Revise laws relating to category D assisted living facilities
SB 524 revises Montana law governing category D assisted living facilities, creating a more formal framework for facilities that serve people with significant behavioral health needs and limited daily living independence. The bill allows category D facilities to operate independently or alongside other licensed facilities, caps them at 15 residents, and sets admission criteria requiring dependence in at least two activities of daily living and a determination that the person is a danger to self or others or has been adjudged as such by a court. It also requires monthly health-care assessments and written care orders, and it specifies that these facilities are not required to use seclusion or restraints, though they must obtain prior approval before using those interventions if they choose to do so.
The bill also integrates category D facilities into Montana’s civil commitment and diversion system. Courts may divert certain individuals from the Montana State Hospital or other inpatient settings to a category D facility when that is the least restrictive appropriate option, and the bill sets out findings a court must make when ordering such placement. It further directs the Department of Public Health and Human Services to provide technical assistance, standardized forms, training materials, and a specialized reimbursement model with enhanced payments for higher-acuity residents and smaller facilities. The act is temporary, with a termination date of June 30, 2029, indicating it is intended to be evaluated after implementation.
The overall sentiment in the legislative record appears strongly favorable. The bill advanced with large margins in both chambers, including unanimous or near-unanimous committee and floor votes in several stages, suggesting broad bipartisan support for expanding community-based treatment options and reducing reliance on the state hospital. The repeated approval of the conference committee report also indicates that the final version was acceptable to both chambers despite earlier amendments and differences.
The main points of contention appear to center on the use of involuntary treatment, restraints, and the role of category D facilities in the commitment process. The bill creates a pathway for court-ordered diversion to a category D facility and allows, but does not require, temporary restraints and seclusion policies, which may raise concerns about patient rights and facility safety standards. Another likely issue is whether the state can adequately fund and staff these facilities, since the bill depends on a new reimbursement model and technical assistance to make the model viable as an alternative to the Montana State Hospital.
SB 524 amends sections 50-5-226, 53-21-127, and 53-21-199, MCA, to formally recognize category D assisted living facilities as a placement option within Montana’s assisted living and civil commitment laws. It changes facility licensing and admission standards, authorizes court diversion to category D facilities in certain mental health commitment cases, and requires the Department of Public Health and Human Services to adopt rules, develop training and forms, and establish a reimbursement structure to support these facilities. The bill affects assisted living operators, residents with behavioral health needs, courts, practitioners, and the state hospital system by expanding community-based alternatives and setting new operational requirements.
The bill’s legislative history shows clear support and relatively little opposition. It passed committee and floor votes by wide margins in both the Senate and House, with several unanimous votes and only modest dissent on some readings and the appropriations stage. That pattern suggests lawmakers broadly agreed with the goal of creating a less restrictive, community-based option for individuals who might otherwise be committed to the state hospital.
The most notable areas of concern are the bill’s treatment of involuntary commitment, the use of restraints and seclusion, and whether category D facilities can safely serve people with serious behavioral health needs. Some lawmakers may have been concerned about shifting individuals from the state hospital to smaller facilities that must still manage dangerous behavior, while others likely focused on ensuring the bill preserved least-restrictive-treatment principles and did not mandate restraints. Funding and implementation also appear to be potential pressure points, because the bill relies on a new reimbursement model, enhanced payments, and departmental rulemaking to make the system workable.