Montana - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Montana Department of Public Health and Human Services (DPHHS) Office of Inspector General (OIG) Licensure Bureau licenses Home Health Agencies to provide intermittent skilled nursing and therapy services. Applicants must submit comprehensive operational policies and procedures for state review at least 45 days prior to their expected facility opening date.

Montana explicitly exempts Home Health Agencies from Certificate of Need (CON) review, allowing new agencies to form without proving geographic necessity. A facility cannot accept any patients until DPHHS issues a six-month provisional license, during which an on-site survey is conducted to verify compliance with state administrative rules before full licensure and Medicare certification can proceed.

1. Service Definition and Scope

In Montana, Home Health Services consist of intermittent skilled nursing care, physical therapy, occupational therapy, speech-language pathology, and home health aide services delivered in a patient's residence. These services must be prescribed by a physician and provided under a formal, written plan of care.

Agencies typically operate as Medicare-certified entities, which allows them to bill both Medicare and Montana Medicaid for acute and post-acute care episodes. The scope of practice is strictly limited to intermittent visits rather than continuous private duty nursing.

• Service Modality: Intermittent skilled nursing and therapeutic visits.
• Authorization Basis: Physician-ordered plan of care.
• Eligible Settings: The patient's private residence or community-based setting.
• Included Disciplines: RN, LPN, PT, OT, SLP, and Home Health Aides.

2. Regulatory and Oversight Agencies

The primary licensing authority is the DPHHS Office of Inspector General (OIG) Licensure Bureau, which handles initial applications, policy reviews, and state surveys. For agencies seeking to bill Medicare and Medicaid, the DPHHS Certification Bureau manages the federal certification process.

Medicaid enrollment and claims processing are managed by Montana Healthcare Programs through the Optum Medicaid Management Services (OMMS) portal.

• Licensing Agency: DPHHS OIG Licensure Bureau (https://dphhs.mt.gov/oig/Licensure/HealthCareFacilityLicensure/lbfacilityapplications/lbhomehealthagency)
• Certification Authority: DPHHS Certification Bureau ([email protected])
• Medicaid Enrollment: Montana Healthcare Programs Provider Enrollment (https://medicaidprovider.mt.gov/)
• Administrative Rules: Montana Secretary of State (https://rules.mt.gov/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana does not restrict the number of Home Health Agencies through a Certificate of Need (CON) program; the state explicitly exempts this provider type from Health Planning Program review. Any legally formed business entity may apply for licensure at any time.

However, an agency is strictly prohibited from accepting or treating any patients until the DPHHS Licensure Bureau has reviewed their policies and issued a six-month provisional license. Applications cannot be submitted more than six months prior to the desired opening date.

• Certificate of Need: Not required in Montana for Home Health Agencies.
• Policy Review Window: Policies must be submitted at least 45 days prior to the expected opening date.
• Application Timing: Do not submit an application earlier than 6 months prior to the desired licensure date.
• Patient Moratorium: A facility may not accept patients until the provisional license is officially issued.

4. Licensure and Certification Requirements

Initial licensure requires submitting an application through the state's online portal (mt-reports.com), paying the required fee, and providing a comprehensive list of professional staff with their Montana license numbers. The prospective administrator must also sign an attestation confirming they have reviewed the state rules pertaining to Home Health Agencies.

Following the issuance of a provisional license, a DPHHS surveyor conducts an on-site survey within the first six months. Agencies seeking Medicare/Medicaid certification must separately coordinate with the Certification Bureau to undergo a federal certification survey.

• Application Portal: Initial or Change of Ownership Application via mt-reports.com.
• Required Attestation: Administrator statement confirming review of Home Health Agency rules.
• Service Area: Must submit a list of Montana counties the agency plans to serve.
• Staff Roster: Must provide a list of all professional staff, including active Montana license numbers.
• Provisional Period: Initial license is valid for six months pending an on-site survey.

5. Medicaid Provider Enrollment

Once licensed and certified, agencies enroll in Montana Medicaid via the OMMS Provider Portal. Home Health Agencies are typically screened as moderate or high categorical risk, requiring an application fee and potential site visits.

Providers must submit their National Provider Identifier (NPPES NPI), proof of Medicare enrollment (if applicable), and any CLIA certifications if they perform in-home laboratory services.

• Enrollment System: Optum Medicaid Management Services (OMMS) Provider Portal.
• Provider Type: Home Health Agency.
• Screening Risk Level: Moderate or High, depending on Medicare enrollment status.
• Revalidation: Required at least every 5 years per CMS guidelines.
• CLIA Requirement: Must enclose a photocopy of current CLIA certification if performing lab services.

