Approved BHSFG Recommendations

This recommendation refines and reconfigures the 0208 Comprehensive Waiver Services rates. It will adjust the rate methodology to better align an individual's support needs with their resources, including increasing Medicaid reimbursement.

Key Accomplishments as of August 2025: DPHHS has finalized the list of services for acuity-based rates, are reviewing tiered rate options, and have a data collection plan. We are also developing a framework for the Supports Intensity Scale® (SIS) pilot assessment.

This recommendation expands the service delivery system to support individuals with complex needs by establishing a more robust continuum of care. It will create a Systemic, Therapeutic, Assessment, Resources, and Treatment (START) certified resource center and clinical team. This team will provide technical assistance and crisis response to existing 0208 Comprehensive Waiver providers. The recommendation also introduces a new residential habilitation service for individuals with complex behavioral and/or medical support needs under the 0208 Comprehensive Waiver.

Update as of August 2025: DPHHS has finalized a contract with the National Center for START (Systemic, Therapeutic, Assessment, Resources, and Treatment) Services (NCSS) to pilot a certified START program. We're also reviewing long-term funding options and assessing the need for additional provider technical assistance.

This recommendation redefines and reopens E&D clinics to better support families. The clinics will handle intake and eligibility for individuals with developmental disabilities seeking the 0208 Comprehensive Waiver, ensuring more efficient support.

Update as of August 2025: On Aug. 26, 2025, the Evaluation and Diagnostic Advisory Committee held its first in-person meeting. Members discussed the previous E&D clinic model and what services to include in the new one.

This recommendation will enhance Targeted Case Management (TCM) by reassessing the reimbursement model, expanding program availability, and piloting a value-based payment model to incentivize providers for improved outcomes.

Update as of August 2025: DPHHS has developed a summary of key challenges, outlining 13 short-term and 9 long-term policy and operational opportunities. Journey mapping and SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goal development is underway across programs to set priorities and guide the design of the future Behavioral Health and Developmental Disabilities (BHDD) Targeted Case Management (TCM) system. Strategy development for this future system is expected to begin in September 2025.

This recommendation implements a tailored care transitions program, such as Critical Time Intervention (CTI), to help individuals released from institutions. The program will provide intensive, short-term support to help them reintegrate into their communities.

Update as of August 2025: DPHHS has developed a research-driven care transitions plan. This plan, which incorporates stakeholder feedback, data analysis, and peer-state and policy reviews, will directly guide the design of the program and the selection of models like Critical Time Intervention (CTI). The program's design is currently in development.

This recommendation will launch a public awareness campaign to increase understanding and improve access to the 988 Lifeline and its behavioral health crisis support.

Update as of August 2025: DPHHS finalized the scope of a Department-wide master services agreement and identified the desired media services, under which the 988-marketing campaign will be launched in the coming months. To inform the design of a Montana-specific 988 marketing campaign, DPHHS conducted numerous interviews with other states, gathering insights and best practices to guide strategy.

This recommendation will redesign reimbursement rates for in-state youth residential services by creating a tiered structure. This structure will align resources with clinical needs and reduce reliance on out-of-state placements in psychiatric residential treatment facilities and therapeutic group homes.

Update as of August 2025: DPHHS has compiled information on youth residential facilities in Montana and comparison states. The Department has also begun discussing an evaluation framework for this recommendation and confirmed that the University of Montana Center for Children, Families & Workforce Development will support stakeholder engagement for rate-setting.

The recommendation will invest in school-based behavioral health initiatives by funding programs, expanding universal behavioral health screening, and collaborating with the Montana Office of Public Instruction (OPI) to adopt supportive policies and identify sustainable funding sources.

Update as of August 2025: This recommendation invests in school-based behavioral health initiatives by funding programs, expanding universal behavioral health screenings, and collaborating with the Montana Office of Public Instruction to adopt supportive policies and identify sustainable funding.

This recommendation addresses behavioral health (BH) and developmental disabilities (DD) workforce shortages by establishing a tuition reimbursement program for case managers and direct care workers. It will also create dual enrollment programs so Montana high school students can earn tuition-free college credits in these fields.

Update as of August 2025: DPHHS has reviewed tuition reimbursement programs and plans to contract with the Western Interstate Commission for Higher Education for a statewide assessment of BH and DD workforce needs. In partnership with the Office of the Commissioner of Higher Education, the Department is also developing a BH and DD dual enrollment program to strengthen the workforce pipeline.

This recommendation expands and sustains Certified Community Behavioral Health Clinics (CCBHCs) to build a more integrated mental health and substance use treatment system with sustainable funding.

Update as of August 2025: DPHHS contracted with Health Management Associates, Inc. to develop the Prospective Payment Rate and draft the Administrative Rules for CCBHCs. Additionally, the Montana Public Health Institute, in partnership with JG Research and Evaluation, was engaged to support community and state system development.