[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6363080,"mediaKeyId","2166744-57db4f3a182d3c6f278916223ea49f95","parentId",2166744,"title","State implements single assessment for youth levels of care and seeks funds for voluntary treatment, partial hospitalization and youth crisis services","audioSeconds",2578,"startMs",6753000,"endMs",9331000,"viewUrl","/Search/View?dp=1&key=2166744-57db4f3a182d3c6f278916223ea49f95&start=6753&end=9331","thumbnailUrl","https://assets.pipeline.soar.com/2166744-57db4f3a182d3c6f278916223ea49f95/thumbnail_6753000.jpg","articleUrl","/articles/6363080/North-Dakota/State-implements-single-assessment-for-youth-levels-of-care-and-seeks-funds-for-voluntary-treatment-partial-hospitalization-and-youth-crisis-services","mediaUrl","https://secure.pipeline.soar.com/6363080-f3ca7e0161f7d18703cb10e834efd758/orig.mp4?Expires=1773699009&Signature=aih2aA-5stvp0TGSsEyNM8QZIciITAPccItUSB1JmI699JNeKmBwxHueu44-1DvmH7IN25XQPAWaNmRC0hr-iIAiD9YOc1hJbMRSyh-4wDdgztltii8vT6QGR6i4x0KqRAhppA~fx1zTLf-KQXx07DOgR8GXGkulvrNFhc5NM2VHChFSCTxWR9H43XkDZuq8g7JkQ1tACLjWDaMEe74ztlvtvjf-38v8gKJ~Nx7R6YFeq5mbw4h0sZGY9UFR-5UsXG5c~xWRNBNO16uMyajvRqaa7dFDf8k~VrETDbQ2xJ7mUPk3ZOi2lLNDU~Olc1wvtk8SkAowhj-2XYvsudezrA__&Key-Pair-Id=KUT5TJCACFTXG","author","House Appropriations - Human Resources Division, ND","date","2025-01-29T00:00:00Z","article","Dr. Shawna Eberhardt, clinical director for behavioral health policy, and Dr. Melissa Kynes, utilization-review administrator with Medical Services, briefed the Appropriations Committee on changes to how the state assesses and routes children and youth to higher levels of behavioral-health care.

One‑assessment rollout: Dr. Kynes said federal rules require independent review when Medicaid-eligible youth are admitted to inpatient psychiatric services and that North Dakota implemented a single, consolidated review process—called the \"1 assessment\"—effective July 1, 2024. The state contracts with an independent vendor (Maximus) to conduct clinical reviews, interview families and issue level-of-care determinations for psychiatric residential treatment facilities (PRTFs), qualified residential treatment programs (QRTPs) and treatment foster care (TFC).

Kynes told the committee there were 413 assessments in the first six months of full implementation, with 355 approvals for PRTF, QRTP or TFC levels of care; she also described how the consolidated process replaces multiple, fragmented entry points and creates a single point of entry so families receive consistent clinical review and state staff can better identify trends.

Voluntary Treatment Program (VTP): Dr. Eberhardt described the VTP, which helps Medicaid-eligible children from private family homes access QRTP placements where clinically appropriate. She said the program’s average episode cost in recent data was about $70,000 per child and that the division had used mental-health block-grant funds to continue placements when statutory appropriations were exhausted; the division requested additional funds so a larger number of youth could be served in the coming biennium.

Partial hospitalization/intensive day treatment and youth crisis services: Eberhardt said access to partial-hospitalization programs (PHPs) and intensive-day treatment is limited in the state and requested funding to develop or expand those services. She also described a proposed youth crisis residential option—non-ER receiving and stabilization centers tailored for children—that would provide short-term, trauma-informed placements and multidisciplinary staffing as an alternative to emergency rooms, detention or certified shelters.

Trauma-focused therapy: The division asked for continued and expanded funding for trauma-focused cognitive behavioral therapy (TF-CBT) training and technical assistance (Treatment Collaborative for Traumatized Youth). The agency reported about 550 clinicians trained since project start and asked for funding to add workshops, expand western‑North Dakota training and increase ongoing technical assistance.

Committee members asked for additional operational data, including the number of youth currently in out-of-home placements, bed availability in PRTFs (agency listed a total licensed capacity of 82 beds and about 73 operational beds) and how many additional inpatient or residential beds might be needed. Agency staff said some of those needs may be addressed by building partial-hospitalization capacity and by expanding community-based services to avoid higher levels of care when clinically appropriate.

