Montana State Legislature

2007-2008 Children, Families, Health, and Human Services Committee

The Children and Families Interim Committee is a joint bipartisan committee of the Legislature that meets between legislative sessions to monitor the Department of Public Health and Human Services; conduct interim studies; and generally review issues related to health and human services.

The committee's activities for the 2007-2008 interim are summarized in the following reports:

Audio Timeline
Mental Health Study: Items for Possible Committee Action
Mental Health Study: Items for Possible DPHHS Action

Final Report: Legislative Mental Health Study
-- DMA Health Strategies Final Report Presentation
-- Full Report -- Draft (This version will be revised based on comments received at the Oct. 14 meeting)
-- Executive Summary and Summary of Recommendations
-- Introduction, Methodology, and Findings on the DPHHS Mental Health System
-- Financing Opportunities and Organizational Recommendations
-- Mental Health Needs in the Criminal Justice System
-- Appendices
-- Policy Research Associates Attachments (Justice-Involved Individuals)
-- Errata

Mental Health and Justice-Involved Individuals
Summary of Law and Justice Interim Committee bill drafts
-- LC 307
-- LC 516
-- LC 517
-- LC 329

Mental Health System Financing
-- System of Care Account: FY 2008 Report
-- System of Care Account: First Quarter FY 2009 Report

Mental Health System Organization
-- Briefing Paper: Montana's History with Managed Mental Health Care

Draft Agenda
August 21 Minutes
August 22 Minutes
Aug. 21 -- Audio Timeline
Aug.22 -- Audio Timeline

SJR 5 Study
-- LCS5-1: EMT License Plates/Tax Credit
-- LCS5-2: EMS Staffing Levels
-- LCS5-3: EMT on Board of Medical Examiners
-- LCS5-4: EMS Tax Incentives
-- LCS5-5: EMS grant program
-- LSC5-6: Confidentiality of EMS Run Review
-- LCS5-7: Medical Direction/EMS Complaints
-- LSC5-7 Briefing Paper
-- Revised Definition of Volunteer EMT
-- Revisions to EMS Bill Drafts

SJR 15 Study
-- LC 38: Economic Credentialing/Conflicts of Interest
-- LC 38: Explanation of Changes to July 22 Draft
-- LC 38: Review of Stark and Antikickback Acts
-- LC 8887: Extend Moratorium on Specialty Hospitals
-- LC 8888: Revise Definition and Licensing of Specialty Hospitals
-- Hospital Lending Practices: Memo and Summary Table 
-- Statutory Requirements in Selected States: Health Care Facility Information

Mental Health Study
-- DMA Health Strategies Presentation

Committee-Requested Legislation
-- LC 148: Friend of the Respondent -- Briefing Paper
-- LC 149 and LC 149b (revised version): Principles and Methodology for Provider Rates
-- LC 150: Sponsor Notification in Administrative Rulemaking -- Briefing Paper

Agency Monitoring
-- DPHHS Legislation: Delayed/Amended Birth Certificates
-- DPHHS Legislation: Streamlining Child Support Enforcement
-- DPHHS Legislation: Senior and Long-Term Care Accountability Rules
-- DPHHS Legislation: Child Welfare Placeholder
-- DPHHS Legislation: Medicaid Third-Party Liability
-- DPHHS Legislation: Medicaid Buy-in Program
-- DPHHS Legislation: Volunteers-Public Health Health Emergencies
-- DPHHS Legislation: ER and Hospital Discharge Data
-- DPHHS Legislation: EMS Statutory Clarifications
-- Rule Review

Minutes: June 10 Full Committee -- June 11 Full Committee
June 10 -- Audio Timeline
June 11 SJR 15 Subcommittee
June 11 Full Commitee -- Audio Timeline

SJR 5 Study
-- LCS5-1 -- Briefing Paper
-- LCS5-2 -- Briefing Paper
-- LCS5-3 -- Briefing Paper
-- LCS5-4 -- Briefing Paper
-- LCS5-5 -- Briefing Paper
-- LCS5-6 -- Briefing Paper
-- SJR 5 Study: Other Statutory References
-- Legislative Audit Memo on EMS-Related Issues

