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' Department of Public Health & Human Services

December 1996

Mental Health Managed Care
Contract Awarded

The Department of Public Health and Human Services (DPHHS)
recently awarded a five-year contract for mental health managed
care in Montana. DPHHS Director Peter Blouke announced at a
November 14 news conference that the new managed care
system will be operated by Montana Community Partners (MCP),
a non-profit joint venture between CMG Health, a Maryland-
based, for-profit corporation, and the Care Coalition of Montana,
a non-profit Montana corporation comprised of 1 5 Montana non-
profit human services organizations.

At approximately $80 million per year, this contract is the largest
contract ever awarded by the State. The actual amount paid to
the contractor will depend upon the number of Medicaid-eligible
individuals each month. Montana's Mental Health Access Plan
(MHAP) is also a first-in-the-nation effort to integrate funding for
all public mental health services (paid either through Medicaid or
the State general fund) to create an integrated, seamless system
of care. In addition to providing more efficient care to consumers,
the new managed care system is expected to save five percent
to six percent, or nearly $4 million a year.

Managed care is a system designed to equitably determine who
shall receive what types of services with what frequency over
what duration from providers with what level of skill, discipline,
and/or experience in pursuit of what outcomes. Mental health
services through the MHAP will be available for any person who
is eligible for Medicaid and who has a covered mental illness. In
addition, MHAP services will be available for adults with severe
mental illnesses and children with serious emotional disturbances
when their family income is 200% or less of the federal poverty
level. Individuals in this second category will be responsible for
paying a portion of their care.

In addition to the cost-savings aspect of managed care, Peter
emphasized that the new system makes sense for other reasons.
"First, people will be able to receive treatment based on need,
rather than funding sources; second, community-based services,
rather than centralized services will be emphasized; and third, the
department can more closely monitor the quality of care that
people will receive."

He continued, "We're excited to be able to begin implementation
plans for Montana's Mental Health Access Plan. This has been
an on-going process since the summer of 1 995, when we first
received federal waiver approval from Health and Human
Services Secretary Donna Shalala. Since that time, many people
put forth a great deal of effort to craft a managed care plan that's
right for Montanans. We definitely see our state as a trend setter
in mental health managed care."

(Continued on Page 2)



December 1

Welfare reform begins: Lewis & Clark,
Cascade, Petroleum, Musselshell,
Golden Valley, Carbon, Stillwater,
Sweet Grass, Judith Basin, Fergus
and Wheatland counties.

World AIDS Day

December 2

Governor's AIDS Awards Ceremony

Montana Club


Begins at 10:00 am

Contact: Linda Frahm

(406) 444-2675

December 5

"Save Old Main Association" (SOMA)
Ceremony with Governor Racicot
Montana Veterans' Home
Columbia Falls
Contact: Mike Hanshew
(406) 444-4077

December 13

DPHHS Advisory Council

Aladdin Motor Inn


8:00 am - 3:00 pm

Contact: Gary Curtis

(406) 444-9530

December 17

Health Information Network
METNET Teleconference

METNET sites in: Billings, Bozeman, Butte,
Glasgow, Great Falls, Havre, Helena,
Kallspell, Miles City and Missoula
8:30 am - 10:30 am
Contact: Donna Hansen
(406) 444-9772

December 19

"Lunch with the Director"

Cogswell BIdg., Room C-209


12:00 pm- 1:00 pm

Contact: Anastasia Burton

(406) 444-2596


Peter S. Blouke. Ph.D.


It is hard to believe, but the
Fifty-fifth Legislature will be
convening in justafewweeks.
Although the difficult issues
facing the Department of
Corrections will probably hold the limelight
DPHHS does account for approximately one-
third of total state spending. I am certain we
will receive our fair share of scrutiny.

