(C) Daily Montanan This story was originally published by Daily Montanan and is unaltered. . . . . . . . . . . Committee overseeing work to get Alzheimer's patients out of state hospital need more data – Daily Montanan [1] ['Blair Miller', 'More From Author', '- October'] Date: 2023-10-25 The new committee that will oversee Montana’s directive to keep patients with a primary diagnoses of Alzheimer’s, dementia and traumatic brain injuries from being involuntarily committed to the Montana State Hospital held its first meeting Tuesday, developing a list of questions it wants answered in order to oversee the state’s progress and possibly recommend legislation to make the transition easier. The Transition Review Committee picked Rep. Jennifer Carlson, R-Manhattan, who sponsored House Bill 29, which set up the committee in the first place, to lead the committee. Sen. Christopher Pope, D-Bozeman, will serve as the vice chair. Carlson’s bill drew wide support during this year’s legislative session , as it aimed to strengthen current law by keeping anyone with a primary diagnosis of any of the three conditions from being involuntarily committed to Warm Springs unless they had injured themselves or others, or had threatened to do so. The bill also forces the Department of Public Health and Human Services to develop and implement a plan by the end of June 2025 to be sure people who meet those conditions have access to community-based services and assisted living facilities they can be sent to during the next few years. But Gov. Greg Gianforte vetoed the bill, asking for amendments before the legislature adjourned, and saying the measure “fails to provide an effective, lawful mechanism to accomplish the intent of the legislation” and that it was too restrictive. Both in his veto memo and a fiscal note written by his Office of Budget Programming and Planning, the executive branch also contended there were not enough skilled nursing facilities or assisted living facilities to meet the demand and assumed many would go to the Mental Health Nursing Care Center in Lewistown – both of which Carlson said were wrong. Carlson wrote a rebuttal saying the work could indeed be done in two years and federal Medicaid money could cover 65% of the cost of using community-based services instead of the Lewistown facility. Lawmakers successfully overrode Gianforte’s veto of the measure, and another tied to Warm Springs reforms, in early June. At Tuesday’s initial meeting for the committee, the group of lawmakers, hospital representatives, and people working with and representing people living with Alzheimer’s and traumatic brain injuries heard updates from DPHHS officials, the Montana Healthcare Association, and the Alzheimer’s Association. At the end of the nearly six-hour meeting, the group agreed on a list of things it wants to hear more about at the next meeting, slated for January, that the committee’s staffer will work to gather during the next several weeks. DPHHS will bring the committee statistics and information on so-called “add-on” reimbursements for facilities that care for patients with behavioral health conditions and how often they are provided to Montana facilities. Montana Healthcare Association Executive Director Rose Hughes told the committee some facilities were not receiving the reimbursements, which often range between $75 and $100 a day per bed. The committee’s research analyst, Milly Allen, also committed to bringing the committee information about the discharge planning process, and challenges reported in people who have been discharged from the Montana State Hospital seeing delays in receiving Social Security benefits. Other asks by the committee members included more information on a grant awarded to the state on Sept. 30 under the BOLD Public Health Programs to Address Alzheimer’s Disease and Related Dementias program at the Centers for Disease Control and Prevention, more information on Montana’s commitment procedures, information on how other states are handling these issues, and an update from both caregivers and organizations that work with patients with brain damage and behavioral health conditions. Hughes had also told the committee that some of the facilities that are part of the association had been working on pre-placement visits to see if a person at the state hospital could receive the care they needed at an outside facility, but there was confusion about that from DPHHS officials. Mike Randol, the Medicaid and Health Services Executive Director for DPHHS, said he was not aware of there being any formal process in place for pre-placement visits, and said his legal counsel had also raised questions about who would be in charge of transferring the patients between state custody and an outside facility, and if a judge’s order would be necessary to do so. Several committee members agreed that despite the confusion over whether, and how, such a process was occurring, they thought it was a good idea to look further into in order to try to get as many of the patients who can be transferred out of the state hospital to new facilities. Another central topic of discussion was how to ensure there were enough facilities and trained staff to handle such specialized patients, especially as a certain level of care facility that allows for locked doors in Montana essentially does not exist because of regulatory barriers. Ann Geiger, the executive director of Liberty Place, an association that represents people with TBIs, said her organization had looked into providing that level of care but said the process was so overwhelming there was no way it could. Others on the committee seemed to agree. “You could pay them $100 an hour but if there’s no one to do the job, it doesn’t solve your problem,” Carlson said. In terms of the state hospital’s and DPHHS’s efforts to restore its Centers for Medicare and Medicaid Services certification that was revoked last year, which means CMS is not reimbursing the hospital for the care it provides, DPHHS Chief Facilities Officer William Evo said that process was about 58% complete and would be ready to submit back to CMS by December 2024. Evo said as of Oct. 11, there were 47 patients occupying the 60 licensed beds in the Spratt Unit at the state hospital, which holds older patients. Out of those patients, 34 of them have a primary diagnosis of Alzheimer’s, dementia or a TBI – or about 72% of the patients currently in the unit. He also said about 47% of the patients that came to the hospital were discharged from long-term care facilities and the other 53% were from private residences or were homeless beforehand. Around 70% of the patients that did go to the state hospital came from Missoula, Yellowstone, Lewis and Clark, Cascade and Flathead counties. While there were some differing opinions about the scope of the committee, like how much money DPHHS might need to utilize in order to fulfill its obligations, and what type of definitions and regulatory statutes the state should more closely adhere to – federal or state – nearly all agreed to work toward getting as much information as possible to ensure the transition works. Carlson and Sen. Dennis Lenz, R-Billings, each worked to dispel disagreements at the initial meeting. “We don’t need to necessarily point fingers or feel defensive or anything, but let’s have that as part of what we want to talk about, and then it becomes a moot point,” Lenz said. [END] --- [1] Url: https://dailymontanan.com/2023/10/25/committee-overseeing-work-to-get-alzheimers-patients-out-of-state-hospital-need-more-data/ Published and (C) by Daily Montanan Content appears here under this condition or license: Creative Commons CC BY-NC-ND 4.0. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/montanan/