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HELENA, MONTANA BgHgfBent otPublic Health & Human Services


July 1997


The Department of Public Health and Human Services has a
number of significant accomplishments to celebrate on its
second anniversary. Montana's welfare reform and mental
health managed care programs have been implemented.
Construction will begin soon on a new state hospital at Warm
Springs. The agency has also begun to implement performance
measurement using benchmarking.

On the second anniversary of the formation of the DPHHS,
the newsletter committee felt it was important to reflect on
the department's goals and to share some employee
perspectives on the reorganization.

The objective of Phase I of the DPHHS reorganization focused
on reorganizing the agency at the state level. These goals
were to:

• Establish an organizational structure based on consumer
needs rather than funding sources or federal categorical

• Establish an organizational structure based on partnerships
between state and local programs to decentralize department

• Facilitate client access to services by eliminating
administrative barriers; and

• Establish a logical relationship among programs with clearly
delineated lines of communication, authority, and
accountability at all levels of program administration.

Phase II goals involve the regional and local levels of the
agency. These objectives include:



"Department for a Day"

Various locations around Great Falls

Contact: Anastasia Burton

(406) 444-2596

July 16

"Lunch with the Director"

CSED Offices

3075 N. Montana Avenue


12:00 pm - 1:00 pm

Contact: Anastasia Burton

(406) 444-2596

July 18

Governor's Council on Families
Cambridge Place
Great Falls
Contact: Gary Curtis
(406) 444-9530

July 21-27

Lead Poison Control Week

July 25

"Every Woman Matters" Campaign kickoff

(Promotes free mammograms for women

who qualify)

Women's Park

Corner of Fuller and Neill


11:00 am

Contact: Dick Paulsen

(406) 444-3624


• Creating policies and procedures that support "one-stop

shopping" or "no wrong door" approaches for customers || ' dphI^ Advisory Council

of departmental services; | , Cogswell Building/Room C-209

m Helena

• Decentralizing planning and decision-making on programs || 830 am -4:00 pm
and services to give greater control to sub-state or district ll ^ Contact: Gary Curtis
levels; |l (406)444-9530

ii August 24

• Completing strategic planning that establishes a set of ii : "Family Fun Day"
departmental performance measures or "benchmarks"; III Sponsored by the Governor's

Ii Council on Families

• Completing changes in departmental financing to better llj Various locations around Great Falls

track departmental expenditures at the county level, reduce 11 ^'5^f?!if^,?^'^'^

^. , . . . , .. , . . (406) 444-9530

the emphasis on categorical funding of services, and |||

increase the department's ability to maximize federal financial ||| |

participation. i

(Continued on Page 3)


How is Decentralization Progressing?

Since almost my first day in this
position, one of tlie major topics
of discussion with provider
groups, consumers, counties and
employees has been
"decentralization." What is it?
Is it nicer to call it "devolution"?
Why is DPHHS doing this to

Laurie Ekanger BACKGROUND: I know that the
DPHHS Director Governor's Task Force to Renew
Government, which

recommended a single health and human services
department, wanted services organized around
consumer needs (not funding streams) and
decisions made as close to affected communities
as possible. So from the outset, decentralization
has been a fundamental concept of DPHHS. The
public advisory council that worked on
departmental reorganization issues devoted an
entire volume to a conceptual discussion of the
value of decentralization.

When DPHHS was created by the 1995 Legislature,
a new Republican Congress had just taken office
in Washington D.C. with an ambitious, revolutionary
agenda to transform federal/state relationships
and block grant all human service funding to
states. Language in HB2 directed the new agency
to have local pilot projects in place to handle
human service block grants and to report back to
the 1997 Legislature. The 1995 Montana
Legislature adjourned fully expecting to be back
before the end of the year to implement federal
block grants.