SJR 15 Study
-- Revised version of LC 38 with May 28 comments
-- For additional comment on LC 38 see Assigned Studies (SJR15) tab below
-- Health Care Facility Survey: SummaryServicesStaffing, Payor Mix 12
-- Briefing Paper: Employment, Staffing, and Insurance Issues

Mental Health Study
-- DMA Health Strategies Update
-- Mental Health Parity: General Overview
-- Children's Systems of Care

Agency Monitoring: DPHHS
-- Rule Review

Minutes: March 17 SJR 15 Subcommittee -- March 17 Full Committee -- March 18 Full Committee
March 17 -- Audio Timeline
March 18 -- Audio Timeline

SJR 5 Study
-- Summary of Testimony

SJR 15 Study
-- LC 38:Economic Credentialing/Conflict of Interest -- Initial Version -- Revised Version
-- LC8888:Specialty Hospitals -- Initial Version -- Revised Version
-- Memo on Initial Bill Drafts -- Memo on Revised Bill Drafts
-- See Assigned Studies for links to Comments Received on Bill Drafts
-- Health Care Facility Survey Update
-- Hospices and End-of-Life Care in Montana
-- Charity Care and Other Community Benefits

Mental Health Study
-- Overview of Montana's Publicly Funded Mental Health System
-- Montana State Hospital Update
-- DMA Health Strategies Presentation

Draft Corrective Legislation
-- LC 41: Clarify exclusions from dangerous drug schedules
-- LC 42: Repeal the sunset provision of the hospital bed tax
-- LC 43: Clarify duration of the caretaker relative educational authorization affidavit

Agency Monitoring: DPHHS
-- Rule Review

Bill Draft on Conflict of Interest, Economic Credentialing
Comments on Specialty Hospitals 

Jan.25 -- Audio Timeline

SJR 5 Study
-- EMS in Montana PowerPoint
-- Reimbursement Issues PowerPoint
-- EMS Elsewhere: Ideas and Approaches Power Point

SJR 15 Study
Hospital Charity Care and Pricing Study and Addendum
-- Requirements in Selected States: Health Care Facility Pricing/Quality and Insurance Information
-- Delivering Healthcare Through Community Health Centers PowerPoint
-- Health Care Facility Survey and Cover Letter
-- NSCL Community Benefit/Tax Exemption Report
-- Health Information Technology: Continuity of Care Record

Mental Health Study
-- Study RFP: Review and Recommendation of Proposals

Agency Monitoring: DPHHS
Explanation of Proposed Cleanup Legislation
-- Rule Review
-- Legal Memorandum: Proposed Changes to Vital Statistics Administrative Rules

--Benefis statement
--St. Peter's Hospital statement and conflict of interest policy 
--Dr. Paul Byorth statement
--Dr. Jim Elliott statement
--Dr. Keith Popovich statement
--Patti Jo Lane statement

Nov. 16 -- Audio Timeline

SJR 5 Study
-- Briefing Paper: EMS by the Numbers
-- Education and Quality Issues in EMS
-- Blackfeet Tribal EMS

SJR 15 Study
-- Updated: Table of Montana Hospitals
-- Updated: Table of Specialized Health Care Facilities in Montana
-- Transparency: Pricing/Quality Transparency
-- Transparency: Texas Center for Health Statistics
-- Transparency: Arizona Hospital Cost Comparisons
-- Transparency: Wisconsin PricePoint
-- Transparency: Pennsylvania Health Care Cost Containment Council Report and Sample Page

Mental Health Study
-- RFP: Explanation and Draft Language and Decision Log Sheet (as approved Nov. 16, 2007)
-- Rhode Island's Integrated Family and Community System of Care 

Agency Monitoring: DPHHS
-- DPHHS Rule Review

SJR 5:  Emergency Medical Services

The 2007 Legislature approved Senate Joint Resolution 5, for a study of emergency medical services in Montana to determine the issues that communities face and to identify strategies for ensuring that services remain in place throughout the state.