Atthetimeof this writing, legislative leadership
has not yet made committee assignments, so
we do not know who will be serving on our
appropriation subcommittee. Once the
committee assignments are made, the
Legislative Fiscal Division will develop a
schedule of appropriation subcommittee
hearings on the department's budget. As soon
aswe havea list of subcommittee membersand
a schedule of hearing dates, we will get this
information out to as many people and
organizations as possible. Whether or not you
agree with the department's position on various
budget or legislative issues, I encourage you to
participate in the legislative process. Legislators
want and need to hear from those who are
directly impacted by their decisions. If you can
not attend hearings in person, submit written

It is my understanding DPHHS will have its own
subcommittee. That means we will spend
almost every morning for the first six - seven
weeks of the legislative session explaining and

defending the department's budget proposal.
This is a very critical time for the department
because it is at the appropriation
subcommittee level that vast majority of
budget and program issues are determined.
Once all of the subcommittees have agreed on
an overall state budget, it becomes very
difficult to make changes. After this point in
the process, it is far more likely that funding or
programs will be eliminated than added.

Because so many people are affected by what
happens during the legislature, we have
reserved the METNET video teleconferencing
system from 1:30pm - 2:30pm every Friday
afternoon during the session to provide an
interactive forum to update people across
Montana on what is happening at the
legislature. Initially, the sites selected for the
METNET updates are: Billings, Bozeman, Butte,
Glasgow, Great Falls, Havre, Helena, Kalispell,
Miles City and Missoula. If there is sufficient
interest, we will add additional sites as

The first update is scheduled for January 10.
The next will be on January 1 7, then we skip
January 24 due to a scheduling conflict, but
will resume again on January 24. The
continuation of these updates depends upon
your, participation, so I encourage you to
attend. Should you have any questions, call
444-2596 or 444-5268.

(Montana's Mental Health Managed Care . . . continued from front page)

An evaluation committee comprised of mental health providers, consumers, family and advocates, along with
state staff and a legislator reviewed and scored the four proposals that were received. They recommended
to Peter that the department enter into negotiations with Montana Community Partners, the highest scoring
proposer, to obtain the best possible offering to the State.

MCP will assume responsibility for mental health providers to MHAP members on April 1 , 1997. MCP has
already begun preparatory work and will begin a toll-free telephone number in January to provide information
to mental health consumers. CMG Health expects to hire 77 employees to work in Montana; 56 of them will
be located at Billings headquarters. Others will be based in Helena, Missoula and Miles City, as well as Montana
State Hospital in Warm Springs and the Montana Mental Health Nursing Care Center in Lewistown. A reduction
in DPHHS staff is not expected.

For more information about the Mental Health Access Plan, contact DPHHS Managed Care Bureau Chief Randy
Poulsen at (406) 444-2706.



Karlene Leonard, Public Assistance Bureau Chief
Child and Family Services Division

Montana finds itself with more choices to make
regarding its public assistance programs due to new
welfare reform legislation enacted by Congress in
August. While the state's welfare reform project.
Families Achieving Independence in Montana
(FAIM) continues its statewide implementation, it
now must incorporate the new federal mandates
and options as necessary. This new federal
legislation includes a multitude of changes and
options for states to consider, but overall is
considered to be more restrictive than previous
welfare policy.

However, the new policy allows states having
welfare reform waiver packages (like Montana) to
retain them and continue operating their own
welfare reform programs, while incorporating the
new federal requirements where appropriate. As
DPHHS began evaluating its welfare reform program
and comparing it to the new federal legislation, it
sought public input at a series of meetings across
the state last month.

Governor Marc Racicot said in reaction to federal
welfare changes, "Just as we consulted with a
diverse array of Montanans in designing our far-
reaching welfare reform program, it was important
to consult again on these latest federal changes.
When you come down to it, families are the
foundation and the glue of our society. So, we must
strengthen families anywhere, any way, and any
time we can."

FAIM was made possible by submitting
approximately 72 waivers from three federal
agencies administering the AFDC, Medicaid and
Food Stamp programs. Those waivers allowed
Montana to develop one of the most comprehensive
welfare reform packages in the nation. About 1 5 of
the waivers from the original FAIM package remain
inconsistent with the new federal legislation, while
the majority of FAIM provisions were incorporated
into the new law. There were also a number of
mandates which were not covered in Montana's
waiver package and several options made available
to the states to include in their revised state plans.

