Vendor presents behaviorally complex care model to Senate committee; proposes $100/day add‑on pilot and $2.96M biennial cost

Dr. Christina Kovacs, chief clinical officer and cofounder of Behavioral Health Solutions, presented the company’s behaviorally complex care model to the Senate Human Services Committee and pitched a two‑year pilot that would provide an add‑on payment and wraparound behavioral health services for high‑needs residents in nursing facilities and basic care.

Kovacs said the Nevada program she helped implement provides an add‑on daily rate (the model she cited ranged between $111 and $326 per day in Nevada depending on the services). For North Dakota she proposed a $100 per‑day add‑on payment for qualifying residents, and described a two‑year pilot with a total estimated biennial cost of $2,961,000. Nikki Wagner, president of the Long Term Care Association, introduced Kovacs to the committee and said the program is one example of a state approach to keep behaviorally complex patients in appropriate, lower‑cost settings.

Kovacs told the committee the model pairs a daily add‑on payment with an on‑site or contracted vendor that provides psychiatric care, medication management, psychotherapy, peer support, activities professionals and training for facility staff. She said the model focuses on nonpharmacological interventions (redirection, psychotherapy, peer support and training) and on reducing unnecessary transfers back to hospitals. Drawing on Nevada data, Kovacs said the program produced measurable reductions in emergency department visits and psychotropic medication use, and she cited a 72 percent reduction in ER visits in the Nevada program’s monitoring data.

The vendor presentation emphasized that the proposed services are not currently billable under existing Medicaid payment structures and that the add‑on would fund services such as staff training in de‑escalation and trauma‑informed care, 1‑on‑1 psychosocial activities, crisis planning, urgent consults to avoid 911 calls, and on‑call clinical support. Kovacs also described billable clinical services that would accompany the program: psychiatric assessment, medication management, psychotherapy, neuropsychological assessment and collaborative care.

Committee members asked technical questions about licensing and program structure. Questions included which state agencies or licensing divisions regulate the psychiatric components (Kovacs said the vendor registers as a behavioral health provider in participating states and that CMS/state survey processes remain the regulatory overlay), whether services are delivered in existing nursing or basic care settings rather than new locked units (Kovacs said the model works in existing nursing and skilled nursing settings), and whether the model has limits on facility or unit size (answers varied by state; some states using locked units have bed limits such as 16 beds, Kovacs said).

Committee members also asked for the vendor’s slides and contact information so the Legislature and department staff could review other states’ data and consider how the concept fits North Dakota’s broader behavioral health continuum. The committee did not take formal action on the vendor proposal during this meeting.

Why this matters: The vendor’s proposal aims to reduce hospital stays, lower emergency visits, and improve outcomes for behaviorally complex patients by funding clinical services and staff training inside existing long‑term care settings. If adopted, the pilot would require new state spending or reallocation of Medicaid funds and changes to reimbursement rules or a new contract vehicle for the state.