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 June 2026: 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.

Join Our Stakeholder Meetings. The Montana Developmental Disabilities Program (DDP) is moving forward with the pilot implementation of the Supports Intensity Scale-A (SIS-A) assessment tool. We invite self-advocates, families, providers, and case managers to attend our upcoming meeting to learn about the transition, ask questions, and share your valuable feedback as we build a more transparent support system together. The next meeting opportunity is July 9^th, 2026, from 1:00 PM to 3:00 PM.

Microsoft Teams meeting

Join: https://teams.microsoft.com/meet/223249849416754?p=O86VRBOQkyhziRvuXK
Meeting ID: 223 249 849 416 754
Passcode: 9J7dV9Nk

• Supports Intensity Scale-Adult Version®, 2nd Edition Fact Sheet (PDF)

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 June 2026: DPHHS is advancing several initiatives to improve crisis intervention for individuals with Intellectual and Developmental Disabilities (IDD) and complex needs:

• START Program Pilot: The Department is partnering with the National Center for START Services (NCSS) to launch a certified pilot program. To ensure long-term sustainability, DPHHS is consulting with NCSS and other states on best practices. The Clinical Services RFP (START Program and START Resource Center) posted on June 3 and will close on July 15. This RFP is being issued to procure a provider to hire and train both the START clinical and therapeutic coaching teams..
• Specialized Training: DPHHS has partnered with IntellectAbility to develop training for staff and stakeholders. This curriculum focuses on recognizing, understanding, and intervening in crises involving individuals with IDD and complex needs.
• Residential Development:  Request for Information responses are currently under review to help design intensive, small-format specialized group homes. Concurrently, a program proposal is being drafted and a workgroup formed to gather ongoing stakeholder feedback.

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 June 2026: After completing an extensive review of recommendations and best practices from providers, schools, and stakeholders, the Department has submitted a new Request for Proposal (RFP).

• Current Action: The scope of work has been finalized, and the internal review process has begun.
• Objective: Secure up to three vendors to provide comprehensive E&D services across the state of Montana.
• Timeline: The RFP is expected to be issued in fall 2026.

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 June 2026:  Guided by data and stakeholder feedback, DPHHS is creating Value-Based Payment (VBP) frameworks across three Targeted Case Management (TCM) service lines. The first pilot focuses on Youth with Serious Emotional Disturbance (SED). To help expand access to TCM services, seven TCM Access Grant awards were awarded to providers to hire additional Targeted Case Managers for this population. The Access Grants for the Adult Mental Health population is currently being reviewed and will be available via Submittable this summer.

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.

• BHSFG Recommendation 8 Fact Sheet (PDF)

Update as of June 2026: After assessing provider capacity, the state will staff the Critical Time Intervention (CTI) program internally through a new Care Transitions Section. A program supervisor started in May 2026, with CTI Workers expected to be hired in July and client services beginning in August. Initially, the program will help individuals discharging from Montana State Hospital reintegrate into Butte-Silver Bow, Yellowstone, and Missoula counties, with further expansion planned.

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 June 2026: DPHHS is collaborating with other state agencies on a statewide master services agreement (MSA) RFP. The RFP was launched on Jan. 22, 2026, and closed on March 12, 2026. The multi-agency review team just concluded their scoring and Department of Administration has begun the contracting process. Later this summer, the Department will launch a Contractor Engagement Proposal (CEP) for the 988-marketing campaign under the MSA. To inform a Montana-specific campaign design, staff interviewed other states to gather best practices.

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 June 2026: DPHHS collaborated with the University of Montana, youth behavioral health providers, and other stakeholders to design a new service level known as the Intensive Therapeutic Group Home (ITGH). This 4-bed high-acuity residential model is intended for youth with complex profiles, including youth under 12, dual diagnosis, multiple disrupted placements, or high-risk behaviors. ITGH prioritizes wraparound principles, unconditional care, and intensive family engagement.

Key developments include:

• PRTF Bed Capacity Grant: The Department granted $618,500 each to Shodair Children’s Hospital and Yellowstone Boys and Girls Ranch to expand the Psychiatric Residential Treatment Facility bed count available to Montana youth. The effort increases treatment accessibility to youth specifically enrolled in Montana Medicaid and Healthy Montana Kids (HMK), with a special emphasis on those with complex care needs who are often harder to place.
• Reimbursement Structure: The Department is contracting with Guidehouse to design reimbursement rates for ITGH and an acuity-enhancement rate modifier for PRTFs and TGHs. These will allow in-state providers to increase staffing and specialized supports to effectively meet youth needs and maintain placement stability.

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 June 2026: The Department has reviewed Medicaid funding mechanisms for school-based initiatives in other states. Staff have met with the National Center for Rural School Mental Health to discuss the Early Identification System (EIS) transition and have begun developing and implementing framework for this program.

The Department has active, executed contracts with both 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 June 2026: In December 2025, the Department launched two key initiatives to bolster the behavioral health (BH) and developmental disabilities (DD) workforce. First, a contract with the Western Interstate Commission for Higher Education (WICHE) was established to conduct a comprehensive statewide assessment of workforce resources and needs. WICHE continues to collect information to better identify workforce gaps across BH and DD services in Montana.

Simultaneously, the Department partnered with the Office of the Commissioner of Higher Education (OCHE) to build a stronger talent pipeline through the development of dual enrollment and micro-credential programs. Several proposals have been received by OCHE for the micro-credential pathways across both behavioral health and developmental disabilities focus areas.

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 June 2026: In May 2026, Montana was selected as one of ten states to receive federal funding to participate in the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program. The selected states will participate in the four-year federal program to establish clinics that serve any Montanan seeking care for mental health or substance use challenges, regardless of their age, place of residence, or ability to pay. By securing this funding, the state will rely less on short-term grants in order to deliver needed care. 

The Department has submitted is Demonstration Grant application to the Centers for Medicare and Medicaid Services. In preparation for an Oct. 1, 2026 go-live, the Department, contractors, and four provisionally certified CCBHC providers are actively reviewing a draft provider manual. Core program focus areas include mobile crisis response, crisis receiving, targeted case management, care coordination, evidence-based programming, quality evaluation, and universal assessment tools.

Key dates include:

• Demonstration Grant Application award: July 1, 2026.
• CCBHC Go-Live: Oct. 1, 2026.