MINUTES OF THE MEETING HUMAN SERVICES AND AGING COMMITTEE

50TH LEGISLATIVE SESSION HOUSE OF REPRESENTATIVES

The meeting of the Human Services and Aging Committee was called to order by Chairman R. Budd Gould at 1:00 p.m. on Tuesday, March 24, 1987 in room 312-D of the State Capitol.

ROLL CALL: All members were present.

HOUSE JOINT RESOLUTION 45

Rep Cal Winslow, Billings, gave a brief overview of the legislation which requests a study of the cost of mandating health insurance benefits.

PROPONENTS

REP LES KITSELMAN LAURIE EKANGER, Administrator,· State Personnel Division DAVID EVANSON, Montana University System

STEVE WALDRON, executive director, Montana Council of Mental Health Centers, presented exhibit 1 in support of the legislation which provides summaries of research findings and discussions on the utilization of rates, costs, and expenditures associated with providers of mental health services.

There were no opponents.

REP WINSLOW then closed the testimony on HJR 45.

HOUSE BILL 886

REP WINSLOW opened testimony on HB 886 and submitted amend­ments to the proposed bill (exhibit 2). He related an issue from the Human Services Subcommittee where a transient hitchhiking through the state happened to falloff a cliff by Great Falls, and at this point the state has paid $150, 000 in medical bills for this individual. He noted this bill addresses the non medical general relief area and doesn't affect any other area. He stated this legislation makes it clear that neither th~ state or the county will be responsible for medical care of non residents. He clarified that the purpose of the amendments to the legislation is to make it clear that non residents of the state will receive only tempor'ary emergency assistance as provided in section one (l).

PROPONENTS

DAVE LEWIS, director of Social and Rehabilitative Services (SRS), stated the bill was drafted in response to the Human Services Subcommittee's concern with the potential situation

HUMAN SERVICES AND AGING MARCH 24, 1987 PAGE 2

of individuals corning into the state for medical treatment and the responsibility falling on the counties. Mr Lewis said that at the present time in the 44 non state assumed counties the statute says the county is responsible for the treatment of illness or accidental injury of transients passing through the county. He stated this legislation protects the counties and the state from individuals who could corne into the state for medical care and shifts the cost from the state to the medical providers for accidental injuries.

OPPONENTS

BILL LEARY, Montana Hospital Association, stated the organ­ization reluctantly opposes the bill as currently drafted, and specifically the repeal of section 53-3-307 MCA. He read his prepared text (exhibit 3) in opposition of the proposed legislation and urged opposition to the repeal of section 53-3-307 MCA and to change the title by striking out "eliminating payments for medical assistance to nonresidents of the state".

JERRY LOENDORF, Montana Medical Association, expressed his concerns with section three (3) and questioned if ambulance services, upon learning that they will not be reimbursed for picking up an injured person, would choose to not serve those individuals.

REP WINSLOW then closed testimony on HB 886.' He noted that it may not be a tremendous ly good idea, as it is a cost shift, but stated that the fact of the matter was that Montana's health care costs are out of control , with this area being a very blatant example. He concluded by saying that $30,000 a year was put into the budget for temporary assistance other than medical care, and if the proposed legislation doesn't pass, then the program would realisti­cally need more money to alleviate the necessity of funding a supplemental request.

EXECUTIVE SESSION - SENATE BILL 170

REP SANDS made a motion to accept the six (6) amendments in exhibit 4 for Senate Bill 170.

A voice vote was taken and the motion PASSED, with Rep Corne' and Rep Squires voting no.

REP SIMON made a motion to accept the amendment in exhibit 5 for Senate Bill 110.

A voice vote Rep Simon, Rep voting yes.

was taken Patterson,

and Rep

the motion Squires, and

FAILED, with Rep Str iz ich

REP SANDS made a motion that Senate Bill 170 BE CONCURRED IN.

HUMAN SERVICES AND AGING MARCH 24, 1987 PAGE 3

A voice vote was taken and the motion PASSED, with Rep Corne', Rep Nelson, and Rep Squires voting no.

EXECUTIVE ACTION - SENATE BILL 246

REP KITSELMAN covered the amendments and areas of concern that were reviewed by the subcommittee and presented the recommendations from the subcommittee to the full committee.

REP KITSELMAN then made a motion to accept the amendments to Senate Bill 246.

REP SIMON requested a letter from the committee to the Legislative Auditor's office requesting a performance audit be performed on the Certificate of Need process.

A voice vote was taken and the motion PASSED unanimously.

REP KITSELMAN made a motion that SB 246 BE CONCURRED IN as amended, including the statement of intent.

A voice vote was taken and the motion PASSED, with Chair­man Gould, Rep Compton, Rep Squires, Rep Strizich voting no.

