules they must obey to serve Montana’s most vulnerable citizens.

The state could pay Medicaid providers based on actual, allowable costs as Medicare pays critical access hospitals. The state could transition to a system that pays providers a set fee per patient per month and requires the provider to meet certain outcome measures. Those ideas and others require collaboration. By listening to and working with Montana health care professionals, community clinics and hospitals, Department of Public Health and Human Services leaders would get help with the difficult decisions foisted on them by state revenue shortfalls.

Editorial: https://bit.ly/2EiZ9ml

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