Montana - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Montana, Homemaker Services provide essential general household support—such as meal preparation, laundry, shopping, and light housekeeping—for Medicaid waiver participants who cannot perform these tasks independently. These services are primarily delivered through the Big Sky Waiver for the elderly and physically disabled, and the Severe Disabling Mental Illness (SDMI) waiver, ensuring individuals can maintain a safe and sanitary living environment without requiring institutionalization.

The single biggest structural barrier to entry in Montana is that the state does not issue a standalone "Homemaker Agency" license. To be approved, an applicant must either obtain a Personal Care Agency license from the Montana Department of Public Health and Human Services (DPHHS) (https://dphhs.mt.gov) Office of Inspector General (OIG) Licensure Bureau (https://dphhs.mt.gov/qad/Licensure), or they must be a registered, commercially insured professional housekeeping/janitorial entity approved directly by the waiver program. You cannot simply enroll as a homemaker provider without first passing through one of these two distinct business credentialing gates.

1. Service Definition and Scope

Montana Medicaid defines Homemaker Chore (SDMI HCBS 335) and Big Sky Waiver Homemaker services as assistance with basic household tasks necessary to prevent institutionalization. These services are strictly limited to household maintenance and do not include direct, hands-on personal care.

The service is only authorized when neither the member nor anyone else in the household is capable of performing the tasks, and no other relative, caregiver, landlord, or community agency is responsible for their provision.

• Covered Task: Light housekeeping including vacuuming, dusting, mopping, and organizing personal spaces.
• Covered Task: Meal preparation, basic cooking assistance, and kitchen cleanup.
• Covered Task: Laundry, linen changes, and basic clothing care.
• Covered Task: Grocery shopping, budgeting for household needs, and essential errands.
• Strict Exclusion: Homemaker services do not include assistance with Activities of Daily Living (ADLs) such as bathing or feeding; those require a Personal Assistance Services authorization.
• Authorization Condition: Services must be explicitly detailed in the member's Person-Centered Plan (PCP) based on documented hazards to health and safety.

2. Regulatory and Oversight Agencies

The Montana Department of Public Health and Human Services (DPHHS) (https://dphhs.mt.gov) is the umbrella agency overseeing all Medicaid and HCBS waiver programs. Within DPHHS, specific divisions manage the waivers while a separate bureau handles facility and agency licensure.

Provider enrollment and claims processing are managed by a third-party contractor, Conduent, through the state's Medicaid Management Information System (MMIS) portal.

• Umbrella Agency: Montana Department of Public Health and Human Services (DPHHS) (https://dphhs.mt.gov) administers the state Medicaid program.
• Licensing Body: DPHHS Office of Inspector General (OIG) Licensure Bureau (https://dphhs.mt.gov/qad/Licensure) issues Personal Care Agency licenses.
• Waiver Operator: DPHHS Senior and Long Term Care Division (SLTC) (https://dphhs.mt.gov/sltc) manages the Big Sky Waiver.
• Waiver Operator: DPHHS Behavioral Health and Developmental Disabilities Division (BHDD) (https://dphhs.mt.gov/bhdd) manages the SDMI Waiver.
• Enrollment Portal: Montana Healthcare Programs Provider Information Website (https://medicaidprovider.mt.gov) hosts the enrollment applications and fee schedules.
• Claims System: Montana Access to Health Web Portal managed by Conduent (https://mtaccesstohealth.portal.conduent.com) processes MMIS claims and provider agreements.

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana does not require a Certificate of Need (CON) for home care or homemaker agencies. There are no closed networks or mandatory RFP procurement windows blocking new applicants from entering the market.

However, the primary structural precondition is that an applicant cannot submit a Medicaid enrollment application for Homemaker Services without first securing the underlying business authority. The applicant must either hold an active Personal Care Agency license from the DPHHS OIG Licensure Bureau (https://dphhs.mt.gov/qad/Licensure) or provide documented proof of being a licensed, insured professional housekeeping/janitorial entity.