Ending: The 1 assessment creates a single, documented pathway for clinical review; the division asked for decision-package funding for VTP, partial-hospitalization start-up, youth crisis residence pilots and TF-CBT expansion and said it would provide further data on capacity and need.","mediaType","Video","parentTitle","House Appropriations - Human Resources Division Jan 29, 2025\t","oneSentenceSummary","Officials described the July 1, 2024 rollout of a single ‘1 assessment’ process for youth needing residential or inpatient behavioral-health care, and presented decision packages asking for funding for voluntary treatment for private-custody youth, partial-hospitalization programs, youth crisis residences and expanded trauma-focused therapy.","taxTitle","Appropriations - Human Resources Division, House of Representatives, Legislative, North Dakota","taxId",28888,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6363084,"Appropriators hear growing use of SUD voucher, recovery housing; IMD cap and opioid settlement funds shape requests",1651,4277000,5928000,"/Search/View?dp=1&key=2166744-57db4f3a182d3c6f278916223ea49f95&start=4277&end=5928","https://assets.pipeline.soar.com/2166744-57db4f3a182d3c6f278916223ea49f95/thumbnail_4277000.jpg","/articles/6363084/North-Dakota/Appropriators-hear-growing-use-of-SUD-voucher-recovery-housing-IMD-cap-and-opioid-settlement-funds-shape-requests","https://secure.pipeline.soar.com/6363084-f96a42d51528ed98fe396def5a9a64b3/orig.mp4?Expires=1773699009&Signature=LWKW9~sCBx49A--G-hp-BVwadZD5TZ1VFXma95Gt7-McAPVbMo-mWOT6XhHcp65hVED4qmM2v9-ILEozjjmc30GrHPJSeL0FJikpGCDkRmna8Kf89rlyo-5ogG4Ybs1Mli5qPKgJtD-FqgSiXHyty8kdR5mEVlBvQUmjhelNChyrs6J1UFiDuwgARvsp11rPA94e145QoRsALrLgJhIciRvVyjgkMbIlCElKFAhONjy4kFXeaZ3oOwnzxohwD9i95jWuzffWfjY2TxgRBeuX2IFowerMbIF0OKVmvgVRXM92HEfFt0MDSTgN71FS48MgbA16N1CI9fvnATETZbktkQ__&Key-Pair-Id=KUT5TJCACFTXG","Laura Anderson, policy director for the Behavioral Health Division, summarized the SUD voucher program and related housing and settlement funding during the committee’s hearing. Anderson said the SUD voucher, launched in July 2016, had approved more than 9,000 individuals overall and that the program continued to show growth in applications through December 2024.

Program mix and costs: Anderson told the committee that residential treatment and higher-cost services account for a disproportionate share of current expenditures. She noted a statutory cap enacted in 2021 that limits SUD-voucher reimbursements for residential (IMD) facilities with more than 16 beds to 45% of total voucher spending; the division’s modeling showed the 45% IMD cap would be met in March of the current fiscal year absent budget changes.

On recovery housing, Anderson said the Recovery Housing Assistance Program launched in May 2022 and reimburses up to 12 weeks of living expenses at approved recovery homes. As of the presentation the program had approved just over 1,200 individuals and the current-biennium appropriation of $1.5 million had been fully expended; the division said it identified internal savings to continue the program through the biennium and requested $1.5 million in the executive budget for the next biennium.

Opioid settlement funds: Anderson outlined the opioid settlement fund process. She said the state has received approximately $22.7 million to date from national settlements, of which $8.0 million was appropriated in the current biennium and the law governing settlement spending requires a portion to go to prevention and workforce. The settlement advisory committee used public listening sessions to set priorities and awarded grants for targeted projects including naloxone purchases, tribal partnerships and programmatic grants; Anderson said 65 applications requested roughly $59 million and 14 were awarded in the first round.

Committee questions touched on the IMD cap and whether legislation or budget language could allow funds to be reallocated within the SUD voucher appropriation to meet obligations. Chairman Nelson and Representative Steaman discussed potential statutory or appropriation-language options; agency staff said they could pursue bill language or amendments to allow reallocation and noted staff had identified bills that could carry amendments.

