Approved BHSFG Recommendations

This recommendation refines and reconfigures the 0208 Comprehensive Waiver Services rates. It will adjust the rate methodology to better align an individual's support needs with their resources, including increasing Medicaid reimbursement.

Update as of February 2026: DPHHS has finalized the list of services for acuity-based rates and is developing the framework for administering the Supports Intensity Scale (SIS) pilot assessment. The Department is finalizing the contract with the American Association on Intellectual and Developmental Disabilities (AAIDD) for the Supports Intensity Scale Adult Version ® (SIS-A) assessment pilot. Once the contract is initiated, the Department will work with AAIDD to begin scheduling the 500 pilot assessments, which will be conducted both in-person and virtually.

Supports Intensity Scale-Adult Version®, 2nd Edition Fact Sheet

This recommendation expands the service delivery system to support individuals with complex needs by establishing a more robust continuum of care. It will create a Systemic, Therapeutic, Assessment, Resources, and Treatment (START) certified resource center and clinical team. This team will provide technical assistance and crisis response to existing 0208 Comprehensive Waiver providers. The recommendation also introduces a new residential habilitation service for individuals with complex behavioral and/or medical support needs under the 0208 Comprehensive Waiver.

Update as of February 2026: DPHHS is advancing several initiatives to improve crisis intervention for individuals with Intellectual and Developmental Disabilities (IDD) and complex needs:

• START Program Pilot: The Department is partnering with the National Center for START Services (NCSS) to launch a certified pilot program. To ensure long-term sustainability, DPHHS is consulting with NCSS and other states on best practices. The Clinical Services RFP is currently under formal review.
• Gap Analysis & Expansion: An RFI has been issued to identify necessary interventions for individuals in crisis who fall outside the initial START pilot or reside in other regions of the state.
• Specialized Training: DPHHS has partnered with IntellectAbility to develop training for staff and stakeholders. This curriculum focuses on recognizing, understanding, and intervening in crises involving individuals with IDD and complex needs.
• Residential Development: The team is drafting an RFI to engage stakeholders and workgroups in designing and implementing intensive, small-format specialized group homes.

This recommendation redefines and reopens E&D clinics to better support families. The clinics will handle intake and eligibility for individuals with developmental disabilities seeking the 0208 Comprehensive Waiver, ensuring more efficient support.

Update as of February 2026: After completing an extensive review of recommendations and best practices from providers, schools, and stakeholders, the Department is moving into the drafting phase for a new Request for Proposal (RFP).

• Current Action: Collaborating with the E&D Advisory Council and internal experts to finalize the Scope of Work.
• Objective: Secure one or more vendors to provide comprehensive E&D services.
• Timeline: The RFP is expected to be issued in late spring 2026.

This recommendation will enhance Targeted Case Management (TCM) by reassessing the reimbursement model, expanding program availability, and piloting a value-based payment model to incentivize providers for improved outcomes.

Update as of February 2026: DPHHS has been engaging in a robust stakeholder engagement plan since November 2025. The Department is using stakeholder feedback and internal subject matter experts to inform the development of a pilot Value-Based Payment program and explore approaches to increase access to TCM services.

This recommendation implements a tailored care transitions program, such as Critical Time Intervention (CTI), to help individuals released from institutions. The program will provide intensive, short-term support to help them reintegrate into their communities.

Update as of February 2026: Following an RFI in November to assess provider capacity for Critical Time Intervention (CTI), the state has opted to staff the program internally.

Development is ongoing with a targeted July 2026 launch. Immediate priorities include:

• Finalizing program design.
• Conducting stakeholder outreach.
• Posting job listings for program staff.

This recommendation will launch a public awareness campaign to increase understanding and improve access to the 988 Lifeline and its behavioral health crisis support.

Update as of February 2026: DPHHS is collaborating with other state agencies on a statewide master services agreement (MSA) RFP. The RFP was launched on Jan. 22, 2026, and will close on March 5, 2026. Under this MSA, the Department will launch a Contractor Engagement Proposal (CEP) for the 988-marketing campaign. To inform a Montana-specific campaign design, staff interviewed other states to gather best practices.

This recommendation will redesign reimbursement rates for in-state youth residential services by creating a tiered structure. This structure will align resources with clinical needs and reduce reliance on out-of-state placements in psychiatric residential treatment facilities and therapeutic group homes.

Update as of February 2026:  DPHHS collaborated with the University of Montana and Juvenile Justice to design a 4-bed Therapeutic Group Home (TGH) model. This high-acuity framework prioritizes wraparound principles, unconditional care, and intensive family engagement.

Key developments include:

• "No Eject, No Reject" (NENR) Strategy: A recent RFI surveyed youth mental health providers to gauge interest in operating under NENR policies.
• Placement Stability: The goal is to mandate admission for eligible high-acuity youth and limit premature discharges, ultimately reducing reliance on out-of-state providers.
• Next Steps: Data from the RFI will be used to finalize policies that stabilize in-state placements.

The recommendation will invest in school-based behavioral health initiatives by funding programs, expanding universal behavioral health screening, and collaborating with the Montana Office of Public Instruction (OPI) to adopt supportive policies and identify sustainable funding sources.

Update as of February 2026: The Department has reviewed Medicaid funding mechanisms for school-based initiatives in other states. Staff have met with the National Center for Rural School Mental Health to discuss the Early Identification System (EIS) transition and have begun developing and implementing framework for this program.

The Department has active, executed contracts with both the Rural Behavioral Health Institute and the University of Montana's Center for Children, Families, and Workforce Development.

This recommendation addresses behavioral health (BH) and developmental disabilities (DD) workforce shortages by establishing a tuition reimbursement program for case managers and direct care workers. It will also create dual enrollment programs so Montana high school students can earn tuition-free college credits in these fields.

Update as of February 2026: In December 2025, the Department launched two key initiatives to bolster the behavioral health (BH) and developmental disabilities (DD) workforce. First, a contract with the Western Interstate Commission for Higher Education (WICHE) was established to conduct a comprehensive statewide assessment of workforce resources and needs. Simultaneously, the Department partnered with the Office of the Commissioner of Higher Education (OCHE) to build a stronger talent pipeline through the development of dual enrollment and micro-credential programs.

This recommendation expands and sustains Certified Community Behavioral Health Clinics (CCBHCs) to build a more integrated mental health and substance use treatment system with sustainable funding.

• Update as of February 2026: The Department is working with contractors and providers to define the criteria and structure for the nine CCBHC core components.

  Specific focus areas include Mobile Crisis Response, Crisis Receiving, Targeted Case Management, care coordination, evidence-based programming, and identifying universal assessment tools for data reporting.

  Providers have submitted draft cost reports to develop the Prospective Payment System (PPS) reimbursement rate.

  Key dates include:

• SAMHSA CCBHC Planning Grant ends: March 31, 2026.
• CCBHC Demonstration Grant submission: April 1, 2026.