HOME HEALTH SERVICES PROVIDER IN MONTANA

PROMOTING HEALTH AND INDEPENDENCE THROUGH IN-HOME CARE SERVICES

Home Health Services in Montana provide medical and personal care to individuals in their own homes. These services support individuals with chronic illnesses, disabilities, or post-acute care needs, enabling them to maintain independence and improve quality of life. Home Health Services are authorized under the Montana Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Montana Department of Public Health and Human Services (DPHHS)

Role: Administers Medicaid waiver funding for Home Health Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Program (DDP) within DPHHS

Role: Ensures quality standards, service delivery, and compliance for Home Health Services within HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Medicaid-funded Home Health Services meet HCBS quality, person-centered planning, and participant protection standards.

2. HOME HEALTH SERVICES OVERVIEW

Home Health Services deliver medical, rehabilitative, and personal care to individuals at home, tailored to their health and functional needs.

Approved providers may deliver:

• Skilled Nursing Care: Health monitoring, medication administration, wound care, and chronic disease management.

• Therapeutic Services: Physical, occupational, and speech therapy to restore and maintain functional abilities.

• Personal Care Assistance: Support with Activities of Daily Living (ADLs) such as bathing, grooming, dressing, and mobility.

• Medical Social Services: Counseling, resource coordination, and support for emotional well-being.

• Home Health Aide Services: Basic care assistance under the supervision of a nurse or therapist.

• Chronic Disease Management: Education and support for conditions such as diabetes, heart disease, or COPD.

All services are based on the Individualized Service Plan (ISP) and ordered by a physician to meet the participant’s medical and personal care needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the Montana Secretary of State.

• Obtain EIN from the IRS and NPI (Type 2).

• Enroll as a Medicaid Waiver Home Health provider via the Montana Medicaid Provider Enrollment Portal.

• Obtain licensure as a Home Health Agency from the Montana Department of Public Health and Human Services (DPHHS).

• Maintain general liability and professional liability insurance.

• Develop comprehensive policies for patient care, health monitoring, safety, and compliance.

• Ensure healthcare staff meet background checks, licensure, and certification requirements.

4. MONTANA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the Montana Medicaid Provider Enrollment Portal for Home Health Services under HCBS waivers.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, healthcare staff credentials, and policy manuals.

Program Readiness Review:

• DPHHS evaluates provider readiness, including healthcare protocols, staff qualifications, and patient safety procedures.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Home Health Services using designated billing codes.

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Montana Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Home Health Agency License

• Proof of general and professional liability insurance

• Home Health Services Policy & Procedure Manual including:

  • Patient assessment, care planning, and physician order documentation

  • Skilled nursing and therapeutic service protocols

  • Health and safety monitoring, medication management, and emergency procedures

  • Staff credentialing, background checks, and continuing education records

  • HIPAA compliance, patient rights, and grievance handling

  • Billing, documentation, and audit readiness procedures

  • Infection control, hygiene, and wellness monitoring practices

6. STAFFING REQUIREMENTS

Role: Home Health Program Director

Requirements: Bachelor’s or Master’s degree in nursing or healthcare administration; licensed Registered Nurse (RN); supervisory experience preferred.

Role: Registered Nurses (RNs)

Requirements: Active RN license in Montana, CPR/First Aid certification, clinical experience in home healthcare.

Role: Licensed Practical Nurses (LPNs)

Requirements: Active LPN license, supervised by an RN, and experience in providing in-home nursing care.

Role: Home Health Aides (HHAs)

Requirements: State certification, basic caregiving skills, supervised by an RN or therapist.

Role: Physical, Occupational, and Speech Therapists

Requirements: State licensure, professional certifications, experience in home health settings.

All staff must complete:

• Healthcare safety, infection control, and emergency response training

• HIPAA and patient rights education

• Ongoing professional development and competency evaluations

• Annual performance reviews and skills assessments

7. MEDICAID WAIVER PROGRAMS

Home Health Services are available under the following Montana Medicaid Waivers:

• Big Sky Waiver (Aged and Disabled)

• Comprehensive Waiver for Individuals with Developmental Disabilities

• Traumatic Brain Injury (TBI) Waiver

• Community Supports Waiver for Adults with Physical Disabilities

• Children's Autism Waiver

Services may include:

• Skilled nursing care and chronic disease management

• Therapy services for mobility, communication, and self-care skills

• Personal care and assistance with daily living

• Emotional and social support through medical social services

• Regular health monitoring and preventive care

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: Montana Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Home Health Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Montana Department of Public Health and Human Services (DPHHS)

Website: https://dphhs.mt.gov/

Developmental Disabilities Program (DDP) — DPHHS

Website: https://dphhs.mt.gov/dsd/developmentaldisabilities

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MONTANA HOME HEALTH SERVICES PROVIDER

WCG provides comprehensive support for launching Medicaid-compliant Home Health Services in Montana.

Scope of Work:

• Business registration, Medicaid enrollment, and licensure assistance

• Policy manual development tailored to home healthcare and patient safety

• Staff credentialing, training program templates, and healthcare documentation guidance

• Medicaid billing setup and audit-prepared claims management

• Branding, outreach, and patient engagement strategies

• Quality assurance systems for infection control, patient safety, and compliance

• Coordination with healthcare providers for comprehensive care planning

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