Ending: The division said it would provide additional specific data on program expenditures and award details and noted that some funding streams (opioid settlement grants) have explicit federal or settlement-linked requirements that constrain flexibility.","Agency staff told lawmakers the substance use disorder (SUD) voucher is seeing increased applications and expenditures, recovery housing assistance spending has grown and the state faces a 45% cap on IMD reimbursements that affects general-fund needs; opioid‑settlement grants are supplementing some initiatives.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6363090,"State seeks millions to expand Free Through Recovery and Community Connect care coordination programs",1266,2094000,3360000,"/Search/View?dp=1&key=2166744-57db4f3a182d3c6f278916223ea49f95&start=2094&end=3360","https://assets.pipeline.soar.com/2166744-57db4f3a182d3c6f278916223ea49f95/thumbnail_2094000.jpg","/articles/6363090/North-Dakota/State-seeks-millions-to-expand-Free-Through-Recovery-and-Community-Connect-care-coordination-programs","https://secure.pipeline.soar.com/6363090-b827cccdd8c7d7a01b3a6218bc6e89f2/orig.mp4?Expires=1773699009&Signature=GCCxZWTR3ia4A8Wdnw67fKFAwXXeyvjQdDWSJ51o~Lyqr5YMqE7zSY0s-H-DVZnse0vacaWWSoUQM-3eNpqnqb0UvxeXUEPsqkAMX87KO2vDZWlEtqcB6IAE5FQIEh8zoF7nkQA20eHZOWrGTuRuuA7GcYcjDQz87f5GhATgaPPYap7iTo4VprtXmzO2ga1jXb-PdkA8SKfzP3bdSqnaOAUsJ8Dd6faHfZNQDUjPH91YSvokR-hHZxqme7NDxpmV-rNIV5fHfTibsyYEMGdZRHtZRUXqHDt0~HjavDJsJPA~4FLKK~jYmIYq24UlzRl3Z56D-2--fR~WLQ0xgpNKJQ__&Key-Pair-Id=KUT5TJCACFTXG","Laura Anderson, policy director of the Behavioral Health Division, described two outcome-based care-coordination programs the department administers: Free Through Recovery, which serves justice-involved adults, and Community Connect, which serves community members not involved with the justice system. Anderson said both programs use care coordination and certified peer support specialists and pay providers when participants reach outcomes in domains such as housing, employment, recovery and law-enforcement interactions.

Free Through Recovery began in February 2018 as a partnership with the Department of Corrections and Rehabilitation. Anderson said referrals to the program come from parole and probation or through DOCR’s internal transition process. She said since 2018, more than 7,000 individuals have been served and that, as of the November program census, about 1,451 participants were active. Anderson told the committee the program prioritizes people with substance-use diagnoses or co-occurring conditions and that Stanford analysis cited in the presentation showed reduced reincarceration among program participants.

Community Connect, launched in 2021 and modeled after Free Through Recovery, focuses on people not in the criminal justice system but with behavioral health needs that create downstream costs in housing, child welfare or health care. Anderson said nearly 8,000 people had been served through Community Connect since its launch, with about 1,400 individuals active in the most recent census; she also said more than half of Community Connect participants were homeless at intake.

Budget request: Anderson summarized the governor’s executive-budget request. For Free Through Recovery she said the base general-fund appropriation is $15.5 million for the current biennium; the executive request adds provider inflation, an estimated $2.4 million to maintain a 1,500 monthly census and about $4.0 million to phase up to a 2,000 census by May 2026, producing a total request of about $22.2 million for the program. For Community Connect she said the base is roughly $15.8 million and the request includes provider inflation plus approximately $4.4 million to phase up to a 2,000 census; the division’s materials show the larger combined biennial request for Community Connect when inflation and census increases are included.

Committee discussion focused on how the two programs’ caseloads are measured and prioritized. Representative O’Brien and Chairman Nelson asked how referrals and counts align with DOCR and whether the department had flexibility to move funds mid-biennium; Anderson and Pam Segnus, executive director of Behavioral Health, said the department works closely with DOCR on admissions and that, later in the biennium, department savings have been used to stabilize program census when necessary. Anderson acknowledged that managing census can be difficult because admissions are driven by partner referrals and individual needs and that the department had used about $1.4 million in intra-department savings in the current biennium to hold the census at about 1,450.

Length of service and unit costs: Representative Murphy asked about average participant length of stay; Anderson said the program average was about 120 days (approximately four months). Anderson and others noted the program is monthly-rate based with incentive payments tied to outcomes; Representative Murphy calculated a rough per-month average near $462 per person when dividing the proposed funding by expected participants.