At its Aug. 22, 2008, meeting, the committee approved seven bills designed to help with recruitment, retention, and cost issues for volunteer EMS providers and to clarify existing laws as proposed in a performance audit of the state agencies overseeing EMS activities. The committee also approved sending letters to the Department of Public Health and Human Services and the Department of Labor to follow up on other issues that were raised in the audit but did not require legislative action.

The committee bills will be introduced in the 2009 Legislature.

Study Plan

Staff Reports

Related Study Materials

The following materials have been presented by individuals invited to speak to the committee on EMS-related issues:

Draft Legislation

After 14 months of study and public comment, the committee approved the following seven bill drafts for introduction in the 2009 Legislature. The drafts will receive House Bill or Senate Bill numbers when they are formally introduced.They can be followed through the Legislature's bill-tracking system to determine their status at any point in the process, by using the LC number listed below.

The committee also asked two state agencies to follow up on other audit issues:

  • Department of Public Health and Human Services Letter
  • Department of Labor and Industry Letter



SJR 15: Health Care Delivery Systems

The 2007 Legislature approved Senate Joint Resolution 15, calling for a study of health-care delivery systems in Montana to determine how the different means of providing health care services affect the cost and quality of care.

Draft Study Plan (Revised Sept. 12, 2007)
Topics to Consider
Final Report

SJR 15 Subcommittee

A subcommittee made up of Sen. Dan Weinberg and Rep. Ernie Dutton is specifically addressing the specialty hospital moratorium and economic credentialing issues involved in the SJR 15 study. Separate bills are proposed: LC 38 for economic credentialing and disclosure related to conflicts of interest and LC8888/LC8887 for specialty hospitals. Background materials include explanationsof LC38 and a draft review of the Stark and Antikickback Acts.

For Meetings that have audio with minutes, please use the audio archive lookup page.

Next Meeting: No other meetings of the subcommittee are planned. The full committee will review bill drafts at the Aug. 22 portion of its meeting.

Previous Meetings:
June 11, 2008 -- Agenda -- Minutes
March 17, 2008: Agenda -- Minutes -- News Release
Feb. 11, 2008: Agenda -- Minutes -- Listen
Jan. 31, 2008: Brief conference call to discuss Feb. 11 agenda. Notes -- Announcement
Jan. 24, 2008: Agenda --Minutes

Meeting Materials

The following materials are being prepared for the August meeting:
--Latest version of LC 38, with explanations and review of federal laws
--Versions of specialty hospital bills, LC8888 and LC8887

The following materials were prepared for the June 10-11 meeting:
--Revised version of LC 38 with May 28 comments. Decision options
-- Additional MHA comments
-- Response on Insurer Survey by State Auditor
-- Comment from MT Physical Therapy Assn.
-- Comment from Great Falls Clinic representative
-- Comment from Billings Clinic representative, Additional Comments
-- Options for economic credentialingreferralsconflict of interest
--Health Care Facility Survey: SummaryServicesStaffing, Payor Mix 12
--Employment, Staffing, and Insurance Issues Briefing Paper

The following materials were discussed at the March 17 subcommittee meeting:
-- LC 38:Economic Credentialing/Conflict of Interest -- Initial -- April Version 
-- LC8888:Specialty Hospitals -- Initial -- Revised
-- Memo on Initial Bill Drafts -- Memo on Revised Bill Drafts 
-- MHA Comments on LC 38
-- MMA Comments on LC 38, LC8888
-- MHA Proposed Revisions to LC 38
-- Great Falls Clinic Comments on Bill Drafts
-- HealthCenter Northwest Comments on LC8888
-- Jim McClean's Comments on Bill Drafts (for physical therapists)
-- Anderson & Baker Comments on Bill Drafts
-- Iowa conflict of interest policy statement

