Appropriations delays action on PRTF Medicaid reimbursement language to allow DHS follow‑up

The Appropriations Committee took up Senate Bill 23‑99 related to medical assistance reimbursement for psychiatric residential treatment facilities (PRTFs). Representative Pyle introduced the policy language directing the Department of Human Services to amend medical‑assistance reimbursement rules so that certain direct‑care costs are reimbursable; the underlined items in the bill included therapeutic leave days and other specific cost categories.

Tim Ginger, an administrator at Dakota Boys and Girls Ranch, told the committee that the rate‑setting and cost‑reporting process is complex. He explained that Medicaid’s medical services division performs rate setting that is used as the basis for private insurance and for Medicaid payments to PRTFs; because children in these facilities do not use Medicare, commercial payers commonly default to the prevailing Medicaid‑derived cost basis. Ginger described how facilities continue to provide services while a child is on therapeutic leave (transportation, family coaching, on‑call intervention) and that holding a bed while providing such services creates unreimbursed costs under current practice.

Committee members discussed caps and administrative implementation. Representative Nelson urged a legislatively established cap rather than leaving it solely to administrative rulemaking; the Department’s review and a fiscal note suggested the change would increase Medicaid costs, and Nelson asked committee staff to verify whether a per‑child cap (for example four leave days per month) would be appropriate. Representative Murphy asked about the fiscal‑note methodology; Ginger said the department used cost reports from providers to estimate the fiscal impact. The committee did not take a final vote and deferred the item for follow‑up; Chairman Bigasaw tasked Chairman Nelson to obtain DHS details on percentage reimbursement used in the fiscal note and on an appropriate cap so the committee can resume consideration at the next meeting.