EXECUTIVE ACTION - HOUSE BILL 886

REP SIMON made a motion to accept the amendments to House Bill 886 submitted by Rep Winslow.

A voice vote was taken and the motion PASSED, with Rep Hansen and Rep Russell voting no.

REP SIMON then made a motion to accept HB 886 as amended.

A roll call vote was taken and the motion PASSED, with ten (10) voting for the bill and eight (8) voting against the bill.

EXECUTIVE ACTION - HOUSE JOINT RESOLUTION 45

REP SIMON made a motion to pass HJR 45.

A voice vote was taken and the motion PASSED, with Rep Cody voting no.

The meeting was adjourned at 2:30 p.m.

R. Budd Gould, Chairman

bg/gmc/hs3.24

DAILY ROLL CALL

HUr--lAN SERVICES AND AGING COMMITTEE ------------------~~~-----

50th LEGISLATIVE SESSION 1987

~\ Date ! ~;zc \\ II -\ A.. ,

-------------------------------- --------- --~----------------------l NAME PRESENT ABSENT EXCUSED

,

REP. BUDD GOULD, CHAIRMAN / REP. BOB GILBERT, VICE CHAIRMA J ~ c;~;

REP. JAN BROWN V REP DUANE COMPTON ./ REP. DOROTHY CODY V

. REP. DICK CORNE' '/

REP. LARRY GRINDE ..V'. REP. STELLA JEAn HANSEN ./

REP. LES KITS ELMAN V REP. LLOYD MC CORMICK v REP. RICHARD NELSON / I

REP. JOHN PA'l'TERSON / REP. ANGELA RUSSELL t/

REP. JACK SANDS V REP. BRUCE SIr-l0N / REP. CAROLYN SQUIRES ,/

REP. TONIA STRATFORD V REP. BILL STRIZICH v

CS-30

STANDING COMMITTEE REPORT

AAaca l4. 1987 _____ --=:._---=~ ___ 19 __

.'..... , un1LSA~ "lEltVICES A:iD AGl~IG Mr. Speaker: We, tlle:~of!UTlittee on ___ .-:&&:=;u=-=-=--~-"'-'----------_______ _ -... '.~~. ;~~ -.. ' ~ ,

report ilOla .. ,.!I. 8111CB.trrIOil HO. "5

cJdo pass o be concurred in o as amended o do not pass o be not concurred in o statement of intent attached

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FIJlSlf \IUD ______ reading c~py (_----,-__

color

REP. R. Bmw GOOL!), Chairman

"". t·

STANDING COMMITTEE REPORT

MJ....RCS :24. 1987 19 --

Mr. Speaker:': BU1CAJI SBRVICU AIlD AGING "'i~,~~

report __ ~.,...-;, 170

o do pass [Jbe concurred in ~ as amended o do not pass o be not concurred in o statement of intent attached

1. Title, 11 •• 10. Pol low1Dq s -palSe.ras­Insert: -CBaTAIS-

UP. !t. DODD GOULD.

2. P~9. 4. l1ne 1. Strike. -drat! os.. for-In •• rt.. -tbo •• Cf'iiiCJS -apprOJted by the board for Uti. in-

1. Paq. 4, 11ne I. ~o11owlD9t -ADRZIA.-In •• rt, -chroDle OpeD aU91. 91a.co~ eay ~ tre4ted. but not

other fora. of qlaaeoaa.-

4. Pa9- 6, l1ne ,_ Followings -dla9g981s-Strik.. -.DcS· Insert: -T Followi .. , ·tr •• ~ftt,-In •• rt, -, aD • .aaaV"'Dt-

5. Pa98 S, liDe 21. StrU., ·U •• -Inserts -41a9nosls, tr •• ~t, and san4q~ent-

6. 'aq8 '. FollowlD9' I1me 12

Chairman

Insert: ·HEW S~IOS. Sect,ion 6. Opto .. trlc ov.~slqbt eo~ltte. -- Aeab8rs -- daty to !D.e.t19ate e~p141nt.. (1) (a) There 1 •• B op~tr1c o .. r.19~t. co.alttae compaeed ot five ••• s&,Ja.._- _ . are I . .. ., 0_ of wbe. ."st. be !1ft

._ tlMt otJIe .. a .... r of the board of we. vbo are appointed by tb'-! board of aMdlc:al

(11) tWO opta.etr1ata who are'aeaber. of the board of opta.etrist. aDd vbo are appoiDted by tb. board of o~trlst.' aDd _

(111) ODe ph.l'IIAci.~ dO 1 ..... aber of the boer4 of pbanucy •• a wIlD 1. appoillt." by tbe bo.rd of phanHey.