• Certificate of Need (CON): None exists in Montana for homemaker or personal care agencies.
• Licensure Prerequisite: Must possess a Personal Care Agency license OR be a registered professional housekeeping entity before Medicaid enrollment is accepted.
• Business Registration: Must be registered and in good standing with the Montana Secretary of State (https://sosmt.gov).
• Federal Identification: Must obtain an Employer Identification Number (EIN) from the IRS.
• NPI Requirement: Must obtain a Type 2 National Provider Identifier (NPI) from the NPPES registry prior to submitting the state enrollment application.
• Waiver Authorization Gate: Even after enrollment, services cannot be billed unless prior-authorized by a waiver case manager (e.g., Mountain Pacific Quality Health or local Area Agencies on Aging).

4. Licensure and Certification Requirements

Providers choosing the agency route must apply for a Personal Care Agency license through the DPHHS OIG Licensure Bureau (https://dphhs.mt.gov/qad/Licensure) using the Bounds Licensing System (https://mt-reports.com/Portal/ProviderLogin.aspx). This process requires submitting comprehensive operational policies.

Providers operating strictly as professional housekeeping entities under the SDMI waiver must submit proof of commercial liability insurance and business registration directly to the waiver program for approval.

• Application System: Bounds Licensing System Provider Portal (https://mt-reports.com/Portal/ProviderLogin.aspx) is used for submitting the Personal Care Agency application.
• Insurance Requirement: Must maintain commercial general liability insurance and worker's compensation coverage.
• Policy Submission: Applicants must submit a policy and procedure manual covering client rights, grievance procedures, and emergency protocols.
• Licensure Fee: Initial and annual renewal fees apply for Personal Care Agencies, typically ranging from $100 to $300 depending on the facility classification.
• On-Site Survey: The DPHHS Licensure Bureau is authorized to conduct on-site visits at any time just cause is present to ensure compliance with state regulations.
• Alternative Pathway: Professional housekeeping entities must provide documentation of their commercial cleaning business status in lieu of a clinical license.

5. Medicaid Provider Enrollment

Once the underlying license or business approval is secured, providers must enroll through the Montana Healthcare Programs Provider Information Website (https://medicaidprovider.mt.gov). Enrollment is processed by Conduent.

Providers must enroll under the specific HCBS Waiver Provider type and complete all mandatory federal disclosures. Incomplete ownership information is the leading cause of application denial.

• Enrollment Portal: Applications are submitted via the Montana Access to Health Web Portal (https://mtaccesstohealth.portal.conduent.com).
• Provider Type: Must select the correct HCBS Waiver Provider classification during the application process.
• Tax Documentation: A completed W-9 form is required to generate 1099 tax information.
• Ownership Disclosure: Mandatory completion of ownership and control information as required by CFR 42 455.100-106; failure to provide this results in automatic denial.
• Application Fee: Must pay the federal Medicaid application fee unless already paid to Medicare or another state's Medicaid program.
• Processing Timeline: Standard enrollment processing by DPHHS and Conduent typically takes 60 to 90 days.

6. Staffing, Training and Background Checks

Because homemaker services do not involve hands-on medical or personal care, direct care workers are not required to hold clinical certifications like a CNA license. However, they must pass strict background checks.

Agencies are responsible for ensuring all staff complete a basic orientation covering client safety, infection control, and mandatory reporting before they enter a member's home.

• Minimum Age: Direct care staff providing homemaker services must be at least 18 years old.
• Background Check: Mandatory name-based and fingerprint-based criminal history checks through the Montana Department of Justice (DOJ) (https://dojmt.gov).
• Federal Screening: Staff must be screened against the federal OIG List of Excluded Individuals/Entities (LEIE) prior to hire and monthly thereafter.
• Orientation Training: Staff must receive agency-led training on client rights, emergency procedures, and basic infection control.
• Supervision: Routine supervision and performance evaluation must be conducted by agency management or a designated supervisor.
• Clinical Certification: No CNA or nursing license is required for staff performing strictly homemaker/chore duties.

7. Documentation, Policies and Records

Montana DPHHS requires providers to maintain detailed service records that align perfectly with the member's Person-Centered Plan. Documentation must prove that the specific tasks billed were actually performed.

Providers must also comply with the federal HCBS Settings Rule, ensuring their policies respect the member's privacy, dignity, and right to control their personal resources.

