State recommends acuity‑based DD rates, START pilot and reopening evaluation clinics to serve complex developmental‑disability needs

Legislators heard details on three BISFIG long‑term recommendations aimed at the developmental disabilities (DD) system: an acuity‑based waiver rate redesign, a START model pilot to serve people with complex co‑occurring developmental‑disability and behavioral‑health needs, and reopening or redesigning evaluation and diagnostic (E & D) clinics for children.

Lindsay Carter, who recently transitioned from DD bureau chief to senior long‑term care administrator, told the committee the first recommendation would replace Montana’s current 0208 waiver rate structure with an assessment‑driven, acuity‑based tiering system. Carter said a standardized assessment administered on a roughly five‑year cycle (with off‑cycle reassessments) would better match provider reimbursement to individuals’ level of support needs. The department estimated one‑time vendor costs of about $875,000 to develop acuity rates and recurring assessment administration costs (roughly $300,000 annually) plus an estimated long‑term increase in day and residential payments (the department modeled an illustrative 5% uplift based on other states’ experience).

Recommendation 3 aims to serve the most complex dual‑diagnosis cases through three components: a START model certification and oversight contract with the National Center for START Services; a short‑term stabilization resource center (30 days or less) to prevent or respond to crisis; and a specialized, higher‑intensity community living service within the 0208 waiver to support people in community placements. Carter told the committee the department estimated initial contract oversight costs (about $900,000), a roughly $1 million resource‑center setup estimate, annualized specialty team costs, and capital/operational estimates for small enhanced residential settings.

Recommendation 4 would reestablish or redesign evaluation and diagnostic clinics (E & D clinics) that were closed in 2018 due to budget actions. Carter said the clinics historically provided multidisciplinary evaluations for children; at their peak the clinics served more than 600 families statewide. The department proposes stakeholder‑driven redesign, an initial design budget (about $50,000) and pilot funding per site, with the department planning to seek federal authority and match in later biennia once pilots are operational.

Ending: Department staff emphasized these items are foundational to expanding provider capacity, keeping people with complex needs in‑state and reducing out‑of‑state placements; they requested legislative consideration of the estimates and offered follow‑up materials on vendor scopes and anticipated waiver amendments.