HELENA — State leaders gave lawmakers an update Tuesday, as they begin implementing a new law requiring people with certain diagnoses to be moved out of the Montana State Hospital.
House Bill 29 says, by June 30, 2025, the Montana Department of Public Health and Human Services must begin transferring patients out of MSH and into community-based services if they have a primary diagnosis of Alzheimer’s disease, dementia or traumatic brain injury. There’s still a lot to be determined before that deadline arrives.
“This is a very serious, important subject that we’re discussing,” said Sen. Dennis Lenz, R-Billings.
HB 29 set up a Transition Review Committee, including lawmakers and representatives for Alzheimer’s, dementia and TBI patients, nursing homes and assisted living facilities, physicians and families of affected patients. The committee is tasked with reviewing DPHHS’s implementation of the law and efforts to find new placements for the patients. Tuesday was its first meeting.
DPHHS leaders told the committee that the state hospital’s Spratt Unit – which houses older patients with dementia or severe mental illness – had 47 patients as of Oct. 11. Of those, 34 had a primary diagnosis of Alzheimer’s, dementia or TBI.
Rep. Jennifer Carlson, R-Manhattan, who sponsored the bill, said she expected the actual number of patients who might be transferred will be much lower than that – possibly closer to 10 or 12. HB 29 includes an exemption, saying patients don’t have to be moved to other placements if they have recently caused or are at risk of causing harm to themselves or others.
One question is what alternate placements will be available for transferred patients.
During Tuesday’s meeting, Mike Randol, executive director of Medicaid and health services for DPHHS, said the department believed there needed to be greater clarity about what would be included in the definition of “community-based” services, as nursing homes wouldn’t fall under the typical definition they use in connection with federal Medicaid standards. However, Carlson and several other speakers said it was always the intention of the bill that nursing homes be a possible placement for these patients.
Rose Hughes, executive director of the Montana Health Care Association, gave a presentation during the meeting on the role long-term care facilities will play in the upcoming transition. Her organization represents nursing homes and assisted living facilities, and she said there have been a number of barriers to those facilities accepting patients with more extensive behavioral health needs, including regulations, the availability of mental health services in the community, ongoing workforce challenges and funding.
“If you can't care for them, you can't take them – as much as you want to, as much as you think it's your duty – you can't do it if you don't have the resources,” said Hughes.
Hughes said the state has offered additional payments in some cases where a patient requires more extensive services, but that the providers she’s heard from have said their requests for those add-ons have frequently been rejected.
Carlson said the cost of providing care at MSH is significantly higher than it would be at other facilities. She said HB 29 allows for some additional funding to be used in carrying out the transition.
Gov. Greg Gianforte vetoed HB 29, saying it “fails to offer a realistic mechanism” for transferring patients and that the 2025 deadline was “unworkable.” However, 67 House members and 39 senators – more than two-thirds of each chamber – voted to override his veto and enact the bill into law anyway.
Also during Tuesday’s meeting, DPHHS leaders gave an update on their efforts to get MSH recertified through the federal Centers for Medicare and Medicaid Services. In 2022, CMS terminated a provider agreement with the hospital after reports of deficiencies at the Warm Springs facility. That meant the state no longer receives about $7 million a year in federal reimbursement for state hospital services.
Will Evo, chief health care facilities officer for DPHHS, told lawmakers they are now more than halfway through the process of preparing for recertification. He said they’ve hired a new administrator, updated their treatment plans and made other improvements to address the concerns that have been raised. He said they recently hosted visits from state overseers, and that the visitors gave positive feedback about apparent improvements in MSH care and in employee morale.
“We certainly have opportunities to be better,” he said. “The leadership team and staff were very encouraged by the visits and feedback, and as I shared yesterday, we have a long way to go, but we've also come a long way.”
Evo said they plan to ask CMS to survey them for possible recertification in December 2024. He said how quickly they might be recertified and start receiving reimbursement again would depend on the federal authorities’ timeline.