(b) Yhe •• aber. of ~ eo.alt~ shall eleet a chairaaa fro. their .-.bar.. Meaber. of the c~itt .. are entitled

. -UP • .:1M alOlRl UUt CARD' ~Ia B1.LL DI 'fU IlOUU or ~~1vr.s

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llUJIIAO Service. cu1d Aqing

Caaa1ttae - MArch 24, 1~a7 ~D f 171) t'aq-e 2 of 2

to>eoapeft •• t1on ~nd tr~v*l expen~ •• Aa proy 1ded for in 31-1-131. .·.be~.t CORpsns4tion ~nd travel ~'p4n.fls And c...t .... o1erlcal a~d a~l~i.tr.tlve .Xper.S~8 ~u.t ~ ~~id h~ ~:~ of orto .. trist~ frca fQnds appropriated to ~hA board .... -1u ordinary operatio"\4.

,2t & ... to; of t::h .. eO!".Uaitt.ee l'ttut be cl'llloed ~)y IV'? ~! th~ repre~.nt~d boards u,on r~c41~t ot a 5iqnod ~rit~~~ Co_plAint reqardi:lq the diagnosis, tr!!!at~ent, Qr ~n"g""~ent of o~ul~r di~~ase ~e it r~late. to th.r4p~utic drug ~~~~~ b~ ~t1 optOllleCri5t.

(3) EACh o! the ~~p~~~p.nt~d hoard2 8b~11 u~~ rec~l?t of 4 co..plaint cone~rni~q th. d1aq5~9i~, treat3ent, or manAqesent of ocular ~i.!~4~ft bY' a~ I)pto!lt9tri.tlt, forv~~l"~ ..1

copy of th4 eomplai~t to ths ~.~~rQ ~! th~ commltte~. ~ach meMber of the ~o~~itt~e ~~all. subject to a~~li~~bl~ confld.ntlallty r~qulr~~ent~, bav« ~ce.aw t~ ~ll r~~~rd~ r~lat~d to thQrap~utl~ dr~q ~c~q. ot t~~ ~ard or ~Ptosetry conc.rninq t!t~ optO!!~tri5t .Jqainat yJ\O!t .'J complAint haa b4ten filed.

(4) The ea~~1tt~~ ~ay inv~.ti~at~ any co~plalnt that it beliaves has a '"alid basi.. T!la 1:1v~sti9c1tion m4., include!.

(A) r&qUiring th~ co~plainaAt, if injuri~. h3ye be.n !lll'ft<Jed, to ,.uMlt to a pby~ical examination,

(b) exaain~ti~~ of ho~pltal e~d other ~dieal record., (e) 1I:ltftr',te .... 11 of th., c~mpl&lnant I!nd to.., aeeuse4

optoaetrist, and Cd) otbor I\v~nU4!'!l of inquiry tendi~~ to 'PT.O". or

disproYe the co!ppla1nt hat that do :'tot r 1 i!u! t~e fonaal.lt~' of the Inve.tiqatlon t~ the l.v~l of A ~r.nt~eted case ~d.in18trativo h~arinq.

(5, Based O~ the fl~d1nq. of tt~ in~~~ti~at1oD, the committee ~ay~

(a) reeomet!!nd t·;) botlrd c:f optc!Iletr1sts that no further action be t~k~~ re94rdinq the ~omplaiat;

(b) r.commen~ t~ tb~ board of o~~ometri~ts that no action be taken ag41nst the 8ub~eet n~tomatri~t, but th~t tbe board ~hould rl!vlev it9 rnll!8 and ",tatutcry pt"ov!fllions relatinq to the ad.l~istr~tlon of preftcr1~tio~ druqa by optoaetrists to amend the rules or p~opo8e 1~~1814tion to ,~~veftt sla11ar occurrene •• , or

(e) recommeDd that the board of optom~tri5t. initiate dlae1p1 t.er.r proceed1nqs.

,,,;." tile ao_letee rfJCOBDlfU'ld. t.hat th8 bORrd of (')Pto.e~ latlata disciplinary ?roeeedinqs, the board DU.t·~ ....... ry actinn to beqln dl~iplinary proc~~inqs.

(7)fa) A copy of the comaittee's decision ~U8t be aall-4 to the complainant.

lb) It tho committee m4ke~ a dooisioD undar subsection (5) (h) or (5,(c), the board of optoaetrtst. shall r~wpond to th. co_itt .. ', decision in vritinq. The !!'4!apOIlSEt r.ltlst be 3ddre •• ed to the board of medical &xa.lnera and tho board of pharl'lacy.-

Renumber: Aubsaquant 3e~tlon.