• Service Logs: Must document the date, exact start and end times, and specific tasks completed (e.g., laundry, meal prep) for every visit.
• Care Plan Alignment: Services delivered must strictly match the tasks and frequencies authorized in the waiver case manager's Person-Centered Plan.
• HCBS Settings Compliance: Policies must ensure the individual's rights of privacy, dignity, respect, and freedom from coercion are upheld in their home.
• Incident Reporting: Must maintain a written policy for reporting suspected abuse, neglect, or exploitation to DPHHS Adult Protective Services.
• Record Retention: All financial, clinical, and service records must be retained for a minimum of 5 years per Medicaid regulations.
• Employee Records: Must maintain personnel files containing background check results, training certificates, and performance evaluations.

8. Billing, Rates and Claims

Claims for Homemaker Services are submitted electronically through the Montana Access to Health Web Portal (https://mtaccesstohealth.portal.conduent.com). Services are typically billed in 15-minute increments.

Rates are established by the DPHHS SLTC and BHDD divisions and are published in the provider fee schedules on the Montana Healthcare Programs website. Claims will automatically deny if the service lacks prior authorization.

• Billing System: Claims are processed through the Conduent-managed MMIS portal.
• Billing Unit: Homemaker services are generally billed in 15-minute increments.
• HCPCS Coding: Billed using standard HCBS codes such as S5130 (Homemaker service, NOS), as specified in the waiver manual.
• Prior Authorization: Claims cannot be paid unless a valid prior authorization from the waiver case manager is on file in the MMIS.
• Fee Schedule: Rates are fixed by DPHHS and updated periodically on the provider type page of the Montana Healthcare Programs website.
• Timely Filing: Claims must typically be submitted within 365 days of the date of service to be eligible for reimbursement.

9. Approval Sequence and Timeline

Becoming a Homemaker Service provider in Montana is a sequential process. You cannot apply for Medicaid enrollment until your business entity is fully registered and licensed (or approved as a commercial cleaner).

The entire process from business formation to receiving the first client referral generally takes 3 to 5 months, depending on state processing volumes.

• Step 1: Register the business with the Montana Secretary of State and obtain an IRS EIN (1-2 weeks).
• Step 2: Obtain a Type 2 NPI from the federal NPPES registry (1-3 days).
• Step 3: Apply for a Personal Care Agency license via the DPHHS Bounds system, or compile commercial cleaning business proofs (30-60 days).
• Step 4: Submit the Medicaid Provider Enrollment application via the Conduent portal (60-90 days).
• Step 5: Receive the Medicaid Provider Number and welcome letter from DPHHS.
• Step 6: Network with waiver case managers (e.g., Mountain Pacific Quality Health) to receive client referrals and prior authorizations.

10. Common Denials and Survey Findings

Medicaid enrollment applications in Montana are frequently delayed or denied due to administrative errors, particularly regarding ownership disclosures and mismatched NPI data.

During post-payment audits or licensure surveys, the most common citations involve inadequate documentation of the specific tasks performed or billing for time that exceeds the authorized care plan.

• Enrollment Denial: Failing to complete the Ownership/Control information section (CFR 42 455.100-106) results in automatic rejection.
• Enrollment Delay: Mismatched taxonomy codes or business names between the NPPES registry and the state application.
• Audit Finding: Service logs missing exact start/end times, specific task descriptions, or required signatures.
• Audit Finding: Billing for direct personal care (ADLs) under a Homemaker authorization code.
• Audit Finding: Providing and billing for services on days or times not authorized in the member's Person-Centered Plan.
• Survey Citation: Failure to conduct or document mandatory background checks before an employee's first day of client contact.

11. Key Contacts and Resources

Navigating the Montana Medicaid system requires interacting with several distinct portals and divisions. Bookmark the provider type pages on the Montana Healthcare Programs website, as manuals and fee schedules change frequently.

For technical assistance with enrollment, providers should contact Conduent Provider Relations.

• Montana Healthcare Programs Provider Enrollment: https://medicaidprovider.mt.gov/providerenrollment
• DPHHS OIG Licensure Bureau: https://dphhs.mt.gov/qad/Licensure
• Bounds Licensing System Portal: https://mt-reports.com/Portal/ProviderLogin.aspx
• Montana Access to Health Web Portal (Conduent): https://mtaccesstohealth.portal.conduent.com
• DPHHS Senior and Long Term Care Division (SLTC): https://dphhs.mt.gov/sltc
• DPHHS Behavioral Health and Developmental Disabilities (BHDD): https://dphhs.mt.gov/bhdd
• Conduent Provider Relations Phone: 1-800-624-3958 (General Montana Medicaid Provider Support)

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