Members of the conference committee on Senate Bill 2399 voted unanimously to add $1,307,174 in general-fund costs to the bill and to accept House amendments with further changes after a discussion about psychiatric residential treatment facilities, reimbursement and recent changes to admissions screening.

The amendment to include the appropriation passed 6-0 on a roll call that recorded aye votes from Senator Lee, Senator Van Osteen, Senator Hogan, Representative Steaman, Representative Wagner and Representative Hawley. The committee then voted 6-0 to accept House amendments and further amend the bill.

The discussion focused on how Medicaid medical-assistance reimburses PRTFs and on recent changes to the state's placement-screening process. Representative Seaman said conferees selected a $500 supplemental payment to help facilities cover fixed costs for keeping beds available, saying the figure attempts to balance some expected savings while recognizing ongoing facility expenses: “We came up with the level of $500 because, there's probably some savings, but we also know they have to provide some services too.”

Sarah Aker, executive director for the Division of Medical Services in the North Dakota Department of Health and Human Services, described a July change to admissions screening called the “one assessment.” Aker said the one assessment evaluates multiple levels of care in a single process — PRTF, qualified residential treatment programs (QRTPs), treatment foster care and community-based options — and produces a recommendation about the most appropriate placement. “We called it the one assessment. And really, it's because it's one assessment that looks at a variety of levels of care,” Aker said. She added the department is still analyzing data to learn where children ultimately receive care and what gaps exist in the continuum.

Committee members and providers said the one-assessment process has made placement determinations more transparent to the department but has also introduced practical challenges for families. A representative of a provider organization told the committee that some families find the new process administratively daunting and that, as a result, some never complete the referral and therefore do not receive alternative services. “We're hearing from families that that's just a really daunting process,” said Tim Ganger, who identified himself with Dakota Boys and Girls Ranch.

Committee members discussed other technical elements of implementation. Aker explained the bill directs the department to use a utilization-control process that includes service authorization and to set a base number of therapeutic-leave days that a facility may use without additional approval; facilities would request additional leave days from the department with supporting documentation. Committee members noted existing administrative licensing rules already include a discharge-planning checklist with requirements such as a seven-day notice to families or custodial workers and medication-transfer steps.

Department staff also told the committee they plan to pursue value-based purchasing work under the agency's budget bill (House Bill 1012) to design a new payment model that could incorporate outcome-based reimbursement for PRTFs. Committee members noted the bill as drafted carries no appropriation, and the committee inserted the fiscal support after reviewing the fiscal note: $647,000 general funds in year one and $880,122 in the following biennium, totaling $1,307,174.

Votes at a glance: the amendment to add costs to SB2399 (moved by Senator Hogan, seconded by Representative Steaman) passed 6-0; the motion to accept House amendments and further amend the bill (moved by Senator Hogan, seconded by Representative Steaman) also passed 6-0.

Committee members said they do not intend to substantially change the bill language in committee but want better information about how children flow through the system and how the department's data and policy work can address access and placement concerns. After the votes the committee disbanded.