:MAt

STANDING COMMITTEE REPORT

__ ~M~.ABC8~~=2~4~' __________ 19 S7

r _~ ____ ~H=U~=aa~~SK~~~C~BS=-~AN~D __ AG--INQ--------------Mr. Speaker: We, the committee on

_____ ~SI~.~ .... ~ .. ~.~·~.~IJ~~~~ao~.~l~.~6~·-----------------------------------------­report

ill as amended o do pass o do not pass

cJbe concurred in o be not concurred in o statement of intent attached

~. R. BODO GOOLD, 1. ~aqe 10, lin~ !1. Ynllowinql -oF2anlza~;on,· las~rt' -pr~f.e:~p.d ~rov1d~r organi~ation,-

2. ?aqi! 10. Followinq: 11fle 1. !nsart, -(l" -PrerQrr~ ?r~vtder arga~i%atlon- ~&ns ~ft

orqanlz4tion that contr~cta with health care providers to pay the ftntire c('st of h~alth c,I!r" ~orvlcCt~ pro.,ided to e~rolla~ ~eebers ~ho have prepaid f.vr tnos4 ~ervtee •• ~d th~t ~ay ?4y !or a ?ortio~ of the ~Grvle~~ provlded to AD enrollee bv a none~ntr~~t health car. prGvlder.-

~ellu~r: sub9~uent sub?$etiona >

Chairman

l. PAq~ 1" line 21. Pollovinqt -estAte,·

'\. Insert: ·h~al t:b flla1ntence orqani 'I.!t ion, ?r~fer1""·~d provl1er ~ org~nlzatlon,·

4. P'l901!t 11. PQllowinq: line 21 Insert: -(26' ·Pr~f~rr~d pro.ld~r orqani~at1on- ~an. ~n

oEq<lni%4tion that contracts with health carn providor" to pAy th4l'! e~tire co.st. of heAlth e8~~ gp'ryic~s ~rovided to enr~lled me~ber. vho h4V~ prepaid !or those ~~rvlces and that may pay for a ,ortion ot the services provided to an p.nrolle" b~' i.} noncontract hft41th care )'lrovtdf!'l".-

~4'!nu"!lber: .sUbSo.q!lent ~tlb.$ctions

5.P4qe 20. 114. 9 'Strike: -SleO,O' ... !nsertt -'15',0.,·

..,.. :a&P.. WDlSLOW IS CAJUtYUG THB BILL IN TU UOUSB 01' REPRBSEJrlA'tXVBS

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S?A~P.M~~ or ~~E~~ SZfo1AT! SILL 24'

S8A&t.e aill ;io. 2"', larch 24, 1937 PA'.I- 2 of 2

Hous~ ffealtn a~d au.a~ Serylc __ s Co~ltte.

A .tate~nt nt int.nt 19 pr@p.red for this bill ~e~u.9 the COQaittea f.lt it was n.e~S8&ry t~ in~ure cOMplianeo with r~qialative 1~t0nt in turt~8rane~ of t~~ ext~n.lon ot rulp.~akinq authority provld~d i~ ge~t1or. 11.

Tb. l.qlalatur. contemplates that tho d@partmen~ o! health and environmental 'lcilll!nees vi11 continue to monitor t!l. ettec~. of certificate of ne~d ~nd o~~~r f~ctors that control ~~pltal tl~.ndltQM. &nd d6yelope#.nt or !leelth c~r •• arvi.:. copacltJ'_ By Pece~r 1, 1~'8, the depftrt~~t sust provid. for the 1981 leqialature an ovalu~tioa of tho need to contiaue ths certificate of Q •• d proqr~. h.yo~d June 30, 191', and idefttify aaT alternati~ 1«9ialati~n that would be needed it certificate of ~&ed v.re to be dinconti~~ed. It ia also this ~1ttee'. 1.teft~ ~~at the leq1s1~tivft audit coas1ttee review, a~d 1f po_aLbI., ftate a perform4nee audit, Qt the certificate ~f " •• d proee •• and make ita r~c~ndatlo~ to the 1989 legislature.

STANDING COMMITTEE REPORT

~as amended ~o pass o be concurred in

o be not concurred in o statement of intent attached

o do not pass

1. yttl., line I. Strike. ·SZCTION·

~ Insert! ·SEC?I05S·

2. Title, I1nft 9. ~ Followlnqt -53-3-201·

Strite I -,.

!n •• rt: -AND 53-3-314,-

~ 3. Page 2, 11n.8 • thrQuqb ••

Y.7ti ti nnw COULD, -,.. ~. -

Strike. ·per.oft- on line 4 through -beCOQ. a· on line ,

.. ... ..98 2. line ,. Strike. ·shall be-

'i"'~. In.ertl ·of the state 1.­~o11owlft9t ·.1191b1e­

Ins.rt, -to apply for·

! S. Paqoe 2 • .. FollowlA9' lin. 16

Inaert. ·Section 3. SeetioD 53-]-31., MCA, is a.ended to reAd!