DPHHS has formed eight work groups to examine
parts of the new legislation and weigh the pros and
cons of the new requirements. The work groups
study these topics: evaluation, fiscal impact,
systems, tribal issues, public assistance programs.

child care, statute concerns and cross-divisional
issues. Work group members include department
staff, service providers and members of the general
public. Most of the work groups have had an
opportunity to meet and develop recommendations
to be included in the state plan.

The newfederal legislation requires a 45-day period
for the general public to learn about and comment
on the required provisions and changes in the way
public assistance programs are delivered in
Montana. The public comment period runs through
December 1 5, 1 996. The state plan was submitted
to the federal agency on November 1, 1996.
(Federal review and the public comment period can
run concurrently.) Early submission of the plan was
financially advantageous for Montana in accessing
block grant funds while retaining its ability to
change the plan based on public input.

DPHHS Director Peter Blouke commented,
"Compared to the federal plan, FAIM is better
designed to move families toward self-sufficiency.
We would like to see Montana retain its FAIM
waivers, which provide a broader range of services
to families. However, the purpose of the public
meetings was to find out what other Montanans
think. We were very interested in hearing a variety
of opinions."

Montana's FAIM program has three components:
The Job Supplement Program is designed for
families who choose not to receive cash assistance.
However, child care services, Medicaid and Food
Stamps are still available to them. Pathways
provides child care, Medicaid and Food Stamps as
well as a monthly cash payment. This component
is time-limited to 24 months. The Community
Services Program requires participants to perform
community services in exchange for welfare.

FAIM began implementation in February 1996 and
will be phased-in statewide by February 1997.
Promising preliminary indications show more
families choosing the Job Supplement Program than
anticipated, thus avoiding the need for a cash
payment and time limits.

While the work groups have been able to lay a
foundation for the state's integration with federal
welfare reform laws, public comment from
communities is critical in attaining a final product
that works for Montana. DPHHS invites all
interested individuals to submit comments by
December 15 to Public Assistance Bureau Chief
Karlene Leonard at (406) 444-1917 or to their
County Office of Human Services Director.


Carl Keener, M.D., Medical Director

Montana State Hospital

Addictive and Mental Disorders Division

Location: Warm Springs, Montana

Telephone: (406)693-7008
Fax: (406)693-7023

Dr. Keener was appointed medical director at Montana State Hospital in April of 1 993. He came
to Montana State Hospital as a staff psychiatrist in August of 1 992. Previously, he had been chief
of the Mental Health Services Branch, Billings Area Office of Indian Health Service, from July 1 969
to April 1971. He returned to Colorado, where he was in private practice until coming back to
Montana in August of 1992.

In his current position. Dr. Keener is responsible for overseeing treatment for the patients at Montana
State Hospital. The hospital is currently running a census of approximately 1 90 seriously mentally
ill patients, including both civilly and criminally committed patients.

He has also served on the Governor's Committee for Managed Care. Prior to coming to Montana,
Dr. Keener was an associate clinical professor at the University of Colorado Health Sciences Center,
an institute associate at the Denver Institute for Psychoanalysis and a clinical associate for the School
of Professional Psychology at the University of Denver.

Since returning to Montana, Dr. Keener's hobbies are hunting, fishing and boating. He also has eight
horses, which he says are proving to be far too many.




standing (L-R): Fair Hearings Office Acting Program Manager Barbara Conrady, Audit and
Program Compliance Bureau Chief Erich Merdinger Seated (L-R): Certification Bureau Chief
Linda Sandman, Quality Assurance Division Administrator Denzel Davis, Licensure Bureau
Chief Roy Kemp.

Photo: Randy Bowsher


A key recommendation of the DPHHS Reorganization Advisory Council was that an on-going
department-wide advisory council be established. Services provided by the department, either directly
or indirectly, touch the lives of virtually every citizen of the state. In addition to the significant impact
on the general health and social well being of Montana citizens, programs administered by DPHHS
also have a very significant impact on the state's economy. Expenditures by the department account
for approximately one-third of total state government spending. Given the size and scope of DPHHS
operations, it is critical that the public be actively involved in major departmental policy decisions that
affect how the department moves forward to achieve its goals.

