Committee tables bill to split health department
Montana State Hospital. Credit Keith Schubert
Admonishing the Montana Legislature for being the 'enabler' of a 'pampered' and 'dysfunctional' health department, Rep. John Fitzpatrick said Monday it's time to break up the largest bureaucracy in the state.
The Republican from Anaconda said legislators have been forking over tens of millions of dollars to the Department of Public Health and Human Services and excusing it from accountability, and it's time for a structural change.
'The problem with DPHHS is it's too big, it's inefficient, and the service quality declines,' Fitzpatrick said.
Fitzpatrick made his remarks in support of House Bill 851, which he said would transfer administration of state healthcare institutions and community-based programs to a new department of health services.
But his arguments didn't fly with the Senate Public Health, Welfare and Safety Committee, which unanimously tabled his bill the same day.
The health department has experienced major and high-profile challenges, most notably the Montana State Hospital's loss of federal funds and decertification by the Centers for Medicare and Medicaid Services in 2022.
However, during the hearing, members of the health community said the department is making progress, and a change would disrupt that trajectory.
Douglas Harrington, state medical officer, said in testimony regarding the confirmation of the health department director, Charlie Brereton, nearly 50 different groups expressed support not only for the director but for the path on which he has set the agency.
Additionally, Harrington said all seven health department facilities have stable leadership.
For the first time in years, nursing vacancies have been reduced by 30%, and the agency is recruiting roughly one new nurse a week, he said. Except for one-on-one visits, he said patient costs are down 25%.
'The bill is highly problematic for us at a time when significant momentum has been achieved,' Harrington said.
The health department annual plan for the current fiscal year — which ends June 30 — said the agency aims to implement 100% of required CMS recertification reforms at the state hospital in Warm Springs.
DPHHS did not respond to a question about whether the hospital will reach that goal this year.
Echoing the comments from many opponents of the bill, Sen. Carl Glimm, R-Kila, said the idea to split the agency is so massive, it would need to be studied first.
Additionally, Glimm said, the state is starting to see positive results.
'Frankly, I think if you rip it in two right now, I think that starts to tear apart some of the effect of what we have going on there,' Glimm said.
Sen. Daniel Emrich, R-Great Falls, said he agreed.
Emrich said the bill wasn't fully baked, essentially directing the governor to issue executive orders to finish it, and he moved to table it, which the committee supported on an 11-0 vote.
Even if legislators resurrect the bill, it may meet a hurdle in the Governor's Office.
At a press conference last week, Gov. Greg Gianforte said he would not comment on the specific bill, but he said generally, his administration is opposed to bigger government.
He said splitting up an agency means two separate executive teams and potential silos that would make government less efficient.
'Those are principles that matter to our administration,' Gianforte said.
The House had supported the bill on an 82-15 vote, and Fitzpatrick was unrelenting in his criticism of the agency in committee. He said the state hospital is not in his district, but it's close, and he gets frequent complaints about it.
Fitzpatrick also said the health department has spent profligately because it has failed to properly recruit, and legislators have been complicit in 'shoveling the public's money out like water going over the dam.'
'DPHHS has burned through $71 million to pay for traveling health care staff,' Fitzpatrick said. 'That's $97,000 a day.'
Most of the people who testified, though, said the bill would have negative consequences for the people the department is serving, although some said they appreciated the sponsor's hunt for efficiencies and his care for Montanans.
Kali Wicks, with national mental health advocacy organization Inseparable, thanked Fitzpatrick for his interest in the topic, but said the bill had the potential to stop progress 'in its tracks' and 'create some issues with continuity of care.'
Wicks agreed it might be time for a study bill if time allowed.
Mike Chavers, representing the Yellowstone Boys and Girls Ranch and the Behavioral Health Alliance of Montana, said change is hard, and progress in public systems can feel 'painfully slow,' but HB 851 would derail momentum.
'We must oppose this bill, not because we're resistant to reform, but because we started to see the fruits of our hard work,' Chavers said.
