Interim Committee Encourages Changes in DD Rate Structure, TCM Cuts

Committee: Children, Families, Health, & Human Services Interim Committee
Author: Sue O'Connell
Posted on January 10, 2018

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A legislative committee has asked the Department of Public Health and Human Services to talk with providers of community services for developmentally disabled people to hear their ideas on how to change the reimbursement rate structure and to see if they would accept reduced rates for providing targeted case management (TCM) services.

The requests came after the Children, Families, Health, and Human Services Interim Committee heard testimony from providers about the funding gaps created by the current rate system. Providers and others also discussed the potential effects of the state's plan to eliminate its current TCM contracts as planned on April 1.

The committee met Jan. 18-19 and took up the subjects as part of its House Joint Resolution 24 study of community services for developmentally disabled adults and its oversight duties related to DPHHS. The agency plans to eliminate the TCM contracts and have state employees provide the services to developmentally disabled people as part of the spending cuts the governor ordered to make sure that state spending this fiscal year doesn't exceed revenues.

For the HJR 24 study, the committee heard panel presentations on three topics: the transition of youth from school-based to community services; the use of the funds allocated by the state to provide Medicaid waiver services to adults; and workforce issues that providers are facing. The presentations prompted the committee to suggest that DPHHS meet with providers to hear their ideas for providing more flexibility in the use of waiver funding.

Also at the meeting, the committee received an update on the efforts of the subcommittee working on the HJR 20 study of transparency in health care pricing. The subcommittee met Jan. 17. Rep. Kelker, presiding officer of the subcommittee, summarized the key information members received on health care pricing and reimbursement and on model cost reduction programs during their day-long meeting.

In other activity:

• the committee heard staff and agency reports on the status of Montana's Medicaid expansion program and related workforce development activities, the implementation of changes to the state's medical marijuana program after passage of an initiative in 2016 and legislation in 2017, and the activities of the Office of the Child and Family Ombudsman;
• the State Auditor's Office presented an overview of drug pricing issues for the HJR 17 study of prescription drug prices, outlining the factors driving drug prices and noting potential areas for state action. The committee agreed to have the State Auditor's Office return in June with any suggestions it may have for legislative or other action on drug prices.
• Custer County Attorney Wyatt Glade and Lewis and Clark County Attorney Leo Gallagher raised concerns about the DPHHS decision not to share toxicology reports with law enforcement when children have been exposed to drugs. They said the agency was failing to follow the requirements of Senate Bill 229, passed by the 2017 Legislature. DPHHS Deputy Director Laura Smith said the department believed SB 229 conflicted with a federal confidentiality statute and was working with the federal government to determine whether that was the case.
  
  The committee agreed to ask legislative leaders to seek an attorney general's opinion on the matter. However, DPHHS notified its Child and Family Services Division employees on Jan. 24 that they should begin sharing the information, making an attorney general's opinion unnecessary.

The next meeting of the full committee will be March 22-23 in Helena. The HJR 20 Subcommittee will meet on Feb. 16. For more information about the meetings or the activities of the committee or subcommittee, visit the committee's website or contact Sue O'Connell, committee staff.

Committee Website: www.leg.mt.gov/cfhhs
Committee Staff: soconnell@mt.gov or 406-444-3597