The following materials were presented at the Feb. 11 subcommittee meeting:
-- Bill Draft on Conflict of Interest, Economic Credentialing
-- Comments on Specialty Hospitals 

The following staff-generated materials were presented at the Jan. 24 subcommittee meeting:
-- Discussion Document: Economic Credentialing/Self-Referral Concerns
-- State Statutes: Specialty Hospitals and Economic Credentialing

The following materials were among those handed out by speakers at the Jan. 24 subcommittee meeting.
--Benefis Statement from Amy Astin
--Byorth Statement
--Jones Statement
--St. Peter's Hospital Statement, Conflict of Interest Policy

Staff Reports

Related Study Materials & Links

Draft Legislation

SB 26 - Economic Credentialing Revisions (LC 341)
SB 52 - Extending Antikickback and Conflict of Interest Regardless of Payor (LC 342)
SB 51 - Describing Health Care Provider Responsibilities, including Disclosure on Referrals (LC 343)

Mental Health Study

The Children and Families Committee heard the final report on its contracted mental health study during its Oct. 14 meeting and acted on several items related to the study. The committee approved the drafting of legislation to:

  • fund existing and new kids management authorities (KMAs) at the community level;
  • provide funds to serve the mental health needs of children up to the age of 6 and of high-risk children with multi-agency needs;
  • clarify existing laws relating to local and regional advisory groups; and
  • request an interim study to create a managed care mental health system operated by a "care coordination organization."

The committee also agreed to ask that legislation proposed by the Law and Justice Interim Committee be amended to include support of local community crisis centers and to require mental health screenings of jail inmates.

In addition, the committee asked that letters to sent to the Department of Public Health and Human Services and to the Department of Corrections, asking the agencies to follow up on several specific items with the next Legislature and with future interim committees. Committee members wanted to ensure that the report's recommendations were considered and pursued over a period of time, recognizing that many of the suggestions needed further review before lawmakers and state officials could determine the best way to put them into effect.

DMA Health Strategies of Massachusetts conducted the study over a six-month period, gathering information from consumers and other stakeholders through the use of interviews, surveys, and focus groups. It also has analyzed data on the use of mental health services in Montana.

The 2007 Legislature approved the study during its May 2007 special session, when it authorized a line-item appropriation of $200,000 in House Bill 2 for "an interim study of mental health." A study resolution initially related to the appropriation was introduced as Senate Joint Resolution 27 in the regular session. The Legislative Council in September 2007 approved a study plan calling for the hiring of a consulting firm to conduct the study, which was assigned to the Children, Families, Health, and Human Services Interim Committee. The committee had agreed in June 2007 to ask that the Council assign the study to the committee.

Mental Health Study Plan

DMA Health Strategies Final Report

The final DMA Health Strategies report is available as either one download (the full report is 144 pages) or in sections, through the following links. The final report, dated Nov. 18, 2008, incorporates comments made at the Oct. 14 meeting and also reflects discussions with DPHHS staff about the data provided for analysis. The significant changes are summarized in an addendum that is located after the Executive Summary.

Staff Reports

Related Study Materials and Links

Draft Legislation

The committee requested the drafting of four bills related to the mental health study. The requests have been assigned the following LC numbers and may be followed in the bill-tracking system when they are drafted and as they proceed through the legislative process.

  • LC 592: Interim study of managed care mental health study
  • LC 593: Fund kids management authorities
  • LC 594: Clarify roles of local advisory groups in the mental health system
  • LC 595: Fund mental health needs of young children and high-risk children with multi-agency needs


Staff Reports

The committee has also approved and sent letters on the following subjects:

Committee Chairman Edith Clark appointed a subcommittee for the SJR 15 study of health care delivery systems, to specifically address the specialty hospital moratorium and economic credentialing issues involved in the Senate Joint Resolution 15 study. Subcommittee members are Sen. Dan Weinberg and Rep. Ernie Dutton.

Additional materials involving the subcommittee are available under the Assigned Studies tab.

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