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Medicaid Providers Say State Health Department Putting Unfair Share of Cuts on Them

Written by Holly K. Michels in the Independent Record on July 24, 2017

In an attempt to adapt to significant budget cuts, the Montana Department of Public Health and Human Services is proposing to reduce reimbursements to doctors and others who treat patients on Medicaid by nearly 3.5 percent.

Providers say that cut is too severe and an unfair way for the department to put the burden of belt-tightening disproportionately on them.

The state legislative committee that oversees the department will file a formal objection to the proposed cuts as well, saying it conflicts with how lawmakers intended the agency make ends meet.

The cuts are included in a proposed administrative rule. The health department will hold a hearing on the proposed rule this Thursday at 8:30 a.m. in Helena at 111 N. Sanders St. and is meeting with reporters Wednesday to discuss the cuts.

The department could have to reduce its budget by $14 million under a law passed by the Legislature this spring requiring mandatory cuts if state revenues came in below what was expected. An announcement is expected Tuesday on how severe cuts will be . . . . Click here to read the entire article.

Montana Mental Health Care Advance Directive

With the creation of advance medical care directives being so popular, people are also asking if they need a Mental Health Care Advance Directive to document their wishes for treatment and care in the event that they become incapacitated through a mental illness. The purpose of the Mental Health Care Advance Directive is to "promote more timely, informed, compassionate, and effective mental health care," among others. See Mont. Code Ann. § 53-21-1301. Disability Rights Montana has created a form and instructions to assist people who experience mental illness to prepare a Mental Health Care Advance Directive to prepare for the possibility that they may become unable to express their own wishes regarding their care and treatment. A Mental Health Care Advance Directive provides the legal authority for provision of mental health care during a period of incapacity, even over the person’s own protests. Mont. Code Ann. § 53-21-1301.

This Mental Health Care Advance Directive form and associated documents and instructions are not legal advice, nor are they a substitute for consultation with an attorney.  Click here to download the Montana Mental Health Care Advance Directive form and instructions.

DRM Education Website and Student Rights Handbook

Disability Rights Montana launched its Education Website and published its Student Rights Handbook. The project is designed to help parents, advocates, and educators learn about the legal requirements and resources available for students with disabilities and to help ensure the civil and legal rights of students with disabilities are protected to the maximum extent of the law.  The site focuses on the educational rights of children with disabilities, but also covers information applicable to students with disabilities of all ages. Our Education Website can be accessed here on our home page by clicking "Education" on the Menu Bar above or directly at The Student Rights manual can be found on the site or directly at  

On the site you will find information about DRM′s education workgroup, the legal rights of students with disabilities, resources for parents, students and educators, and sample forms to assist parents and advocates in protecting student’s rights. It is our hope that this website will be a valuable resource for everyone working to educate Montanans of all abilities. 

We welcome feedback and comments for how we can improve our Education Website as well as information about resources and practitioners we should include. As always, if you have questions, please feel free to contact DRM. DRM’s Education Website and Student Rights Handbook were authored by Tal Goldin, supervising attorney for DRM’s Education Unit, with editing assistance from Kelsi Steele, DRM Education Advocate, and Laurie Danforth, DRM paralegal and executive assistant.  The project was supported in part by a generous grant from the Montana Justice Foundation.

Overview of the 2017 Legislative Session

DRM went into the session with some very good proposals from interim committees and the Sentencing Commission. These included bipartisan proposals to expand waiver slots for senior and long term care by 200 over the biennium to address a waiting list of over 500, to create an interdisciplinary committee to review our antiquated guardianship laws, provide funding for the area agencies on aging and for respite services, funding for housing to transition people from prison to the community, licensure of peer support specialists for people with mental illness, suicide prevention efforts, and reforms to the current sexual assault laws to more appropriately address how sexual assault actually occurs.

These proposals were great ideas and many were successful through the process. However, given the tight budget and lower than predicted revenue for the biennium, those that had fiscal implications had a much more difficult time. The funding for the area agencies on aging and the funding for respite services did not materialize. In addition, although the proposal for additional waiver slots for senior and long term care along with increased rates for assisted living services passed through both houses, in the last days of the session, it was made contingent upon certain revenue projections that are likely unrealistic.