The agency's chief legal counsel, Paula Stannard, said the bill could raise a 'significant legal issue' depending on the way Montana broke up the department.
Stannard said federal rules require a single state agency to administer the state Medicaid plan, and a split could risk federal funds if it created separate points of contact.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Axios
26 minutes ago
- Axios
Congress' "doc fix" spurs value-based care concerns
Physicians are divided over how the massive Republican budget bill moving through Congress would insulate doctors from future Medicare cuts without continuing financial incentives to provide better care through alternative payment models. Why it matters: The "doc fix" championed by the American Medical Association, among other groups, would solve a long-standing complaint about the way Medicare pays physicians. But some physician groups worry it would maintain a system long criticized for tying pay to the volume of procedures delivered and the number of patients seen. State of play: Physician practices that agree to be paid based on patient outcomes get bigger payouts in exchange for taking on the extra financial risk are in line, under current law, for a pay boost through a key adjustment called the conversion factor, starting next year. But the version of the GOP budget bill that passed the House of Representatives would instead create a single conversion factor for all physicians that's updated based on Medicare's measure of inflation. That would leave providers in the performance-based payment models getting higher payments than currently prescribed from 2026 through 2028, but lower payments than outlined in current law after that through 2035, according to an analysis from Berkeley Research Group viewed by Axios. Primary care physicians and providers embracing value-based care worry that removing an incentive for participating in the models will set back efforts to move Medicare toward a more holistic payment system that's meant to improve patient care. "Signals matter in health care," said Shawn Martin, CEO of the American Academy of Family Physicians. "I think it's a signal [to physicians] of an entrenchment back in fee-for-service." The American College of Physicians, the trade group for internal medicine doctors, told lawmakers last month that it's concerned the policy as structured will disincentivize doctors' participation in value-based care. "It's being marketed as a long-term fix," said Mara McDermott, CEO of value-based care advocacy group Accountable for Health. "I don't read it that way. I read it as creating a new cliff." Zoom out: Many provider groups are also concerned that the legislation doesn't fix the 2.83% cut to physicians' Medicare payment that took effect in January. The American College of Surgeons in a May statement praised lawmakers for recognizing that Medicare physician payments have to be adjusted for inflation, but that the legislation's provision "is not sufficient to make up for the 2025 cut, and more work is needed." The other side: The AMA wrote to House leadership last month that it "strongly supports" the provision to consolidate into one conversion factor and tie updates to inflation starting in 2026. Reductions made to the conversion factor over the past half-decade to keep the physician fee schedule budget neutral have made private practice financially impossible for many doctors, the AMA said. "It is absolutely vital that this issue be addressed," the letter to House leaders said. The AMA disagrees that the provision would discourage participation in alternative payment models, it told Axios in an email. Although payment updates to alternative payment model physicians starting in 2029 would be lower than current law provides, those doctors will still get positive payment updates overall, it said. Between the lines: The policy would go into effect as the Trump administration seeks to leverage Medicare alternative payment models to drive HHS Secretary Robert F. Kennedy Jr.'s priorities of prevention and personal choice in health care. The Centers for Medicare and Medicaid Services told Axios it does not comment on proposed legislation, but said it's continuing to prioritize policies that encourage providers to join payment models that reward high-value and coordinated care. Reality check: Just about all physicians and physician trade organizations agree that stable Medicare payment updates with some link to inflation is necessary to ensure continuous access for Medicare patients, AAFP's Martin said. It's "extraordinarily healthy" for physician advocacy groups to have different opinions on exactly how to reach that conclusion, he added. The Senate is currently debating what to include in its own version of the reconciliation bill.
