House bill NO. 939

INTRODUCED BY J. Gillette

By Request of the ****

A BILL FOR AN ACT ENTITLED: "AN ACT AUTHORIZING IMPLEMENTATION OF THE CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC MODEL; ESTABLISHING DUTIES OF THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES; ESTABLISHING REQUIREMENTS AND PERFORMANCE MEASURES FOR CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC SERVICES; establishing reporting requirements; and PROVIDING EFFECTIVE DATES."

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:

NEW SECTION. Section 1. Certified community behavioral health clinics -- department duties -- reporting requirement. (1) Subject to available funding, the department shall establish a program no later than July 1, 2025, for the implementation of certified community behavioral health clinics that meet the requirements of Public Law 113-93 and related federal regulations and guidance.

(2) In determining the reimbursement rate for a certified community behavioral health clinic under the healthy Montana kids plan provided for under Title 53, chapter 4, part 11, and the medical assistance program provided for in Title 53, chapter 6, the department shall:

(a) establish and execute clear criteria of the costs that are allowed and disallowed in the development of the encounter rate to be paid to a certified community behavioral health clinic under a prospective payment system;

(b) establish and execute a detailed plan for analyzing cost reports submitted by providers seeking to become certified community behavioral health clinics to ensure that the encounter rate developed for the provider accurately reflects the actual costs of providing care and that disallowed costs are not included in the rate; and

(3) The department shall monitor and evaluate certified community behavioral health clinic services, outcomes, and impacts. Monitoring and evaluation efforts must include but are not limited to:

(a) developing and implementing a plan to reduce duplicative billing of services, fraud, waste, and abuse;

(b) reviewing data on quality measures reported by each certified community behavioral health clinic;

(c) establishing the circumstances under which a certified community behavioral health clinic would lose its certification; and

(d) determining the costs to the medicaid program or other state-funded programs of providing behavioral health care services in a community or region before implementation of the certified community behavioral health clinic program and the costs, including any cost reductions, of providing those services after implementation of the certified community behavioral health clinic program. The costs must include payment for hospitalizations and emergency department visits.

(4) The department shall provide regular updates to the children, families, health, and human services interim committee and the health and human services interim budget committee on:

(a) the status of implementation of certified community behavioral health clinics;

(b) the impacts of implementation on services for individuals with behavioral health needs;

(d) the percentage of high users of medicaid services who have reduced use of medicaid-funded services; and

(e) the community and state-level costs and costs savings related to certified community behavioral health clinics.

NEW SECTION. Section 2. Certified community behavioral health clinic requirements -- billing practices -- performance measurements. (1) In addition to the services required under federal law and regulation, a certified community behavioral health clinic shall directly provide the following services:

(a) targeted case management;

(b) peer and family caregiver services and supports; and

(2) A certified community behavioral health clinic may directly provide or contract with a third party to provide the following services:

(a) outpatient primary care screening and monitoring;

(b) services for veterans and members of the armed forces; and

(3) (a) If a screening indicates that a person is in urgent need of services, a certified community behavioral health clinic shall provide clinical services and an initial evaluation within 1 day of the first contact with the patient.

(b) A certified community behavioral health clinic shall provide a new patient with a comprehensive person-centered and family-centered diagnostic and treatment planning evaluation. The evaluation must be completed within 30 calendar days of the patient's first request for services.

(4) A certified community behavioral health clinic shall provide outreach and education by:

(a) establishing an outreach team to work in hospitals and critical access hospitals to encourage individuals presenting with behavioral health needs at an emergency department to obtain ongoing behavioral health treatment through the clinic to reduce the need for emergency department care;

(b) designating clinicians to work with local law enforcement agencies in order to:

(i) train law enforcement officers in methods for responding to individuals with behavioral health needs; and

(ii) respond directly to individuals who have come into contact with law enforcement because of behavioral health issues; and

(c) designating staff members to encourage the use of the clinic's services by individuals who use a high volume of medicaid resources but who have not been actively receiving behavioral health treatment.

(5) The billing practices of a certified community behavioral health clinic must:

(a) provide that private insurance plans are billed first and that medicaid is billed as a payer of last resort;

(b) include an income-based sliding fee scale that is made public; and

(c) establish that the certified community behavioral health clinic may not refuse services to a person who is unable to pay.

(6) In addition to any federally required reporting, each certified community behavioral health clinic shall collect and report to the department, in a deidentified manner, data on the following quality measures:

(a) changes in the functional assessment scores of patients; and

(b) baseline and subsequent changes in a patient's:

(i) status as housed or unhoused;

(ii) engagement in work; and

(iii) law enforcement involvement.

(7) A certified community behavioral health clinic that contracts with another provider for services as allowed under federal law and regulations and this section is responsible for:

(a) collecting and reporting on the data required under subsection (6) and any other information required by the department; and

(b) ensuring that the contracted provider follows all applicable state and federal laws and regulations.

NEW SECTION. Section 3. Appropriation. The following amounts are appropriated to the department of public health and human services for the purposes of preparing for the implementation of certified community behavioral health clinics as provided in [section 1]:

General Fund Federal Special

Fiscal Year 2024 $327,109 $327,109

Fiscal Year 2025 $325,832 $325,832

NEW SECTION. Section 4. Codification instruction. [Sections 1 and 2] are intended to be codified as an integral part of Title 53, chapter 21, part 10, and the provisions of Title 53, chapter 21, part 10, apply to [sections 1 and 2].

NEW SECTION. Section 5. Effective dates. (1) Except as provided in subsection (2), [this act] is effective on passage and approval.

(2) [Section 3] is effective July 1, 2023.