Chairman

·53-3-314. County of f1A&neia1 responsibility. (1) ?h. coanty responsible tor benetit. provtd.d ~der this ~h.pt.r i. tbe county of re.idence of the person matin9 application for .s.iatanc ••

(2) "edical coata covered by qeneral r.liel ~dic.l ••• istance are t~. financial r.8pon81bl1ity of the tre.ted per.cn·. c:o.ty of r •• ia.aee. IDstitatlonal1zatioQ for

, . . ... .., ............ t:.t.ftee ktP-.. -~P""'~ _ted •. '." ... 1'" not .. __ ... ,," roddeney.

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ReD..a.rl S1ibaeqgeat •• etloas

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ROLL CALL VOTE

_______ H_U_MA_N_S_E_RV_IC_E_S_A_N_D_A_G_I_U_G ____ CO''tHITTEE

DATE __ 3,.;../_2--:4/,--8_7 __ BILL NO. HB 886 NU~BE~ -=~~~---

NAME A'JE NAY REP. BUDD GOULD, CHAIRMAN A REP. BOB GILBERTJ VICE CHAIRHAN X REP. JAN BROWN ). REP. DUANE COMPTON ") REP. DOROTHY CODY ) REP. DICK CORNE' X REP. LARRY GRINDE 'A REP. STELLA JEAN HANSEN X REP. LES KITSELMAN X REP. LLOYD MC CORMICK 'J.. REP. RICHARD NELSON 1 REP. JOHN PATTERSON X REP. ANGELA RUSSELL 'I, REP. JACK SANDS X REP. BRUCE SIMON X REP. CAROLYN SQUIRES Y REP. TONIA STRATFORD X REP. BILL STRIZICH X

TALLY 10 8

Secretary Chairman

MOTION: Rep Simon made a motion to accept House Bill 886 as

amended •.

Form CS-31 Rev. 1985

... 1 • -

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..

..... :

a-n. II ... I , +;::: J

DATE.. 3 ~y -0 HB. ttrL y~ ~, "u'" W p.. '- 0 ~ o1'{"

tmLIZWCB AID' cOSts. 01 MER'UL HBAXD BENErITS """. 0 • _, "

" Provided b.low .ue SUlllllt4ri.es o~ r ..... rch liDding .. /di .. cuasioa on utilization rates and costs, and expenditures associated with mental.bMlth services o~ providers •

Blue Cro •• of We.tem Penn.ylvania. (1976). The effect. of outpatient psychiatric utilization on t~e costs of provid1n1 third-party coverage (Research Series 18). PeJl1l.ylvania: J .... on, J •. , Shumsu, L.J., & YOWlg, W.W.

SWIIII8ry' Despite' the rising nuaber of peoplereceiviua outpatient mental health care coverage, there is .till a reluctaDcy on the part of third-party payor. to provide such. coveraae and 'the inability of practitioner. to agree on treatment pla1l8 and to provide evidence of treatmeu~ .uccess. This study M .. ured the difference in other medical co.t. after initiation of mental health trea~nt. Thi. study concentrated on 136, persons aaakini at least one o\1tpatient mental health claia to Blue Cross of Westem Peansylvan1a. Data .howed that following mental health care cont~ct, the IIlOnthly coat per patient for medical service. dropped from $16.47 to. $7.06, a $9.41 savings. Inpatient and outpatient medical visits decreased by more than 54%. ~ This data is further aaalyzed in terms of ses, age, and employment level. The author. present several factors that must be considered prior to the conclusion that mental health care utilization will decrease 'medical util1zation and costs. .

Eastwood, M.a., & Trevelyan, M.H. (1972). Relationships between physical and psychiatric'd1aorders. PSIcholosicalMed1c1ne, 1. 363-372. (on-order)

Feuerberg, M.A. (1984). Provider type., setttnis. utilization, and espenditures for aental health conditions. Unpub~shed.draft •

. ' SWIIII&ryr UsiD& data froa the Na ticma1 , Medical Care Utilization and Ezpenditurea S~ey (NMCUES), estimates are obtained for the number of p.~.~U"'t" •• 1C1i aimually for aabulatory mental' health care, for the choice of

.. ttiDa of, care,. and fo~, the level of utilization and co.t of an e.timated 13.6 a1111ou'people, 6.0% of the population,