Fortunately, the guardianship committee proposal was ultimately passed, as was peer support certification, sexual assault reform, transitional housing, suicide prevention, as well as new proposals such as certifications for board certified behavior analysts, a requirement that insurance cover mental health and substance abuse care as they cover physical illness claims, provide a new assisted living licensure to help divert people with Alzheimer’s or dementia from involuntary commitment at the Montana State Hospital, prohibit DPHHS rules from discriminating against children in foster care, require habilitation services under the Healthy Montana Kids Plan, and require DPHHS to comply with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements from federal Medicaid law.

Given the budget situation this session, we saw no provider rate increases in the budget. As providers of mental health, developmental disability, and personal care services have fallen far behind in their ability to provide a living wage to their employees, address deferred maintenance and cover fixed costs, the absence of an increase in Medicaid reimbursement rates dealt a real blow to these community systems that provide essential services to people with disabilities. There were some proposals to increase wages for some of these workers. Although it was well acknowledged that the current wages are unacceptable, increased wages for direct care workers was generally unsuccessful. Fortunately, a study of the developmental disability services system in Montana, which identify this as one of the issues to be addressed, was passed by the legislature to be addressed in the interim.

There were other disappointments this session as well. A proposal to keep a 12 bed unit on the Montana Developmental Center (MDC) campus open to provide crisis services passed. The MDC closure process has been very successful so far but is not yet finished. Therefore this decision is quite premature. We strongly believe that crisis services should be established throughout the state, instead of concentrated on the MDC campus. We still see abuse and neglect rates that are unacceptable at MDC, and we have no reason to believe that this will improve once it is reduced to 12 beds from the current 23.

We also were very disappointed that proposals to provide special education to students up to 22 years old as well as address special education funding failed. After an excellent hearing where many parents and advocates spoke convincingly about the need for these services to extend to age 22, the cost of the proposal was just too much during a legislative session with such a tight budget.

Proposals to give due process to people found guilty of felonies but mentally ill before they are sent to the prison, and to ban solitary confinement of inmates with mental illness also did not survive the process. However, we were happy to see that interim studies of the use of solitary confinement in our adult and youth correctional facilities as well as the purpose of all of our correctional facilities both passed the legislature.

We were happy to see the demise of measures to make misdemeanor assault into a felony if the victim was a nurse, allow up to a year in jail for public nuisance offenses by homeless people, ban people from using the bathroom that does not correspond to the gender on their birth certificate, which would inexplicably burden people with disabilities with personal care attendants of a different gender, and penalize the "fraudulent" use of a service animal, where there is no means to demonstrate the non-fraudulent use of them.

Click here to read the DRM E-Newsletter which includes a summary and outcome of bills DRM followed throughout the session.


PAIMI Advsory Council Meeting

The PAIMI Advisory Council meeting is scheduled for Wednesday, September 27, 2017, from 10:00 a.m. until 2:15 p.m., at the Disability Rights Montana Office located at 1022 Chestnut Street, Helena, Montana. The public is welcome. If you wish to attend, please call our office at 449-2344 or 1-800-245-4743 and let us know whether you need an accommodation.

DRM Board of Directors Meeting

The DRM Board of Director’s meeting is scheduled for Thursday, September 28, 2017, from 9:00 a.m. until 3:00 p.m., at the Disability Rights Montana Office located at 1022 Chestnut Street, Helena, Montana. The public is welcome. If you wish to attend, please call our office at 449-2344 or 1-800-245-4743 and let us know whether you need an accommodation.

Disability Rights Montana's specialty license plate is now available. You can purchase the plate by visiting your county treasurer's office. A one-time administrative fee and production cost for the specialty plate will be collected along with the standard vehicle registration fee and sponsor donation fee.

DRM License Plate Design

$20 Yearly Tax-deductible Donation to DRM
$10 One-time Administration Fee
$10 One-time Production Cost

Please show your support with the DRM license plate! Your purchase of the plate includes a $20 tax-deductible donation to support DRM and its work to protect the rights of Montanans with disabilities.