DPHHS set up an Office of State/Local Relations
with Gary Curtis as its coordinator, who
immediately set to work developing the local pilot
projects directed by HB2. Due to legislative
direction to have pilot projects by July 1, 1996,
projects were pursued out of the DPHHS director's
office simultaneously with developing a new
organizational structure, management team, and
legislative/budget packages. The new DPHHS
management team finally had opportunity to
address as a group the issue of decentralization
in May 1997 with me.

PILOT PROJECTS: Four areas of the state stepped
forward to work with Gary to explore becoming
pilot projects: community leaders in Missoula
County, the Lewistown area (MACO District 6),
the Wolf Point area (MACO District 1) and several

county commissioners from the Golden Triangle
(Great Falls/Conrad/Shelby) area. I have now
met with representatives from all four groups. I
am very grateful for the careful, thoughtful work
done by these groups to provide DPHHS, and
me in particular, with advice on this issue.

Some of the common concerns from these groups
included: a perception that DPHHS intended to
reorganize further into a 12 district delivery system
unless the pilots developed an alternative;
frustration with the magnitude and vagueness of
the task; general lack of clear understanding about
the purpose or goal; and difficulty overcoming
local fears.

CURRENT STATUS: For one thing, a major
impetus for the pilot projects - block grants -
never materialized from the federal government.
DPHHS funding remains very categorical with
over 500 programs. These run the spectrum
from centralized (like Medicaid claims processing)
to contracted with county governments (like public
health programs) to privatized (like aging services).
What the pilots and the department's management
team seem to have concluded independently is
that a one-size delivery system will not fit all
programs, nor should it, and that discussion of
further structural reorganization is, as one person
put it, "a solution looking for a problem."

I have told the pilot sites our agency has no plan
to reorganize into 12 districts. However, it was
critical for me to also convey that the DPHHS
management team wants very much to be
responsive to any and all suggestions to improve
services. We want to focus on service: 1) better
communication with the public, local elected
officials and especially county commissioners
about what DPHHS does and does not do; 2)
measurement of outcomes to report to the
taxpayer what they are getting for their tax dollars;
3) assessment of consumer and customer
(including the taxpayer) satisfaction with services;
and 4) better partnerships with private charitable
organizations and others to identify needs not
met by government.

FUTURE: The pilot site in Lewistown does not
plan to continue as a separate project. The
other sites may continue in order to build on the
working relationships and communication this
experience has fostered and to work with DPHHS
on the four areas listed above.

(DPHHS 2nd Anniversary

Continued from front)

We asked Jeff Ireland, supervisor of the Medicaid
Managed Care Section, for his thoughts. Jeff
served as chair of the Reorganization Employee
Work Group. In particular, we asked him the extent
to which he believes we are moving toward
accomplishing the goals of the reorganization, how
we've progressed or not progressed, and what he
feels are the most pressing issues that need to
be addressed in order to move the agency toward
meeting these goals.

"Phase I of the reorganization focused on the
agency at the state level. I believe that we are
on track as far as the Phase I goals. We've
developed strategic plans, have established a
department-wide advisory council. We are now
developing benchmarks and performance
measures, and pursuing an automated data
collection and reporting system. The agency has
reduced the number of its divisions, thus improving
internal communications. These actions are the
direct results of the recommendations made by
the reorganization advisory committees."

He continued, "Phase II of reorganization focuses
on restructuring at the regional and local levels.
While I have not been directly involved in this
process, my feeling is that we have not yet met
our goals in this area. We have had difficulty
defining the population we were targeting. As a
result, this process has been necessarily and
deliberately slow."

Jeff concluded by saying, "Establishing a centralized
data collection system is extremely important and
an issue that will save time and money. We
should continue to emphasize the importance of
developing agency benchmarks."

Pamela Carter is an eligibility assistant/FAIM
coordinator in the Musselshell County Office of
Public Assistance and was a member of the
Reorganization Employee Work Group. She
commented, "I have noticed some changes on
the local level. The number of divisions in the
department has decreased, there seems to be
more emphasis on streamlining forms across
department lines, but working with confidentiality
issues continues to be a concern."