"~.t:e4 90.4 m11liou vi.ita to MDtal health care providers. Of I~OUP reporting mental. health condition., 54.8% mada ouly 1-2 '

year, accoWlting for O1Lly 9.51 of total expenditure. for a81i'tal " __ ..... via!ta. whUa 7.3% are hiab ut1.lizera of care and provide for 44.2% . of tbe,- total expenditures. Sett1q; varies nth ut1l1zatiOl1. Of the expeud1turea for low utilizers, 12.~% of the costs'are for visits to offica baaed p.ychiatrists. whila 38.6%,are for visits to M.D.'s. Por high,ut1l1&ers,vi.it. to psychiatri.ts account for 29.8% of the co.ts and visita to p.ychologists 40.4% of the coats. Insurance coveraga for these coata varies by type of provider. ' "

l409G

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Frank, G.R., & Kamlet, M.S. (1985). Direct costs and expeDditures for mental health care iathe United States in 1980. Hospital & Community Psychiatry, 36, ~~'-~~I ___ .~L~rMlr) --

Psychiatry-psycholoSY conflict: Origins ~~2S~..2!..!!!.IE2!~::"'~:!S!!!!!U:!!2..£!'!:!:!1!!5~ i, 203-208.

Psychologists and Union Mental Health Benefits: Design for the Future. (1983) GLS !asociates, Philadelphia, PA.

Summary: Research review indicates: Uti1izatiou of melltal health services falls ill~o predictable and insurable patterns.' !&lchor. sWIIID&rized two ujor pOillts: evell with t,he most generous benefits,' 'users of outpatient melltal health services had fewer than 20 visits per ~pi80dej utllizatiou patterns differ by provider sett~ns in that plana such ~s Be/BS have .fewer users per thousand but higher ave rase numbers of visits per episode. Ou the issue of add1n& psycholosists as a class of provider, research shows that the addition of psycholosists .to health benefit plans can actually decrease cost per enrollee of these plana. Concluaioua were baaed on the developm .... t of relat~ve coat units by type of beuefit packaae. Researchers assumed no illcrease ill users/lOa a and a 5% illcrease in users/1000.This study also summarized basic info, on utilization rates: NIMH, based 011 epidem1olosical studies dat1n& froa19S4 through 1973, has estimated that ill any Siyeu. year, 15 perc,at of the' population will suffer from mental disorders. with 10% of the populatiou ha~ a mental disorder at any point in tiaa •. Of persons with IIGtal,cliaoriera# who received care, it was estimated that 73% were seen solely 111 the saeraJ. health sector; 19% were seen in the specialty mental health area, 8% have seen both. Over half of all of the patients seell for mental disorders received care from non~sych1atr1c physicians. Trends ill utilizatiou of mental health

. services have been toward increased ellpbaais on outpatient care, with a larse pr~portion of the care beins rendered by non-psychiatric physicians.

Goldberg, 1.0., Allen, G., Kessler. L.G., etal. (19 ). Ut1llzat1on of medical services after short-tera psychiatric therapy in a prepaid health plan secciUs. Medical Care, .ll, 272-286. (on-order)

Haukin-~ J.R., Steinwaches, D.M., et ale (1~82) Use of general medical care sevices by persoua with mental disorders. Archives of General Psychiatry, 39, 225-231. (on-order) ,

Jones, O.lt{.(l976). three years findings of the Insight program, Unpublished report, Utah: Copper Division of the !<emecott Copper Corporation, Salt Lake City. (ou~er) ,

Jones, O.P.~ & Vischi, T. (1979). Impact'of alcohol, drug abuse, and mental health treatment on medical care utilization: A review of the literature. Unpublished report. Rockville, MD: Aleohol, DnS AbU.8, aDd Mental Health Administration.

1409G

3

AMENDMENTS TO HB 886 (Introduced Bill Copy)

Re: Temporary Emergency Assistance, etc.

1. Title, Line 8. Following: "AMENDING" Strike: "SECTION" Insert: "SECTIONS"

2. Title, Line 9. Following: "53-3-201," Insert: "AND 53-3-314,"

3. Page 2, Lines 4 through 6. Following: "Any"· Strike: remainder of line 4 through "become a" on line 6 in

their entirety

4. Page 2, line 6~ Following: "resident" Insert: "of the state of Montana" Following: "eligible" Insert: "to make application"

5. Page 2, line 17. Following: line 16 Insert: "Section 3. Section 53-3-314, MCA is amended to read:

53-3-314. County of financial responsibility. (1) The county responsible for benefits

provided under this chapter is the county of residence of the person making application for assistance.

(2) Medical costs covered by general relief medical assistance are the financial responsi­bility of the treated person's county of resi­dence. Institutionalization for medical services does not change such residency.