Get Your Raffle Ticket Now to Support Disability Rights Montana

Support Disability Rights Montana and become eligible for great prizes by entering the 23rd annual Montana Shares Raffle. Montana Shares is a partnership of nonprofit organizations working to build better communities across Montana. Contributions to member groups are made through Montana Shares each year during statewide workplace giving campaigns. All donations to the raffle support Montana Shares in its efforts to helping Disability Rights Montana and other nonprofits diversify fundraising and raise public awareness. Raffle tickets and the list of prizes can be downloaded by clicking here.

We urge you to enter the raffle today and help support this great organization. Through Montana Shares, Disability Rights Montana is able to raise thousands of additional dollars through workplace giving each year and raise public awareness within state and federal agencies and the more than 150 other workplaces that take part in the annual giving campaign.

To enter the raffle, return the tickets, along with a check before September 9th, 2017 to:

Montana Shares
P.O. Box 883
Helena, MT 59624

Thank you for your support of MontanaShares and Disability Rights Montana.

DRM released its May 2017 issue of its Transition Newsletter. You can access the Newsletter by clicking here. Articles include: Self-Employment; PASS Plans; Meet these Entrepreneurs: Lissie's Luv Yums, Melissa Clark, CEO, and Isaac Baldry, owner of Isaac Baldry Consulting.

Triumph From the Trenches - a WIN for People
with Disabilities!

Written by: Montana Fair Housing

Kristen Newman, Montana Fair Housing and the US Department of Justice won, by unanimous verdict following a seven-day trial, $37,343 in compensatory and punitive damages against Jaclyn Katz, a Real Estate Broker and agent, and property manager in Bozeman.

Kristen Newman, a person with disabilities, was charged a $1,000 security deposit for her service dog, Riley. At trial, Kristen testified that Riley assisted her in living with the symptoms of her disabilities, and that she repeatedly informed Katz that charging a deposit for a service animal was illegal, adding that she understood she would have to pay for any damage caused by Riley. Katz refused to waive the deposit for Riley, and even threatened to terminate Newman’s tenancy.

In September 2013, Kristen contacted Montana Fair Housing for support and information. "Being able to go to Montana Fair Housing for help and have people who would be there for me from beginning to very end, was integral for me as a person with a disability."

In December of 2013 Ms. Newman and Montana Fair Housing filed complaints of housing discrimination with the U.S. Department of Housing and Urban Development (HUD). Despite multiple efforts during the HUD investigation to conciliate the cases, Katz refused to change her practices. In August of 2014, HUD issued a finding of reasonable cause to believe Katz discriminated against both Kristen and Montana Fair Housing.

Following the issuance of the charge, the Defendants elected to file in federal court.

The verdict includes $11,043 in compensatory damages for Ms. Newman, $20,000 in punitive damages for Ms. Newman, and $6,300 for Montana Fair Housing, Inc.

For additional information or assistance, please contact:

Montana Fair Housing
501 East Front Street, Suite 504
Butte, MT  59701
Montana Relay: 711
Voice 406-782-2573

Best Practices in Community Services for People Who Have Developmenta...

Below is a video of a converation with Allan Bergman with a positive view of the national movement to close institutions, as it has led to the creation of systems that help people live fuller and more positive lives than they had in institutional settings.

This video is a follow-up to the first in the bipartisan public education series "Best Practices in Community Services for People who have Developmental and Intellectual Disabilities" which was held on March 23, 2016, at the Montana Capitol. The bipartisan public education series was developed by Senator Ed Buttrey and Senator Mary Caferroto to help build understanding of cri More....

DRM Releases Report
Disability Rights Montana released a report January 23, 2015, with significant details of numerous case stories of abuse and neglect at the Montana Developmental Center.  Investigations conducted by the Department of Justice over the course of the past year reveal that twenty-seven staff members, including the Director of Quality Assurance and Superintendent, have been involved in the case stories.  Some of the cases involve serious injuries, rape, and felony assault.   

DRM has monitored MDC for more than twenty years, and cites a climate and culture at MDC that perpetuates and tolerates abuse.  The cases cited in the report document slapping, grabbing, squeezing, pulling residents by the ankles, throwing them hard to the ground, kneeling o More....