Currently, DPHHS has 54 advisory councils involving over 600 members. The department is in the
process of reviewing all of the various advisory councils to eliminate duplication and ensure the
continued relevance of the remaining councils. Individual programs within the agency will continue
to have a need foradvisory councils whose membership includes consumers and representative of the
general public. However, these councils will deal primarily with very program specific issues, such as:
mental health, long-term care, developmental disabilities, child care, etc. The DPHHS Advisory Council
will have responsibility for department-wide oversight and interdivisional coordination of services.

Initially, it is anticipated that this council, whose members were appointed by Director Peter Blouke,
will focus primarily on three main areas: 1 ) the evolution of the decentralization/devolution process;

2) the development and implementation of a performance based system of program evaluation; and

3) issues relating to budget priorities and legislative initiatives. To fulfill its mission, the council will not
be involved in the day-to-day administration or management of the department. Rather, the council
will be involved with development of the major policy issues that will be required to implement the
department's goals.

The council's first meeting is scheduled for December 13 in Helena at the Aladdin Motor Inn.
more information, contact State/Local Relations Coordinator Gary Curtis at (406) 444-9530.




Location Telephone Representing

Caruso, Ken Huson 626-4305

McLaughlin, Mike Great Falls 771-8339

Haight, Randy Bozeman 994-5646

Hermanson, June Poison 883-9459

Miles, Joan Helena 447-8351

Patton, Fred Helena 443-3696

Wade, Deb Helena 442-3238

Pichette, Alicia Helena 442-8309

Keating, Wendy Helena 444-2648

Adams, Jim Helena 442-4600

Hudson, Sarah Billings 651-9258

Runkel, Bob Helena 444-4429

Johnson. Sally Helena 444-3900

Peters, M.D., Bill Bozeman 587-9202

Hart, Fern Missoula 721-5700

Espy, Nancy Broadus 456-2588
To Be Announced

Sen. Vivian Brooke (D) Missoula 728-3438

Rep. Ernest Bergsagle (R) Malta 658-2154

General public. Child Supp. Enf. Div.

Mental health field, providers

Child care, children's services

Independent Living Council, advocates for

disabled individuals

Public health

Senior citizens


Developmental disabilities, consumers

Department of Labor and Industry


Low-income consumers, FAIM participants

Office of Public Instruction

Department of Corrections, juvenile justice

Public health, Medicaid, providers, physicians

County commissioners, local programs

County commissioners, local programs

Native Americans




ifOftioii AeiiiiviMiNirs in pumuc NiALfM

The Montana Public Health Association (MPHA) honored several individuals and three local coalitions
for achievements in public health, during the association's annual conference in Great Falls, October
1 - 3.

Dale Taliaferro, Helena, received the Mary E. Soules Award, MPHA's highest award, for distinguished
service in public health. Dale retired in May 1 996 and had served as chief of the Health Systems
Bureau, Health Policy and Services Division, DPHHS and as administrator of Health Services Division
in the former Department of Health and Environmental Sciences (DHES). Most recently. Dale was
instrumental in developing and advocating for Montana's Public Health Improvement Plan.

Special Recognition Awards were presented to persons nominated by their peers for "making a
difference" and "going the extra mile". Those receiving SRA were:

Alberta St. Pierre, Rocky Boy Tribal Health

Elaine Fordyce, Nurse Consultant, Family and Community Health Bureau, DPHHS

Cherry Loney, Health Officer, Cascade County, Great Falls

Jeanne Seifert, Dawson County Health Department Director, Glendive

Linda Davis, Lake County Health Department Director, Poison

Special Recognition was also given to Senator Mignon Waterman, Helena and Representative Bill Tash,
Dillon for their support of the Montana Public Health Improvement Plan.

