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New federal opioids law will help ease Billings treatment provider's wait list -- in a year

Billings Gazette - 11/2/2018

Nov. 01--A federal law forcing a Billings addiction treatment provider to keep beds empty even as its waiting list grows has been relaxed.

On Oct. 24, President Donald Trump signed a law aimed at addressing the opioid crisis.

The law allows nurse practitioners and physician assistants to prescribe buprenorphine, a drug that helps ease withdrawal symptoms. Proponents say this will help expand access to treatment, especially in rural areas.

It adds methadone -- which curbs drug cravings -- to the list of prescriptions covered by Medicare so that older patients with opioid addictions can get help.

For Rimrock Foundation, which runs addiction treatment programs in Billings, the new law provides a way to circumvent the federal law banning Medicaid funds from paying for services at a mental health center with more than 16 beds. Rimrock has 40 beds in its main facility. Due to the 16-bed limit, more than a dozen beds may sit open despite a lengthy waiting list of lower-income patients.

The federal restriction dates back to 1965 and, according to Rimrock CEO Lenette Kosovich, was in part an attempt by Congress to steer away from large-scale ineffective mental health treatment, like that depicted in Ken Kesey's 1962 novel, "One Flew Over the Cuckoo's Nest."

Until now, states have had to apply for a federal waiver on the 16-bed limit -- a process that can take up to a year.

The new law allows state Medicaid programs to bill the federal government through fiscal year 2023 for Medicaid patients aged 21 to 64 to be treated at facilities like Rimrock, but only for 30 days within a 12-month period.

But the changes don't kick in until October 2019, Kosovich said. Still, she applauded the development, calling it "a step in the right direction."

The state health department also welcomed the new legislation, but said its ability to benefit Montana could hinge on whether Medicaid expansion remains in effect beyond its 2019 sunset date.

"We are excited about the legislation and are eagerly awaiting federal guidance, but without Medicaid expansion, the change will not help Montana very much because the population impacted is likely to be those who are also eligible for Medicaid through expansion," wrote Jon Ebelt, DPHHS spokesman, in a statement.

There were roughly 40,000 Montanans covered by Medicaid during the first month of expansion, according to a recent report by the Bureau of Business and Economic Research at the University of Montana. By March, that number had risen to 94,000, the report said.

While opioids have caused 1,334 overdose deaths in Montana between 2003 and 2014, meth remains the No. 1 abused hard drug in the state.

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