~3T Gefte~e%-~~ie~-~~-~~-~~-a ~~eft~~eft~--~&-~-~~-~--~fl~--ee~ft~y wft~eft-~fte-~esi~~~~~~-~~t~~y-re~~~r­~ft~-me~~ee%-e~~eft~~eft-~ft~~~a%%y-eee~rre~T"

Renumber: remaining sections

Purpose: To make clear that nonresidents of the state of Montana will receive only-temporary emergency assistance as provided in section 1. The amendments further clarify that medical assistance is not available to nonresidents.

2 3 .4 5 6

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86

TESTIMONY IN OPPOSITION TO HB 886

by

William E. Leary, Special Consultant

Montana Hospital Association

EXHIBIT .. >.r 3 DATE ;:) -:1 'j .',' r\

HB ~ FF \'

We reluctantly must oppose this bill as currently drafted,

specifically the repeal of Section 53-3-307 MCA.

Montana hospitals must morally, if not legally, accept,

assess and treat all persons who appear at our emergency rooms and

if a physician so orders, admit these persons for more extensive

treatment regardless of whether they are residents of the state or

not.

If there is a car accident that involves transients, the

hospital is the second (after the ambulance) health care provider to

see the victim or victims.

The law has always been clear in mandating that the county

where the accident happened is responsible for the medical and

hospital care of said transients.

Certainly,.the hospital is going to try their best to locate

any third party payer or any funds tnat the transient may have to

cover the hospitalization, but if all this fails, we must look to

the county for payment.

Montana hospitals have already accepted a two year freeze on

Medicaid reimbursement for taking care of the qualified Medicaid

clients - now to deny US the opportunity to collect from the

counties for accidents that may occur to the transients who are

traveling through our state is almost more than we can bear.

Isn't it enough that we charged off $5.7 million in Medicaid

discounts in 1985 and $6.4 millio~ in Medicaid discounts in 1986,

plus $1.6 million charity care in lS85 and $2.4 million charity

care in 1986?

clow much mor~ is this legiSlature going to tell US to switch

to the other users of care? How much is too much before we have

to close down some of our rural hospitals or increase our rates

high enough to pay for all these losses?

MBA Testimony on HB SSS/page 2

As a native of Montana I, too~ am very concerned about the

stories of bus loads of transients being brought from other states

so they can take advantage of our liberal welfare laws, but I must,

and you must, feel co~passion for the transient traveling ~hrough

the state who becomes involved in an accident. Have the counties

or the state that administer the state assumption program documented

that the payout for medical and hospitalization expenses for

accidents to transients is exorbitant?

I urge you~ opposition to the repeal of Section 53-3-307 MeA

and to change the title by striking out "Eliminating Payments for

Medical Assistance to Nonresidents of the State;".

357 GENERAL RELIEF 53-3-309

Work experience and training program - aid State general relief assistance - state to 10 families with dependent children program. establish work program. 53-2-822. Title 53. ch. 2. part 7.

53-3-305. Effect of refusal to work. Any recipient of general relief who is subject to the provisions of 53-3-303 and 53-3-304 and who without cause refuses to perform work 'Ilssigned to him as therein provided shall lose his eligibility for general relief for 1 week for each refusal.

History: En. Sec. 5, Part 2, Ch. 82, L. 1937: amd. Sec. 13, Ch. 129, L. 1939; amd. Sec. I, 0.180, L. 1963; amd. Sec. 28. Ch. 121, L. 1974; amd. Sec. I, Ch. 208, L. 1974; amd. Sec. 29, a. 37, L. 1977; R.C.M. 1947, 71-307(3).

53-3-306. Repealed. Sec. 28, Ch. 670, L. 19.85. History: En. 71-302.2 by Sec. I, Ch. 225, L. 1974; amd. Sec. 25, Ch. 37, L. 1977; R.C.M.

1947. 71-302.2(part); amd. Sec. 2, Ch. 450. L. 1979.

53-3-307. County medical assistance not to be paid from state funds - exception. (1) County general relief medical assistance under 53-3-206 shall not be entitled to be paid from state funds.

(2) Medical expenses arising from accidental injury to interstate transients shall be paid from county funds and reimbursed by the state upon submission of a proper claim. 'History: En. 71-302.2 by Sec. I, Ch. 225, L. 1974; amd. Sec. 25, Ch. 37, L. 1977; R.C.M.

i. 1947, 71-302.2(part); amd. Sec. 26, Ch. 670. L. 1985. !

Compiler'. Comments 1985 Amendment: In (1), inserted "general

relier' and substituted "53-3-206" for i' "53-3-103". i I!