Awards for at least 25 years of exemplary service in public health in Montana were presented to four
Cascade City-County Health Department employees:

Peter Frazier

Adrienne Gue

Robert Stevenson

Darrell Furan

Certificates of Appreciation were presented in acknowledgement of special leadership or partnership
efforts to:

Marlinda Fulton, Cooperative Health Center Dental Services, Helena

Cascade County Tobacco Free Montana Coalition

Diane Curnow, Butte-Siiver Bow Family Planning, Butte

Cascade County Breast and Cervical Cancer Coalition

Cascade County Teen Health Initiative

During the annual business meeting, members voted to initiate an award honoring a person new to
public health who shows extraordinary potential for a career in public health. This award will honor
Marlene Stellmon, public health nurse consultant with the former DHES, who died earlier this year.

montana public health association

Fergus Countv Hosts First
"Department for A Day"

DPHHS Director Peter Blouke, along with
administrators Dan Anderson, Gary Curtis,
Nancy Ellery, Mike Hanshew and IVIaryAnn
Wellbank participated in the first "Department
for a Day" in Lewistown on November 15.
"Department for A Day" visits are an effort to
have DPHHS administrators and local partners
get to know each other.

According to State and Local Relations
Coordinator Gary Curtis, "For the devolution
process to move ahead, it is important for
these relationships to be established. Local
agency personnel need to put names with
faces and feel they can call us here in Helena.
At the same time, we need to learn much
moreaboutthe work that is taking place in the

Fergus County Human Services Director Boni
Braunbeck coordinated the day's full agenda.
The visit began with a tour of local human
services offices, HRDC and Job Service, which
are co-located in Lewistown. The

administrators visited with staff during this
tour. Lunch with the County Commission and
the general public was hosted at the
Community Center, where a panel discussion
with DPHHS administrators was facilitated by
Commissioner Kathie Bailey. In addition, the
group toured Project Reach, Central Montana
Medical Center and Montana Mental Health
Nursing Care Center.

The next "Department for a Day" will be
scheduled when the legislative session ends in

Information Security Access
Policy Finalized

The official "Policy and Process for Information
Security and Database Access" for DPHHS is now
final. This policy allows better data sharing
between divisions and a better balance in the
handling of confidential client information.

DPHHS has the responsibility for ensuring that
confidential data under the control of the
department are not compromised, while at the
same time ensuring that programs are properly
administered. The established policy will validate
any request for access to privileged information
against a framework of legitimacy criteria
designed to test the appropriateness of the
request. The governing principle to be followed
is that client information will only be shared on a
"need-to-know" basis that is in the best interest of
the client, effective administration of the program
and the health and safety of Montana's citizens.

Three levels of confidentiality have been defined
in the policy: Level 1 is information of a general
nature about the characteristics of the population
served by a program; Level 2 is the client
demographic and basic services information; and
Level 3, considered the most sensitive data, is
detailed information about an individual client's
personal background or previous and present
services provided by the department. These
levels are defined more extensively in the actual

As administrators of federal assistance programs,
DPHHS personnel must maintain state and federal
regulationsto maintain clientconfidentiality. Prior
to the reorganization, personnel from each of the
various agencies abided by their prospective
agency's written policy regarding confidentiality.
However, with the reorganization, the differences
in policies coming from previous agencies made
it difficult to do business. It soon became
apparenta standardized policyforthedepartment
was needed.

Training on the new policy began last month. For
more information, contact Dewey Barnes at

News and information about the programs
and people in the DPHHS will be presented in
this monthly newsletter. This edition was
produced by a committee of employees from
various areas of the agency. The Newsletter
Committee welcomes your suggestions and
comments. Ideas may be sent by regular mail
or ZipMailed to the DPHHS ZipMail Box.

DPHHS attempts to provide reasonable
accommodations for any known disability that
may interfere with a person participating in
any service, program or activity of the
department. Alternative accessible formats of
this document will be provided upon request.
For more information, call (406) 444-2596 or

Newsletter Committee members are: Randy


Online LibraryMontana. Dept. of Public Health and Human ServicesDPHHS News (Volume 1996 DEC) → online text (page 1 of 2)