Montana State Legislature

2011-2012 Children, Families, Health, & Human Services

The committee's activities related to the HJR 8 study of childhood hunger, Medicaid monitoring, the Montana Marijuana Act, and other oversight activities are summarized in its final report, "A Look at Health and Hunger in Montana: Reviewing Programs for Montanans in Need." Activities related to the SJR 30 study of childhood trauma are summarized in a separate report, "Strengthening the Response to Childhood Trauma in Montana."

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Medicaid Monitoring

The Children and Families Committee decided at its June 2011 meeting to spend a portion of the interim reviewing issues related to Medicaid. Committee members decided in September 2011 to incorporate the following topics into their work plan:

  • the use of waivers;
  • managed care options;
  • provider rates;
  • privatization;
  • proposals for block grants and blended rates;
  • the effects of federal health care legislation on Medicaid; and
  • activities in other states.

To date, the committee has undertaken the following activities:

  • September 2011: Received an overview of the Medicaid program and issues related to potential changes to the program under federal health care legislation. A presentation by the National Conference of State Legislatures touched on the types of efforts states have taken to try to control Medicaid costs.
  • November 2011: Reviewed issues related to containing Medicaid costs, including the use of managed care. Representatives of UnitedHealthcare discussed the benefits of the managed care programs they operate, while representatives of mental health providers and hospitals reviewed Montana's past experience with a managed care mental health system. They also highlighted issues that any future managed care plan should take into consideration. The committee also heard about the Health Improvement Program, which is a type of managed care program now used in Montana for Medicaid patients with multiple medical needs.
  • January 2012: Reviewed issues related to error detection in Medicaid billing and to provider rates. Two representatives of Emdeon, a health care data network, discussed ways in which data can be analyzed to prevent incorrect payments. Representatives of the Department of Public Health and Human Services and the Montana Department of Justice discussed the state's current efforts to detect errors and fraud. Representatives of hospitals and of organizations that provide services to children with mental health needs and to people with developmental disabilities talked about how fluctuations in Medicaid reimbursement rates have affected their ability to provide services.
  • March 2012: Received information about matters related to the state's response to the Medicaid expansion under the federal health care law. A DPHHS respresentative discussed the computer system changes the state is making to meet the requirement that the health insurance exchange make determinations about which insurance applicants are eligible for Medicaid or Healthy Montana Kids. A University of Montana Bureau of Business and Economic Research representative discussed the ongoing survey of insured and uninsured Montanans that may provide information about how many more people may be eligible for Medicaid in 2014.
  • May 2012: Approved a bill for introduction in the 2013 Legislature to appropriate $6.5 million in general fund and up to $9.6 million in federal funds to cover the anticipated funding that Medicaid providers lost in fiscal year 2011, when the governor was required by law to make spending reductions. Gov. Schweitzer eliminated a scheduled 2% increase in non-physician provider rates and a 6% increase in physician rates. The bill directs DPHHS to seek federal Medicaid funds to match the state appropriation and appropriates additional general fund money if the federal funds are denied.
  • June 2012: Revised the bill draft for the provider rate payment to appropriate only the $6.5 million in general fund, in fiscal year 2013. The revision was made because of concerns that federal funding could not be authorized quickly enough to match the use of general fund dollars in fiscal year 2013.
  • August 2012: Examined the implications of the Medicaid portion of the U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act. Representatives of governmental consulting firms KPMG, Leavitt Partners, and Deloitte provided information and perspectives about state options in the wake of the decision. The University of Montana Bureau of Business and Ecnonomic Research provided updated information about its survey of insured and uninsured Montanans, providing in-depth information about the study's findings on the potential size of the Medicaid expansion population in Montana and the potential costs the state could incur as the costs of providing care to that group gradually shifts to the states.

Proposed Legislation

Staff Reports

Related Links and Study Materials

The 2011 Legislature approved Senate Joint Resolution 30, for a study of childhood health trauma. The resolution called for a study of promising and evidence-based practices for the prevention of childhood trauma and for reducing its effects on children.

Legislators ranked the study seventh out of 16 study resolutions in a post-session poll, and the Legislative Council in May 2011 assigned the study to the Children and Families Committee.

As outlined in the adopted study plan, the committee began its SJR 30 activities at its March 2012 meeting. Members heard from a number of speakers who covered topics as far-ranging as the development of a child's brain to the ways in which the state responds to reports of child abuse and neglect. The presentations were designed to give national, state, and local views of the many issues associated with childhood trauma. In May, committee members heard more about the Child and Family Services Division workforce and related issues, oversight options for state child abuse and neglect efforts, the use of interdisciplinary teams, and barriers to providing more early intervention services.