She added, "It seems the goals of the
reorganization process must be carried forward
from the top down. We need continued leadership
to implement new ways of doing business. In our
rural communities, we continue to strive for creative
ways to serve our participants and we do not see
much duplication of services. Resources are scarce
and we try to share or pool our resources to
better serve the public."

Pamela finished by saying, "I feel we need to
constantly re-evaluate our goals on a point by
point basis. We need to continue to ask questions
like 'Where are we with Phase I? What have we
achieved in Phase II? Have we accomplished our
goals? Do we need to redirect and refocus our
goals? Where do we go from here?' We need to
assure there is an evaluation process in place to
measure our progress."

We asked State and Local Relations Coordinator
Gary Curtis to discuss the progress of
decentralization. He said, " Decentralization has
been difficult! Difficult to define, difficult to build
consensus around and difficult to implement.
Obviously, we still have a lot of work to do.

Under the direction of Director Laurie Ekanger,
decentralization will become more of a department-
wide project, instead of being primarily focused
in the director's office. Leadership for
decentralization is going to come primarily from
the divisions and from local areas."

Gary added that DPHHS administrators have agreed
to change the focus of agency decentralization
efforts from that of shifting control to concentrating
on becoming customer-focused. In addition,
administrators have decided not to promote a 12-
district structure or an inter-program block grant.

He concluded by saying, "The idea of
decentralization was to make things better by
responding to calls for action from local areas.
My personal experiences out in the field have led
me to believe the calls many of us heard for
'local control' were as much calls for involvement,
participation and flexibility, as they were for control.
So I think this change in focus is very appropriate."

DPHHS Child Support Enforcement Division
Modification Technician Vickie Doggett died
tragically on May 24, 1997. Vickie, 32,
had worked for the State of Montana since
1991 in the CSED Administrative Unit,
Locate Unit and Modification Unit. She is
survived by three sons, James, Michael
and Marcus of Townsend.

A memorial fund has been established to
assist with funeral expenses and to help
her children. Memorials may be sent to:
Valley Bank, Attn: Customer Service,
Memorial Fund-Vickie Doggett, P.O. Box
5269, Helena, MT 59604. We extend our
deepest sympathy to Vickie's family.


Ed Amberg, Quality Assurance Director

Montana State Hospital

DPHHS Addictive and Mental Disorders Division

Location: Warm Springs, MT 59756

Telephone: (406) 693-7007
FAX: (406) 693-7023

Ed Amberg has been quality assurance director at Montana State Hospital (MSH) for the last two
years. He began employment at the hospital in 1979 as a recreation therapist. Ed moved to Montana
from Michigan, where he had worked in correctional and community developmental disability programs.

Ed earned a master's degree in public administration in 1990 from the University of Montana and
since that time has held a series of positions at MSH related to organizational change and quality
improvement. Ed was honored as Montana's Outstanding Mental Health Service Provider in 1986.

In his current position, Ed supervises the hospital's quality assurance and utilization review activities,
as well as the admissions and staff development departments. He has also served on the Mental
Health Planning and Advisory Council and the Managed Care and Independent Evaluation Selection

Ed's wife, Helen, is also employed at MSH as the program supervisor for the Geriatric Treatment
Program. They have two children. In his spare time, Ed enjoys fishing, skiing, backpacking and

Photo Anastasia Burton
"48 Hours" reporter Doug Longhini (center) observes DPHHS Clinical Lab Specialist Kim
Newman perform e-coli testing. The news show was covering the investigation of emerging
strains of e-coli which were discovered in Montana this spring. State Epidemiologist Todd
Damrow and Lab Services Manager Anne Weber were also interviewed. The report will
air July 10 at 9:00 pm on your local CBS affiliate.


The Incentive Award Program was created by the
November, 1993 special session of the Legislature
and became effective on December 23, 1993.
This program was established to recognize
innovative ideas in Montana state government.
An idea or suggestion becomes eligible to be
nominated for an award when it is implemented
or when documented achievements and outcomes
can be determined. Individual employees, groups
or teams of employees and non-employees may
all be eligible for nomination.