Ending: Committee members pressed the agency for more recent monthly census data and cautioned that Community Connect’s eligible population is less defined than Free Through Recovery’s justice-involved cohort. Agency staff promised to provide additional census data and documentation of the methodology used to estimate future need.","Agency officials told the Appropriations Committee their outcome-based programs that link behavioral health supports with other systems served roughly 1,400–1,500 people and the executive budget proposes increases to bring both programs to a 2,000-person monthly census over the next biennium.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6363093,"State behavioral health agency cites billing overhaul and client-enrollment work as drivers of $17.2 million projected revenue gain",963,631000,1594000,"/Search/View?dp=1&key=2166744-57db4f3a182d3c6f278916223ea49f95&start=631&end=1594","https://assets.pipeline.soar.com/2166744-57db4f3a182d3c6f278916223ea49f95/thumbnail_631000.jpg","/articles/6363093/North-Dakota/State-behavioral-health-agency-cites-billing-overhaul-and-client-enrollment-work-as-drivers-of-172-million-projected-revenue-gain","https://secure.pipeline.soar.com/6363093-554c9b0734b16815c2327e8b1b14e568/orig.mp4?Expires=1773699009&Signature=RooEtmvlakYlq8Ajh60wG9BJQ2D4SpnzU3sb9KDCWSusgJ~BJKfp-fY1LxYwXcR91VjID8jzA0G3oxxcoL6gK7PgQ6OWb2nE99Ar0QOnQ91L34H6ZEGZGO98byyhrEu6-hdIYIHC-Nob8qtX6Yc0k023MqnJp7FOtrLLBRJUZvuY1kzr5y7X2tReZOeS1qx0o2eMYkUxBcLp2IBsVy5vRa4Db5kNGX7vaaTIrY0sZ33YL-iLJsVhIA8ITb0u1YsxZRJ85zefyAA0QM5LPUK7u1mjAN9wZH1SYt8YydjqAcIn~R-1yc7kmalqqyfck3D5ttgKBMw6HTxdNh2KLiq-8w__&Key-Pair-Id=KUT5TJCACFTXG","Laura Anderson, policy director for the Behavioral Health Division at the North Dakota Department of Health and Human Services, told the Appropriations Committee the division has reorganized billing and related functions and is projecting higher reimbursement as a result. \"Our rev cycle director was hired about 11 months ago,\" Anderson said, and the work since then has focused on client access, coding, credentialing and timely filing to increase billable revenue.

The division said the policy and administration team now includes a revenue cycle and a quality and technical services vertical totaling about 100 positions; many were moved into the team from other HHS units. Those positions handle tasks ranging from billing and coding to client access and credentialing. Anderson said one newly hired client-access staff member helped sign up 20 individuals for insurance coverage, a change she called illustrative of the expected gains from targeted enrollment work.

Why it matters: The division presented charts showing combined revenue for the clinics and state hospital. Anderson said the current biennium’s actual-plus-projected revenue totals about $43.6 million and the division is projecting roughly $60.8 million for the next biennium, a projected increase of about $17.2 million tied largely to improved billing, higher utilization of insurance, and process changes.

Division leaders gave examples of the work underway: establishing workload standards for billing staff; creating a client-access team that enrolls patients in Medicaid or commercial plans where appropriate; addressing credentialing and accounts-receivable delays; and aligning the electronic health record (EHR) workflows to support billing and clinical documentation needs. Anderson said the EHR is shared by clinics and the state hospital and that some one-time funding requests on the agency’s list would support data migration or backup solutions for the record system.

The committee asked how durable the revenue gains are and whether growth will continue beyond the next biennium. Representative Steven and Representative Murphy asked whether the projected increases reflect steady growth or one-time recoveries; Anderson replied that the improvements target systemic issues—credentialing, enrollment and billing workflows—so some increase is expected in the next biennium but slower growth thereafter as the team “realizes national best practices.”

The presentation noted vacancies and recent position shifts into the new revenue-cycle team; Anderson said about 31 vacancies listed at the time of the report had been or were being filled and that many new positions were requested through the FTE block-grant process.

The department did not present a final, binding revenue guarantee and staff said questions about specific claim-level recovery (for example, where third-party billers may have been responsible) would require follow-up with the revenue-cycle director and finance staff.

Looking ahead: Committee members asked for follow-up details including (1) examples of claims where an outside payer was available and the voucher or state funds were used instead, (2) breakdowns of productivity expectations for billing staff, and (3) confirmation of the EHR migration and redundancy plans included among the division’s one-time requests. Anderson said staff would return with additional documentation and that the rev-cycle team would continue to track and report measurable gains.

Ending: The division emphasized that the revenue-cycle effort is intended to strengthen long-term billing practices, not to substitute for other funding, and that it supports the larger policy goals of improving access and quality across clinic and hospital services.","Department of Health and Human Services behavioral health leaders told the appropriations committee that a newly formed revenue cycle team, client-access work and EHR improvements are expected to raise combined clinic and state-hospital revenue from about $43.6 million to roughly $60.8 million in the next biennium.","actionData","errors"]

Article not found

State implements single assessment for youth levels of care and seeks funds for voluntary treatment, partial hospitalization and youth crisis services

Appropriators hear growing use of SUD voucher, recovery housing; IMD cap and opioid settlement funds shape requests

State seeks millions to expand Free Through Recovery and Community Connect care coordination programs

State behavioral health agency cites billing overhaul and client-enrollment work as drivers of $17.2 million projected revenue gain