6. Staffing, Training and Background Checks

Montana Home Health Agencies must employ qualified clinical staff licensed to practice in the state. The agency must designate an administrator responsible for day-to-day operations and a clinical manager (typically a Registered Nurse) to oversee patient care.

All staff must undergo background checks, and Home Health Aides must complete specific training and competency evaluations regarding infection control, patient rights, and emergency response.

• Administrator: Must attest to understanding state rules and oversee agency operations.
• Clinical Manager: Must be a licensed RN or physician responsible for clinical oversight.
• Nursing Staff: RNs and LPNs must hold active Montana licenses.
• Home Health Aides: Must complete documented competency evaluations and ongoing training.
• Background Checks: Required for all staff providing direct patient care.

7. Documentation, Policies and Records

Agencies must maintain a comprehensive Policy and Procedure Manual that complies with the Minimum Standards for All Healthcare Facilities and specific Home Health Agency Rules. This manual is heavily scrutinized during the initial 45-day review period.

Clinical records must include the physician-ordered plan of care, comprehensive patient assessments, visit notes, and discharge summaries, all maintained in compliance with HIPAA.

• Policy Manual: Must be submitted 45 days prior to opening for DPHHS approval.
• Plan of Care: Must be signed by a physician and updated regularly.
• Clinical Records: Must document all assessments, interventions, and patient responses.
• Infection Control: Written policies for preventing disease transmission in the home.
• Emergency Preparedness: Documented plans for patient care during natural disasters or emergencies.

8. Billing, Rates and Claims

Home Health Services are billed to Montana Medicaid using standard CMS-1500 or UB-04 claim formats via the OMMS portal. Services often require prior authorization based on the patient's Medicaid waiver or state plan eligibility.

Rates are established by the DPHHS Senior and Long Term Care Division and are published in the state's fee schedules. Providers cannot bill Medicaid until they receive written notice of their enrollment approval and effective date.

• Billing Portal: OMMS Provider Portal.
• Claim Format: Standard institutional or professional claims depending on the specific service code.
• Prior Authorization: Often required for extended therapy or nursing visits.
• Premature Billing: Claims submitted prior to completion of provider enrollment will be denied.
• Fee Schedule: Published annually by Montana DPHHS.

9. Approval Sequence and Timeline

The process begins with submitting the licensure application and policy manual to the DPHHS Licensure Bureau. The state requires at least 45 days to review the policies before the expected opening date.

Upon approval, a six-month provisional license is issued. The agency then begins seeing patients and undergoes an on-site survey within that six-month window to secure full licensure and initiate the Medicare/Medicaid certification process.

• Step 1: Submit application and policies via mt-reports.com (max 6 months prior to opening).
• Step 2: DPHHS policy review (minimum 45 days).
• Step 3: Issuance of 6-month provisional license.
• Step 4: On-site state survey during the provisional period.
• Step 5: Federal certification survey and Medicaid enrollment via OMMS.

10. Common Denials and Survey Findings

Applications are frequently delayed or withdrawn if the provider fails to upload required documentation or if there is no movement on the application within designated timeframes. DPHHS explicitly warns that inactive applications will be withdrawn.

During the provisional survey, common citations include failure to follow the physician's plan of care, incomplete home health aide competency documentation, and inadequate infection control practices.

• Application Withdrawal: Occurs if the application is initiated but lacks provider movement or required uploads.
• Policy Deficiencies: Manuals that fail to address Montana-specific administrative rules.
• Care Plan Deviations: Providing services not explicitly ordered by the physician.
• Staff Credentialing: Missing or expired Montana professional licenses in the personnel files.
• Premature Operation: Accepting patients before the provisional license is officially issued.

11. Key Contacts and Resources

Prospective providers should direct licensure questions to the DPHHS OIG Licensure Bureau and certification questions to the Certification Bureau. Medicaid enrollment inquiries are handled by Montana Provider Relations.

Utilize the state's official portals for application submissions and rule verifications to ensure compliance with current standards.

• DPHHS Licensure Bureau: 406-444-2676 (PO Box 202953, Helena, MT 59620)
• DPHHS Certification Bureau: 406-444-2099 or [email protected]
• Montana Provider Relations: P.O. Box 4936, Helena, MT 59604
• Licensure Application Portal: https://mt-reports.com/portal/LicenseList.aspx
• Medicaid Enrollment Portal: https://medicaidprovider.mt.gov/

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