An agency director may approve an award of up
to $500 or up to 40 hours of paid leave for an
innovation for which a documented value cannot
be calculated. Directors may approve an award
of up to $17,000 for an achievement or outcome
with a documented value.

DPHHS recently presented two incentive awards.
These awards were given to Connie McEachern
of Disability Services Division and Susan Ramsey
of the Child Support Enforcement Division for
researching innovative ideas, implementing those
ideas, and documenting the savings to the agency.

Connie McEachern has been a state employee
for 19 years and is currently the budget analyst
for Disability Determination Services (DDS).
Connie designed a spreadsheet to track productivity
of medical consultants. Once DDS was able to
document productivity, they were able to establish
numerical goals for the medical consultants. This
new accountability ultimately increased efficiency
and decreased medical consultant time. Ultimately,
the total DDS budget significantly decreased.
Connie received an award based on these savings.

Susan Ramsey is the project manager for the
Child Support Enforcement Division (CSED). The
division has an in-state toll- free number for the
public to access its Customer Service Unit. Many
callers from within the Helena calling area were
using this toll-free number, resulting in CSED
incurring a charge for each of those incoming
calls. Susan researched this problem and
discovered the local calls could be blocked and
the caller given a message to call the local number
instead of the toll-free number. This resulted in a
decrease in the CSED monthly phone charges.
Susan's award was based on these documented

Patty Smith in the Personnel Office is the DPHHS
Incentive Award Coordinator. If you have an idea
you would like to submit or have any questions
about the Incentive Award Program, contact Patty
at (406) 444-4211.



The company responsible for administering the
department's $400 million mental health managed
care program is pursuing merger discussions with
a larger corporation in order to compete in the
ever-changing field of managed care.

CMG Health of Maryland is the managing partner
of Montana Community Partners (MCP), which
won the state contract last November. CMG will
apparently merge with Merit Behavioral Care, a
larger managed care company from New Jersey.
Ironically, Merit, in affiliation with Blue Cross/
Blue Shield of Montana, was the third-place bidder
for Montana's Mental Health Access Plan (MHAP).

The MHAP is now almost three months old and
progressing well, despite the complications
surrounding its implementation. Montana Community
Partners is working hard to make this program work
successfully for consumers and providers.

Managed Care Bureau Chief Randy Poulsen of
the DPHHS Addictive and Mental Disorders Division
said, "Ideally, the pooled resources of these two
managed care companies will provide even better
service for the plan's mental health clients.
However, our contract with MCP and CMG will
remain in place, and we expect the program to
operate just as their proposal stated."

The main difficulty during implementation had
been the lawsuit filed by Vista of Montana, Inc.,
one of the unsuccessful proposers for the MHAP.
Vista sued to halt implementation of the contract
with MCP, contending that the evaluation of
competing proposals was flawed because of a
conflict of interest by one or more members of
the evaluation committee. Hearings on a motion
for an injunction were held in District Court this
spring, and Judge Jeffery Sherlock had prepared
his decision on the injunction early last month.

No one will know what his decision was, because
on June 6, CMG Health and Vista announced
they had reached a settlement and that Vista
would drop the suit. CMG will pay Vista $1.2
million as compensation for Vista's costs of
preparing its proposal. CMG has provided DPHHS
with written assurances that no part of the
settlement will come from its Montana revenues,
nor will any portion be charged to administrative
expenses for the MHAP.