The committee approved four legislative proposals as a result of the study:

  • LCCF04, creating an ombudsman office for child abuse and neglect matters;
  • LCCF05, requiring the Department of Public Health and Human Services to seek national accreditation of its child and family protective services program;
  • LCCF07, revising confidentiality requirements for child abuse and neglect reports by expanding the list of relatives who may obtain information from the reports and requiring DPHHS to respond to inquiries from people who have reported suspected abuse and neglect; and
  • LCCF10, to transfer $10 million to the Endowment for Children. Interest from the endowment goes to the Children's Trust Fund, which makes grants to local abuse prevention and mitigation efforts.

Staff Reports

Related Links and Materials

The 2011 Legislature approved House Joint Resolution 8, for a study of childhood hunger. The resolution called for a study of the degree to which Montana children lack access to nutritious food and ways to alleviate childhood hunger and improve access to healthy foods for children throughout the state.

Legislators ranked the study sixth out of 16 study resolutions in a post-session poll, and the Legislative Council in May 2011 assigned the study to the Children and Families Committee.

As outlined in the adopted study plan, the committee gathered information from September 2011 through January 2012 on existing food-assistance programs, farm-to-school efforts, barriers to wider use of various programs, and specific stakeholder suggestions for alleviating childhood hunger.

As a result of the study, the committee agreed to:

  • introduce two bills in the 2013 Legislature, to encourage wider use of the School Breakfast Program and to provide grants to out-of-school programs that alleviate hunger;
  • send a letter to the Office of Public Instruction asking the office to create an online clearinghouse of nutrition education information; and
  • send a letter to farmers' markets around Montana encouraging them to start accepting Supplemental Nutrition Assistance Program (SNAP) benefits.

Proposed Legislation

  • LCCF02: School Breakfast Program Incentives, May 2012 version
  • LCCF03: Grants for Food Programs for Children, May 2012 version

Staff Reports

Related Links and Study Materials

The 2011 Legislature passed House Bill 142, which requires a review of advisory councils and agency reports that are required by state law. The Children and Families Committee is required to review the advisory councils related to the Department of Public Health and Human Services, as well as reports that the agency must submit to the Legislature.

Based on its review, the committee will decide whether any of the councils or reports should be eliminated or whether the requirements for a council or report should be changed.

The committee reviewed information related to the councils and reports at its May 14, 2012, meeting. Members also took public comment at that time. At their June 2012 meeting, they decided against introducing legislation to eliminate or revise any of the councils or reports.

Overview Reports

Individual Reports on Advisory Groups

 

Agenda
 

Aug. 21 Agenda -- News Release

Final Reports

HJR 8 Study: Childhood Hunger
-- Informational Briefing Papers with Options for Consideration, Sue O'Connell, January 2012
    -- Increase Use of School Breakfast Programs
    -- Support Montana Farm-to-School Programs
    -- Review Issues Related to Food Deserts
    -- Create an Education Clearinghouse
    -- Expand Use of SNAP Benefits at Farmers' Markets
    -- Support Gleaning Programs
    -- Donate Montana Correctional Enterprises Food Products
    -- Flexibility in the SNAP and TANF Programs
-- Summary of Suggestions to Date, November 2011
-- Summary of Gap Information Presented to Date, November 2011
-- Unused SNAP Benefits, November 2011
-- State-Run Food Assistance Programs, Sue O'Connell, September 2011
-- Adopted Study Plan, September 2011
-- Draft Study Plan , June 2011

SJR 30 Study: Childhood Trauma
-- Confidentiality and Its Exceptions, Alexis Sandru, June 2012
--Case Worker Conditions: Historical Backdrop, Compiled by Casey Barrs, May 2012
-- Addressing Childhood Trauma: Localized Responses and Oversight Mechanisms, Casey Barrs, May 2012
-- Adopted SJR 30 Study Plan, Oct. 20, 2011
-- Revised SJR 30 Study Plan, Aug. 19, 2011
-- Draft Study Plan, June 2011

Medicaid Monitoring
-- New Questions for the Medicaid Expansion, August 2012
-- Planning for the Medicaid Expansion, March 2012
-- Provider Rates: Overview and Recent History in Montana, January 2012 
-- An Overview of Medicaid Waivers, November 2011
-- An Overview of Managed Care, Sue O'Connell, November 2011
-- Montana's History with Managed Mental Health Care, September 2008
-- Medicaid: An Overview, Sue O'Connell, September 2011
-- Medicaid Enrollment by County/City

