Appropriations committee trims and adds measures to Human Resources Division bill, including behavioral-health grants and state-hospital financing

The House Appropriations committee on Human Resources amended a draft appropriations bill to add and clarify funding for behavioral-health projects, juvenile diversion services and state hospital financing while removing a controversial rate-review provision.

Committee members voted to strike subsection 2 of Section 21 — a provision that would have required a complete rate review and changes to utilization limits for developmental disability services — and approved a package of new and revised sections that the committee agreed to fold into the bill.

The package includes a $12,960,000 behavioral-health facility grant for the Northeast Human Service Region; an authorization for the Bank of North Dakota to provide a $130,000,000 line of credit for a new state hospital; a $239,112,030 human services finance fund figure; an $8,000,000 opioid settlement fund allocation; and one-time appropriations for juvenile diversion services and other targeted items. Committee staff said the block-grant underfunded amount is 20,157,874.

"I guess I would move to strike section 2, subsection 2," Representative Peter Steeman said when he offered the motion to remove the subsection, which a committee roll call later approved unanimously. Committee staff member Keith summarized the budget details during the session: "the underfunded amount on there should be 20,157,874." Vice Chairman Steeman later described a separate line-item change: "we just saved a million dollars," when the committee reduced avail eCare funding from $2,000,000 to $1,000,000 by relying on roll-up funds.

Other specific amendments the committee discussed and agreed to include: - Section 6: a $12,960,000 behavioral-health facility grant for the Northeast Human Service Region, sponsored by Representative O'Brien. - Section 7: changes to a community cultural center grant that would require applicants to show 50% of the funds required to complete a project in order to qualify for the grant. - Section 10 and 11: department-recommended amounts for the Human Service Finance Fund ($239,112,030) and the Opioid Settlement Fund ($8,000,000). - Section 13: authorization for a $130,000,000 Bank of North Dakota line of credit tied to the new state hospital project and establishment of a state hospital steering committee with legislative appointees. - Section 17: authorization allowing the Department of Health and Human Services to spend up to $10,000,000 for capital projects and maintenance for facility operations, including demolition. - Section 21: committee-approved removal of subsection 2, which had called for full rate review of developmental disability services; the motion to strike was moved by Representative Steeman and seconded by Representative Wagner and passed on roll call, 8-0. - Avail eCare: the committee reduced the avail eCare line from $2,000,000 to $1,000,000, using roll-up or leftover federal funds for the remainder; the motion passed 8-0. - Juvenile justice diversion services: a one-time appropriation of $750,000 was added to fund direct payments to statewide resources for youth at risk of justice involvement; the department was given direction to convene a committee of DHHS divisions, human service zone representatives, the Department of Public Instruction, school representatives and legislators to review programs and report to legislative management and the Children's Cabinet. - FASD clinic funding: Representative Murphy moved an amendment for $643,661 (general fund) to restore/restructure clinic funding; the committee discussed the amendment and the amount was confirmed during the session as a general-fund item. - Community Health Trust Fund item: Representative Mitscog moved to add $750,000 from the Community Health Trust Fund to continue the State Health Strategies grant program; the motion was seconded and carried.

The committee repeatedly returned to procedural questions about whether to vote on sections individually or in a package. Chairman Nelson and staff proposed moving the discussed sections forward as a group, allowing members to pull individual sections later if desired. Representative O'Brien moved to add the language discussed during the meeting into the bill; Representative Steeman seconded that omnibus motion, which the committee approved on roll call, 8-0.

Committee staff said they would compile the amendments into an amended bill and a statement of purpose for submission to the legislative drafting office, with a best-case turnaround of the next morning and a most-likely completion by noon the following day.

The meeting also included several policy and technical changes the department requested, including updates to reporting language for salaries and wages under the block grant (quarterly reporting to be included), changes to lease language to allow 99-year terms for the state hospital and life skills transition center, adjustments to medical-cost voucher distributions (noted as moving to a 50/50 distribution in one subsection), and continuation language for provider rate intent (moved to 2% on the long sheets that day).

The committee clarified that some language — such as existing federal coronavirus funding appeal limitations — is carryover language from prior bills and remains in the draft for as long as federal funds are available.

Throughout the session committee members and staff repeatedly noted that some line items and sections would be updated once the final long sheets and numeric reconciliations were complete; multiple sections were described as "to be updated once we have all the numbers finalized." Committee staff said they expected to finalize the amended bill for the full committee and floor consideration within the next day.

Votes at a glance - Strike Section 21, subsection 2 (remove full rate-review language for developmental disability services): motion by Representative Peter Steeman; seconded by Representative Wagner; vote: 8 yes, 0 no — outcome: passed. - Reduce avail eCare funding from $2,000,000 to $1,000,000 (use roll-up/leftover federal funds for the balance): motion by Representative Steeman; seconded by Representative O'Brien; vote: 8 yes, 0 no — outcome: passed. - Add $750,000 from the Community Health Trust Fund for State Health Strategies (match requirement retained): motion by Representative Mitscog; seconded by Representative O'Brien; vote: 8 yes, 0 no — outcome: passed. - Omnibus motion to add the additional sections and amendments discussed into the bill (includes juvenile diversion, behavioral-health jail funding language, FASD change, state hospital financing language and other sections): motion by Representative O'Brien; seconded by Representative Steeman; vote: 8 yes, 0 no — outcome: passed.

What this means The committee’s actions add targeted behavioral-health and community public-health investments to the Human Resources Division appropriations bill, formalize financing authority for a state hospital project, and remove a provision that would have allowed the department to unilaterally implement broad rate and utilization changes for developmental disability services without a collaborative industry process. Several items remain contingent on final numeric reconciliations on the long sheets and on drafting staff to incorporate the approved language into the formal bill draft.

Source material for this article is drawn from committee discussion and roll-call votes recorded during the Appropriations - Human Resources Division session; quotations and vote outcomes are taken verbatim from the meeting transcript.