Montana State Hospital recertification, forensic and civil commitment strains drive facility changes

Montana health officials told the Legislature’s Section B subcommittee that capital upgrades and operational reforms are central to restoring the Montana State Hospital’s federal certification and that rising forensic and civil commitment demand has strained bed capacity across the state.

Department clinician and interim practice lead Dr. Doug Harrington said the seven-facility healthcare division has ‘‘permanent administrators’’ in place for the first time and pointed to recent positive survey results: ‘‘all the facilities in fiscal year 24 and 25 have had successful surveys, either CMS, VA, or OIG, and that's a first.’’

The nut graf: Officials and legal counsel outlined two related problems. First, the state hospital must complete numerous anti-ligature and infrastructure capital projects before it will seek multi-year federal recertification (the department has targeted late 2025 but said construction timing could extend into 2026). Second, courts’ use of court-ordered evaluations, the ‘‘fitness to proceed’’ process and a persistent population of defendants found ‘‘guilty but mentally ill’’ (GBMI) are using forensic beds and slowing throughput for civil commitments.

LFD and department testimony described the capital-focused path to CMS recertification. Dr. Harrington said the hospital received a multi-year state license in October 2024 and that the remaining obstacle to CMS certification is completion of capital projects that address conditions of participation (notably anti-ligature upgrades). He described a phased construction and patient-move plan that uses a leased wing at Shodair called ‘‘Grasslands’’ to move patients while work proceeds on campus.

Chad Parker, the department’s deputy chief legal counsel, explained the forensic and civil legal framework. He summarized the court-ordered evaluation (COE) and ‘‘restoration’’ process for defendants judged unfit to proceed. He cautioned that court practice varies and that case-by-case court orders have, at times, constrained the department’s ability to discharge patients: ‘‘we are being prevented from discharge in many circumstances across the state right now, based upon a belief that there's an intermediary step,’’ he said, adding that the department has litigated interpretation disputes in court and seeks clearer process flows.

Galen Forensic Mental Health Facility (FMHF) capacity is limited (53 beds); department witnesses said a static GBMI population of about 27 patients occupies many forensic beds and that the mix of commitments and restoration orders contributes to wait lists for court-ordered evaluations. Dr. Kevin Flanagan, Montana State Hospital CEO (remote), said operational changes cut contract nursing spend from an earlier peak and that leadership changes have reduced certain contract costs: he told the committee his team’s work ‘‘has reduced over time by about 50% from his highest point in fiscal year 2025. So far, it's saved about $660,000.’’

Committee members pressed the department for tracking and timeline details. LFD and department staff agreed to provide updated per-resident cost comparisons, historic contract spending, overtime baselines, and a schedule for capital milestones tied to recertification. No formal committee decisions were taken in the hearing; staff and the department set follow-up deliverables and suggested additional briefings from Department of Administration/A&E on construction schedules.

Ending: The meeting closed with a ten-minute break and agreement to return with supplemental documentation; public commenters (health systems, NAMI Montana, veterans advocates) urged the committee to fund the path to recertification and to support capacity-building across the behavioral-health continuum.