. 53-3·308. Responsibility for general relief. (l) The county boards of I. public welfare and the department, in accordance with this chapter and other i' relevant statutes, are responsible for the provision of general relief to indigent r, or misfortunate persons as follows: . , , (a) Counties without state-assumed welfare services shall provide general

.;, relief consistent with their duties as specified in Title 53, chapter 2, parts 3 red 7, and this chapter. · t:' ,(b) In counties with state-assumed welfare services, general relief must be Ii' provided by the department and must be consistent with its duties as speci­H' fled in Title 53, chapter 2, part 8, and this chapter. '; (2) In counties without state-assumed welfare services, general relief must

'Ii, ~ paid from the county poor fund as authorized in 53-2-321 through ,j' ill ~-2-323. . ii! ... (3) In counties with state-assumed welfare services, general relief must be Iii paid from and may not exceed money available through: .

· :,:" (a) a general appropriation for such purpose; · !l.:,. (b) county mill levies as provided for in 53-2-813; and '. d, ',' (c) federal or other assistance. · "; .. H1storr. En. Sec. 3, Ch. 670, L. 1985.

'l: ,;.

'" 53-3-309. Form of relief. The choice as to the form or forms of relief :, ':. provided is at the discretion of the county welfare department in counties :~ . ';. r "" ~ )'

Amend SB 170, Third reading copy, blue. Rep. Sands

Version of ======> 3/24/87 COMMITTEE CONSIDERATION

1. Title, line 10. Following: "PRESCRIBE" Insert: "CERTAIN"

2. Page 4, line 7. Strike: "drugs used for"

EXHIBIT II DATE 23· ·87 ,.. '5[3/70

Insert: "those drugs approved by the board for use in"

3. Page 4, line 8. Following: "ADNEXA." Insert: "Chronic open angle glaucoma may be treated, but not

other forms of glaucoma."

4. Page 6, line 6. Following: "diagnosis" Strike: "and" Insert: "T' Following: "treatment" Insert: ", and management"

5. Page 6, line 21. Strike: "use" Insert: "diagnosis, treatment, and management"

6.Page 8, Following: line 12 Insert: "NEW SECTION. Section 6. Optometric oversight committee

-- members -- duty to investigate complaints. (l)(a) There is an optometric oversight committee composed of five members. The members are:

(i) two physicians, one of whom must be an ophthalmologist and the other a member of the board of medical examiners, who are appointed by the board of medical examiners;

(ii) two optometrists who are members of the board of optometrists and who are appointed by the board of optometrists; and

(iii) one pharmacist who is a member of the board of pharmacy and who is appointed by the board of pharmacy.

(b) The members of the committee shall elect a chairman from their members. Members of the committee are entitled to compensation and travel expenses as provided for in 37-1-133. Members' compensation and.travel expenses and committee clerical and administrative expenses must be paid by the board of optometrists from funds appropriated to the board for its ordinary operations.

(2) A meeting· of the committee must be called by any of the represented boards upon receipt of a signed written complaint regarding the diagnosis, treatment, or management of ocular disease as it relates to therapeutic drug usage by

Amend Senate Bill 170

1. Page 4, line 7. Following: "of" Insert: "topical ll

Following: "drugs" Insert: "and oral antibiotics"

XTOl \wp\lee\amdsb170.02(pg3)

EXHIBIT ___ ---....., ....... ___ ,,-',

DATE 2 ~ t . j HB 5 t:.., I -j 0

VISITORS' REGlSTER

HUMAN SERVICES AND AGING COMMITTEE

lULL NO. HOUSE BILL NO. 886 DATE ____ ~MA~RkCHn_~2~4~,~1~9~8~7L_ ________ ___

SPONSOR REP. WINSLOW

-----------------------------~---------------------------------NAME (please print~ RESIDENCE SUPPORT OPPOSE

//

IF YOU CARE TO WRITE COMMENTS, ASK SECRETARY FOR WITNESS STATEMENT FORM.

PLEASE LEAVE PREPARED STATEMENT WITH SECRETARY.

CS-33

VISITORS' REGISTER

HUMAN SERVICES AND AGING

DILL NO. HOUSE JOINT RES. # 45 DATE

SPONSOR REP. WINSLOW

COMMITTEE

MARCH 24, 1987

-----------------------------~------------------------~ --------NAME (please print) RESIDENCE SUPPORT

I t,YiJl'1C1Rr CaO+ , of AdtnfLl Y . , (UL.r.i (J

La. CoU..,:te. , /

Ma.r-Itne B I ILVln c.

Jk' 0 lv: -JI-,f.<.Pv, ,

X' J;!J2~

-------OPPOSE

.-

IF YOU CARE TO WRITE COMMENTS, ASK SECRETARY FOR WITNESS STATEMENT FORM.

PLEASE LEAVE PREPARED STATEMENT WITH SECRETARY.

CS-33