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Montana - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Montana, Adult Health Transportation is not licensed as a distinct healthcare facility type by the Department of Public Health and Human Services (DPHHS); instead, providers are approved by enrolling directly as a Montana Medicaid provider under the Specialized Non-Emergency Transportation or Commercial Transportation provider types. The service is funded through the state's Medicaid program and the Severe and Disabling Mental Illness (SDMI) Home and Community Based Services (HCBS) waiver, providing non-emergency medical transportation (NEMT) to covered appointments and waiver services for eligible members.

The most significant structural precondition for providing this service is that all trips must be prior-authorized by the Medicaid Transportation Center, operated by Mountain Pacific Quality Health (MPQH). Providers cannot simply enroll and begin billing; they must be selected by members who have obtained prior authorization (PA) for the specific trip, and specialized non-emergency transportation (wheelchair or stretcher van) requires the provider to hold a Class B Public Service Commission license.

1. Service Definition and Scope

Montana Medicaid covers non-emergency medical transportation to assist eligible members in accessing Medicaid-covered services. The state categorizes this into Commercial Transportation (taxi, bus, commercial air or ground carrier) and Specialized Non-Emergency Transportation.

Specialized Non-Emergency Transportation is defined as transport in a van designed for wheelchair- or stretcher-bound members. It is intended for members whose disability or physical limitation prevents them from using other forms of transportation, and it does not require the level of care provided by an ambulance.

2. Regulatory and Oversight Agencies

The Montana Department of Public Health and Human Services (DPHHS) oversees the Medicaid program and the SDMI HCBS waiver. Provider enrollment is managed through the Montana Healthcare Programs Provider Information website.

Prior authorizations and trip approvals are managed by Mountain Pacific Quality Health (MPQH), which operates the Medicaid Transportation Center under contract with DPHHS.

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana does not restrict NEMT provider enrollment through a closed broker network, RFP procurement, or Certificate of Need process. Providers may enroll directly with Montana Medicaid on an open basis.

However, to enroll as a Specialized Non-Emergency Transportation provider, the applicant must already possess a Class B Public Service Commission license. Additionally, all actual service delivery is gated by the requirement that the member must obtain a Prior Authorization (PA) from the MPQH Medicaid Transportation Center before the trip occurs.

4. Licensure and Certification Requirements

DPHHS does not issue a specific "Adult Health Transportation" healthcare license. Instead, providers must meet the state's general transportation and business licensing requirements.

For Specialized Non-Emergency Transportation (wheelchair/stretcher vans), the primary credential is the Class B Public Service Commission license, which regulates commercial passenger transport in the state.

5. Medicaid Provider Enrollment

Providers must enroll through the Montana Healthcare Programs Provider Enrollment portal. The process requires submitting a full enrollment application, including ownership and control disclosures as required by CMS.

Providers must obtain a National Provider Identifier (NPI) from the NPPES registry before applying, unless they qualify as an atypical provider. SDMI HCBS waiver providers must specifically use HCBS code 28 for their provider type.

6. Staffing, Training and Background Checks

While the DPHHS transportation manual does not detail extensive state-level driver training mandates, enrolled Medicaid providers must ensure their staff meet basic qualifications.

Providers are screened monthly against federal exclusion lists to ensure no staff or owners are barred from participating in Medicaid.

7. Documentation, Policies and Records

Providers must maintain documentation of their qualifications, participation agreements, and state licenses. The state's fiscal agent maintains these records on behalf of DPHHS.

Providers must immediately report any status changes, such as changes in ownership, address, or licensure, in writing to the fiscal agent.

8. Billing, Rates and Claims

Claims for transportation services must be submitted on a CMS-1500 claim form and must include a valid Montana Medicaid procedure code, diagnosis code, and the prior authorization code obtained from MPQH.

Providers may receive a "blanket authorization" (one PA number for multiple services over a specific period) for recurring trips. Procedure codes and rates are published in the transportation fee schedule on the Provider Information website.

9. Approval Sequence and Timeline

The approval process begins with obtaining the necessary Public Service Commission license (if applicable) and an NPI. The provider then submits the full enrollment application to the fiscal agent.

The fiscal agent verifies the application and forwards it to DPHHS for final approval, assignment of procedure codes, and rates. Claims cannot be processed until enrollment is complete.

10. Common Denials and Survey Findings

Enrollment applications are frequently delayed or denied due to incomplete ownership and control disclosures. CMS strictly requires this information for all publicly funded healthcare providers.

For claims, the most common reason for denial is the failure to obtain a Prior Authorization from the MPQH Medicaid Transportation Center before the trip occurs.

11. Key Contacts and Resources

Providers should utilize the Montana Healthcare Programs Provider Information website for manuals, fee schedules, and enrollment forms. The MPQH Medicaid Transportation Center is the primary contact for trip authorizations.

For SDMI HCBS waiver specific questions, providers interact with the Behavioral Health and Disabilities Division.

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