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A good idea for getting better value for Montana taxpayers and better care for seriously emotionally disturbed children fell victim to state politics this spring.

The fate of House Bill 100 is regrettable because Montana and some of its most vulnerable children have been denied an opportunity to set up a better system with a pilot project for Medicaid children’s mental health care that would have paid providers based on whether their care actually benefited the kids.

The saga of House Bill 100 also illustrates how partisan politics can kill a good bill.

The story starts in the Interim Select Committee on Efficiency in Government where the children’s mental health care pilot was proposed and strongly endorsed by the committee of half Democrats and half Republicans.

Sponsored by Rep. Ron Ehli, R-Hamilton, HB100 was proposed because Montana Medicaid generally pays a preset rate for services, regardless of the quality of that service.

Pay for performance

HB100 summarized its rationale: “Research in other states indicates that linking provider payments to desired outcomes and quality improvements results in improved access to care, better care integration and coordination, family-focused planning, earlier and less restrictive intervention and a reduced number of treatment days.”

At a January hearing, proponents of the bill included representatives of Yellowstone Boys and Girls Ranch, Intermountain Children’s Home, Billings Clinic, National Alliance on Mental Illness-Montana and Montana Children’s Initiative. There were no opponents.

The bill passed the House 96-2 on Feb. 11, spent a month and a half in a Republican-dominated Senate committee where it was heavily amended and realistic financial incentives for service improvement were nixed.

The Senate passed the amended bill, but the House unanimously rejected it.

The bill went to conference committee where the unworkable Senate amendments were removed and the composition of the task force was changed so that instead of two Republican legislators and two Democratic legislators, the task force would have four Republican lawmakers and two Democrats.

Democrats on the conference committee protested the change from equal partisan legislative representation.

Some Senate Democrats and virtually all House Democrats voted against the conference committee bill, which passed the Senate 40-10 and passed the House 58-42.

In his veto statement Gov. Steve Bullock did not mention the partisan composition of the proposed task force. Instead, he said the bill is unnecessary.

“The Department of Public Health and Human Services is proceeding under those existing authorities with studies and measures that will serve the purpose of this bill,” Bullock said.

Ehli, the bill, sponsor told The Gazette that the veto is very disappointing.

“The bill was a great bill going to the governor,” he said. “This is something providers wanted, seeing if we could come up with efficiencies in Medicaid spending.”

HB100 proposed that a task force, composed primarily of people in the mental health field, spend the next two years figuring out how to set up a pilot project.

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The expenditure over the next two years would have been $20,000 for meetings.

The proposal would have been presented to the 2015 Legislature, which, along with the governor, would have decided whether to proceed.

HB100 was a recognition that Medicaid must change drastically to produce better value for the limited money available.

No more committee

Bullock also vetoed the bill that would have continued the Interim Efficiency in Government Committee for another two years, saying: “I think the lieutenant governor can accomplish a similar mission at less cost to the state.”

The bill proposed spending $80,000 on the efficiency committee.

According to information on the legislative website, 10 bills were introduced on behalf of the 2011-2012 efficiency committee. Four died in the Legislature, one (HB100) was vetoed and five were signed into law.

The governor is responsible for following through on his veto statements. We look forward to learning what efficiencies Lt. Gov. John Walsh and Bullock’s cabinet come up with.

We call on the governor to direct the Department of Public Health and Human Services to work with Montana children’s mental health stakeholders to design a pay-for-performance pilot that he will present to the 2015 session.

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