SB 423 Monitoring: Montana Marijuana Act
-- Developments Through August 2012, Sue O'Connell, August 2012
-- Registry Statistics for July 2012
-- Developments Through June 2012, Sue O'Connell, June 2012\
-- Registry Statistics for May 2012
-- Developments Through April 2012, Sue O'Connell, May 2012
-- Registry Statistics for April 2012
-- Developments Through March 2012, Sue O'Connell, March 2012
-- Registry Statistics for February 2012
-- Developments Through December 2011, Sue O'Connell, January 2012
-- Registry Statistics for December 2011
-- Developments Through October 2011, Sue O'Connell, Nov. 4, 2011
-- Developments from June 2011 through August 2011, Sue O'Connell, September 2011
-- Registry Statistics for August 2011
-- Registry Statistics for July 2011
-- How SB 423 Changes Current Law, Sue O'Connell, June 2011
-- Overview of Legal Action, Julianne Burkhardt, June 2011
-- Initiative Referendum to Overturn Law, Sue O'Connell, June 2011
-- Registry Statistics for May 2011

Agency Monitoring: DPHHS
-- Administrative Rule Review, Alexis Sandru, Aug. 6, 2012
-- Administrative Rule Review, Alexis Sandru, June 13, 2012
-- Administrative Rule Review, Alexis Sandru, May 2, 2012
-- Administrative Rule Review, Julianne Burkhardt/Alexis Sandru, March 2012
   -- DPHHS Response to Committee Objection, Feb. 3, 2012
-- Administrative Rule Review, Julianne Burkhardt, January 2012
-- Administrative Rule Review, Julianne Burkhardt, November 2011
-- Administrative Rule Review, Julianne Burkhardt, September 2011
-- Administrative Rule Review, Julianne Burkhardt, June 2011
   -- Committee Letter Related to Proposed RVRBS Rule, June 22, 2011
   -- DPHHS Response to Committee Letter, June 28, 2011

CFHHS Proposed Legislation

By the conclusion of the 2010-11 interim, the Children, Families, Health, and Human Services Interim Committee had approved 10 bill drafts for iintroduction as committee bills in the 2013 Legislature. The bills are related to the committee's two assigned studies, as well as to monitoring activities the committee undertook regarding the Medicaid program and general health and human services issues.

The bills are listed below by topic area. The LC number listed first represents the number given to the bill during the committee review process. This link will provide a copy of the bill draft that was approved by the committee.

The LC number in parentheses reflects the drafting number assigned to the bill after the committee voted to introduce the measure as a committee bill. That number may be used to follow the bill's progress on the LAWS bill-tracking system before it's introduced. After the bill is introduced, it will be assigned a House or Senate bill number. At that point, either the official bill number or the LC number may be used for tracking purposes. Using one of those numbers in the LAWS system will give you the latest version of the bill as it makes its way through the legislative process.

House Joint 8 Resolution Study: Childhood Hunger

  • LCCF02: Provide Incentives for School Breakfast Programs (LC 120)
  • LCCF03: Provide Grants for Food Programs for Children (LC 122)

Senate Joint Resolution 30 Study: Childhood Trauma

Medicaid Monitoring

  • LCCF1A: Provide Payments to Medicaid Providers (LC 121)

Other Health and Human Services Legislation

  • LCCF06: Clarify Health Insurance Coverage of Routine Patient Costs During Cancer Clinical Trials (LC 240)
  • LCCF08: Revise Reporting and Investigation of Alleged Abuse at the Montana Developmental Center (LC 310)
  • Review Information Related to Maternal Deaths (LC 311; draft not yet available)

The Legislature, including the Children, Families, Health, and Human Services Interim Committee, plays a significant role in the administrative rulemaking processand is authorized to review administrative rules for compliance with the Montana Administrative Procedure Act, also known as MAPA. More information about the rule review process, the Committee's role and responsibilities, objections to administrative rules, and rules currently proposed by the agency under the Committee's purview is available below or by clicking on the links above.

Contact Alexis Sandru at asandru@mt.gov for more information on administrative rule review by the Committee.

Administrative Rule Review

The Montana Legislature may authorize administrative agencies to implement and carry out legislative enactments through the adoption of administrative rules. An administrative rule is an agency regulation, standard, or statement of general applicability that implements, interprets, or prescribes law or policy or describes the organization, procedures, or practice requirements of an agency. See 2-4-102(11), MCA. When this occurs, the Legislature establishes law through the adoption of statutes and authorizes an agency to make specific rules or regulations to implement or interpret those statutes. Once adopted, administrative rules carry the full force and effect of law and are subject to judicial challenge.