Health Line
an hour ago
- Health Line
A Guide to the Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) is a federal agency that provides health coverage to millions of people. It oversees programs like Medicare, Medicaid, and CHIP. The CMS works closely with the entire healthcare community to improve the equity, quality, and outcomes within the healthcare system. What is CMS? CMS is the federal agency that helps provide health coverage for more than 160 million people across the United States. It oversees the following health insurance programs: Medicare Medicaid Children's Health Insurance Program (CHIP) Health Insurance Marketplace CMS aims to strengthen and modernize the United States healthcare system and provide access to high quality care and improved health at lower costs. About Medicare Medicare is a federal health insurance program for people 65 years old and over. Those under 65 years old who have an eligible illness or disability may also qualify for coverage through Medicare. Medicare has four parts that offer different coverage for your healthcare needs: Part A: This is also known as hospital insurance. It covers inpatient care in facilities like hospitals and skilled nursing facilities. Part A also covers some home healthcare and hospice care. Part B: This is also known as medical insurance. It covers outpatient care and services you might receive from a doctor, specialist, or other healthcare professional. Part B also covers durable medical equipment (DME) and some home healthcare. Part C (Medicare Advantage): This is an alternative to Original Medicare (parts A and B). It offers the same coverage but is provided by Medicare-approved private insurance companies. Medicare Advantage plans also typically include prescription drug coverage (Part D) and additional benefits, such as vision, hearing, and dental. Part D: This offers prescription drug coverage. Part D plans are offered through Medicare-approved private insurance companies. If you have Original Medicare, you can purchase a stand-alone Part D plan from one of these companies. The CMS oversees and manages the Medicare program. The Social Security Administration (SSA) manages Medicare enrollment and income-related monthly adjustment amounts (IRMAA) for Part B and Part D. About Medicaid Medicaid is a health insurance program that is run by individual states according to federal requirements. It is funded by both the state and federal governments. Medicaid provides health coverage to around 71.1 million people, including: adults with lower incomes pregnant individuals children older adults people with disabilities It is possible for you to qualify for coverage from both Medicaid and Medicare at the same time. This can help reduce or eliminate your out-of-pocket costs. About Children's Health Insurance Program (CHIP) CHIP helps provide comprehensive health insurance benefits to children. Each state runs its own CHIP program, which means that the exact coverage and benefits may vary. While states can choose what benefits to offer in their CHIP program, there are certain healthcare services they must include: dental vaccines behavioral health well-baby and well-child visits About the Health Insurance Marketplace The Health Insurance Marketplace can help you find health coverage if you don't already have it through Medicare, Medicaid, or employment. It can also help you: find answers to questions about health insurance compare health insurance plans for affordability and coverage find out if you are eligible for tax credits for private insurance or health programs like Medicare and Medicaid enroll in a health insurance plan that meets your needs Summary The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees health coverage programs like Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). It has a mission to strengthen the United States health system and provide access to high quality care and improved health at lower costs. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Yahoo
11 hours ago
- Yahoo
Lower costs for lifesaving treatment coming to Oregon in 2026
PORTLAND, Ore. (KOIN) — Lifesaving cell and gene therapy will be offered at lowered costs to people on the Oregon Health Plan (OHP) in 2026. The OHP is Oregon's Medicaid program, offering coverage for healthcare services. The implementation of this new cut to costs will help those who are covered under OHP and are seeking treatment for a rare or severe disease. 35 states, including Oregon, applied to the Centers for Medicare and Medicaid Services' (CMS) 'Cell and Gene Therapy Access Model' (CGT), designed to lower costs to patients in need as well as the states offering these services. The plan intends to begin by focusing on sickle cell disease, a condition in which red blood cells are misshapen due to a gene mutation. OSU falls victim to budget cuts, putting a damper on scientific research This disease is genetic and disproportionately affects those with African ancestry, with 9 of 10 of those affected by the disease identifying as Black. The condition can cause extreme health difficulties. Emma Sandoe, Medicaid Director for Oregon Health Authority, said, 'The cost of cell and gene therapies for sickle cell disease is a real barrier that prevents Oregonians from living longer, healthier.' The CGT program will also help patients in preparation for cell therapy. Before the therapy, patients undergo myeloablative chemotherapy, a process that can affect future fertility. CGT will cover, or drastically reduce the cost of, fertility preservation treatments as well as travel expenses and much more. 'This initiative is a big step forward in promoting innovative treatments and increasing access to lifesaving treatment,' Sandoe said. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