Neither DPHHS nor the Department of Administration
participated in the settlement talks or the settlement
itself. "We are confident that our evaluation process
was fair and correct, and we were anxious to have
the court uphold the award to Montana Community
Partners," Randy said.
(Continued on Page 7)


A pay plan granting raises averaging two percent
over each year of the biennium passed the
Legislature and was signed by Governor Marc
Racicot. Individual annual base rate increases
will range from one percent to slightly over four
percent. The monthly state contribution to
employee health insurance premiums will increase
from $225 to $245 in fiscal year 1998, and to
$270 in fiscal year 1999. The combination of
base rate and insurance premium increases
represents an estimated three percent annual
average increase in employee total compensation
in each year of the biennium.
The pay plan continues use of "target market ratios"
adopted last biennium. Target market ratios provide
a method for progressing employees from the entry
salary to the market salary (midpoint) of their grade
pay ranges based on years of service with the
state. Individual employee progression raises will
vary from zero to slightly over three percent
depending on an employee's grade, market ratio
(current position in pay range) and years of service.
Employees hired on or before September 30, 1994,
will receive progression raises on September 27,
1997, and on September 26, 1998. Employees
hired after September 30, 1994, will receive
progression raises on the first day of the pay
period which includes their anniversary date.
Grade pay ranges increase one percent in each
year of the biennium. All employees will receive
these one percent increases including those
employees over the maximum salary for their grade.
Most employees will receive the range increases
when their progression raises occur.

Questions concerning the pay plan or individual
employee pay raises under this plan should be
directed to payroll or personnel staff.


Survey forms will be distributed this summer to
all DPHHS staff to gather information about their
opinions toward their employment and working
environment within the department. DPHHS
Director Laurie Ekanger would like to use the
results of the survey as a kind of "baseline" to
measure satisfaction and identify areas that need
improvement within the agency. The survey will
be conducted again at a future date to determine
if progress has been made in those areas that
are found to need improvement.
One of the main issues addressed by the survey
will be communication between staff and the
various levels of management, such as supervisors,
bureau chiefs and administrators. Other issues
to be addressed in the survey will be identified
through employee focus groups. Those topics
may include training, space, equipment, and career
advancement opportunities.

The survey will be conducted by a surveyor outside
the department. The surveyors will ensure that
confidentiality of the survey respondents is
maintained. After respondents fill out the forms,
they will be mailed to a data entry site outside
the agency for tabulation and for analysis. Every
staff person in DPHHS will have an opportunity
to respond. The results should be received by

At a later date, DPHHS will explore the possibility
of setting up ongoing customer satisfaction surveys
to gather information from its service providers as
well as from its customers. Several other areas of
state government have used this management
technique to improve customer service.

Look for survey results in the newsletter this fall.

Conference Attendees Honored

At the fourth annual Governor's Breakfast for Children
held in Butte recently during the joint conference of
the Montana Eligibility Workers Association, Family
Support and Child Abuse Prevention Networks,
Governor Marc Racicot praised attendees for their
dedication to the prevention of child abuse and
their continuing efforts to help Montana's families.
The Governor said he was proud of the work the
groups had done since welfare reform was passed
and he reiterated his support for the "Families
Achieving Independence in Montana" (FAIM) program.

Several individuals received awards at the breakfast.
Family Support Network Executive Director Barbara
Sample was honored for her exceptional dedication
to preventing child abuse and strengthening
families. Barbara developed a program to serve

90 families at risk for child abuse and neglect in
the Billings area.

Senator Dorothy Eck, (D)-Bozeman, was given an
award for her dedication to the prevention of
child abuse.

"A Commitment to Excellence" (ACE) award for
outstanding service was presented to the following
members of the Montana Eligibility Workers
Association: Chris Croucher, Dawson County;
Pamela Carter, Musselshell County; Patty Pedula-
Boles, Madison County; Pat French, Meagher
County; and Lavelle Walker, Ravalli County.
Family Preservation Services Coordinator Kate
Mrgudic was also recognized for her special
contribution to the DPHHS Child and Family
Services Division.


Pat Casteel received recognition in March for 40 years of service to the state of Montana. Pat worked

the entire 40 years in the Cascade County Office of Public Assistance.

Charlie McCarthy of the Helena office of Child and Family Services Division was recognized this spring

for 30 years of service.

Joseph Thompson from the Montana Developmental Center received recognition in June for 30 years of


Online LibraryMontana. Dept. of Public Health and Human ServicesDPHHS News (Volume 1997 JUL) → online text (page 1 of 2)