Administrative agencies are required to follow certain procedures in adopting administrative rules. These procedures are set forth in the Montana Administrative Procedure Act (MAPA). The purpose of MAPA is to ensure that the public receives notice of agency rulemaking and is provided an opportunity for meaningful public participation. MAPA also establishes general uniformity for rulemaking across agencies and provides due process safeguards to the public and to those that will be regulated by the administrative rules.

Administrative rules are published in the Administrative Rules of Montana (ARM), which is updated twice a month by the Montana Administrative Register (MAR). The MAR contains rulemaking notices regarding proposed new, amended, or repealed rules. The MAR also contains notices of adopted rules, recently issued attorney general's opinions, and notices of vacancies on state boards. The ARM and MAR are maintained by the Secretary of State's office and may be accessed at the following website: http://www.mtrules.org/.

 

Role of the Children, Families, Health, and Human Services Interim Committee

The Legislature, including the Committee, plays a significant role in the administrative rulemaking process and is authorized to review administrative rules for compliance with MAPA. As part of this process, legal staff for the Committee notifies the Committee members of proposed, amended, or repealed administrative rules and of any concerns regarding the rulemaking process.

The Committee is responsible for reviewing administrative rules from the Department of Public Health and Human Services.

There are several avenues for Committee involvement in the agency rulemaking process. Specifically, the Committee may take any one or combination of the following actions:

  • Request an agency's rulemaking records for checking compliance with MAPA. 2-4-402(2)(a), MCA.
  • Prepare written recommendations for the adoption, amendment, or rejection of a rule and submit those recommendations to the agency proposing the rule and submit oral or written testimony at a rulemaking hearing. 2-4-402(2)(b), MCA.
  • Require that a rulemaking hearing be held in accordance with the provisions of 2-4-302 through 2-4-305, MCA. 2-4-402(2)(c), MCA.
  • Institute, intervene in, or otherwise participate in proceedings involving this chapter in the state and federal courts and administrative agencies. 2-4-402(2)(d), MCA.
  • Poll the Legislature by mail to determine whether a proposed rule is consistent with the intent of the Legislature. The results of the poll are admissible in any court proceeding involving the validity of the proposed or adopted rule. 2-4-403 and 2-4-404, MCA.
  • Require an economic impact statement relating to the adoption of a rule. 
    2-4-405, MCA.
  • Object to all or some portion of a proposed or adopted rule and delay the adoption of the rule for sixth months or delay the effective date of the rule until the day after final adjournment of the next legislative session. 2-4-305(9), 2-4-306(4)(c), and 2-4-406(4), MCA.

Objections to Administrative Rules

The Committee may elect to object to a proposed or adopted administrative rule. If a majority of the members of the Committee notify the chair that they object to a proposed administrative rule, the Committee must notify the agency of the objection and that the Committee intends to address the objection at the next Committee meeting. Following notice of the objection, the rule may not be adopted until publication of the last issue of the register that is published before the 6-month period during which the adoption notice must be published. The Committee may withdraw its objection and allow the adoption notice to be published.

If the Committee meets and objects to all or some portion of a proposed rule before it is adopted because it considers the rule not to have been proposed or adopted in substantial compliance with 2-4-302, 2-4-303, and 2-4-306, MCA, the rule or portion of the rule objected to is not effective until the day after final adjournment of the next regular legislative session. The Committee may withdraw its objection to the administrative rule or the rule may be changed to comply with Committee's objections and concerns. However, the failure of the Committee to object in any manner to the adoption, amendment, or repeal of a rule is inadmissible in court to prove the validity of any rule.

The significance of an objection to an administrative rule is that the Committee may delay the effective date of the administrative rule for 6 months or until the adjournment of the next legislative session. In addition, following an objection the agency may not enforce or implement the proposed administrative rule in question until the new effective date. Finally, by objecting to an administrative rule, the Committee may shift the burden to the agency in a court proceeding to prove that the rule or portion of the rule objected to by the Committee substantially complies with the provisions of MAPA.

Administrative Rule Review Materials for DPHHS

Date Overview
Sept. 25, 2012 Administrative Rule Review

Aug. 6, 2012

Administrative Rule Review

June 13, 2012

Administrative Rule Review
May 2, 2012 Administrative Rule Review
March 8, 2012 Administrative Rule Review

Feb. 3, 2012

 DPHHS Response to Committee Objection

Jan. 23, 2012

 Committee Letter Objecting to RVRBS Rule

Jan. 12, 2012

Administrative Rule Review

Nov. 4, 2011

 Administrative Rule Review
Sept. 1, 2011 Administrative Rule Review
June 28, 2011 DPHHS Response to Committee Letter
June 22, 2011 Committee Letter Related to Proposed RVRBS Rule
June 13, 2011

Administrative Rule Review
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