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.

Update as of November 2025: DPHHS has finalized the list of services for acuity-based rates and is developing the framework for administering the Supports Intensity Scale (SIS) pilot assessment. The Department is finalizing the contract with the American Association on Intellectual and Developmental Disabilities (AAIDD) for the Supports Intensity Scale Adult Version ® (SIS-A) assessment pilot. Once the contract is initiated, the Department will work with AAIDD to begin scheduling the 500 pilot assessments, which will be conducted both in-person and virtually.

Supports Intensity Scale-Adult Version®, 2nd Edition Fact Sheet

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 November 2025: DPHHS has been actively working with the National Center for START (Systemic, Therapeutic, Assessment, Resources, and Treatment) Services (NCSS) to lay the groundwork for the pilot a certified START program. The Department has created and intends to submit the START Clinical Services RFP draft for formal review in November, 2025. Additionally, the Department has solicited input from community providers and is formulating an RFI to guide the determination of what additional intervention and training is needed to supplement the work of START for individuals not within that pilot program and in other areas of the state who are experiencing crisis. Finally, the team is exploring successful state models for intensive, specialized, small format group homes.

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 November 2025: The Department has held three Evaluation and Diagnostic Advisory Committee meetings and met with previous and current E&D clinic providers. The team is also exploring other states' E&D model designs and eligibility criteria. This recommendation is currently in the information-gathering phase to inform program design.

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 November 2025: DPHHS has developed a Strategic Vision document and is identifying key stakeholders to inform a robust stakeholder engagement plan for the targeted populations. This work is anticipated to start this month and continue into early 2026.

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 November 2025: The Department released an RFI in November to assess provider capacity for Critical Time Intervention (CTI) in select Montana counties.

Additional work included a site visit to the Montana State Hospital to review CTI integration into existing workflows. Stakeholder engagement in select locations has begun and will continue into early 2026.

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 November 2025: DPHHS drafted and submitted a Department-wide master services agreement (MSA) RFP, which will facilitate the 988 marketing campaign. To inform a Montana-specific campaign design, staff interviewed other states to gather best practices. The Department's current focus is launching the 988 campaign through the MSA. The MSA RFP is anticipated to go live in early 2026, with the 988 marketing campaign following shortly after.

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 November 2025:  The Department has compiled information on youth residential facilities in Montana and comparison states. An evaluation framework discussion has begun, and the University of Montana Center for Children, Families & Workforce Development is confirmed to support stakeholder engagement.

The first internal stakeholder workgroup was held Sept.15th, and external sessions are being planned.

The Department is preparing to release an Request for Information (RFI) to youth mental health providers regarding their interest in operating under a "No Eject, No Reject" (NENR) policy. This policy aims to decrease reliance on out-of-state providers and stabilize youth placement by requiring admission of high-acuity youth (if eligible) and limiting premature discharges.

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 November 2025: The Department has reviewed Medicaid funding mechanisms for school-based initiatives in other states. Staff met with the National Center for Rural School Mental Health to discuss the Early Identification System (EIS) transition and have initiated discussions on an evaluation framework.

Internal stakeholder meetings have begun, and external meetings are planned for the coming months.

Finally, the Department is in the final steps of executing contracts with the Rural Behavioral Health Institute and the University of Montana's Center for Children, Families, and Workforce Development.

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 November 2025: The Department is contracting with Western Interstate Commission for Higher Education (WICHE) to conduct a statewide assessment of behavioral health (BH) and developmental disabilities (DD) workforce resources and needs.

DPHHS is also contracting with Office of the Commissioner of Higher Education (OCHE) to develop a BH and DD dual enrollment and micro-credential program to strengthen the workforce pipeline.

Work on both components will begin upon contract execution.

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 November 2025: The Department is working with contractors and providers to define the criteria and structure for the nine CCBHC core components.

Specific focus areas include: Mobile Crisis Response, Crisis Receiving, Targeted Case Management, care coordination, evidence-based programming, and identifying universal assessment tools for data reporting.

Providers are still submitting cost reports to develop the Prospective Payment System (PPS) reimbursement rate.

Key dates include:

• SAMHSA CCBHC Planning Grant ends: December 30, 2025.
• CCBHC Demonstration Grant submission: April 1, 2026.