Montana - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Montana Department of Public Health and Human Services (DPHHS) Developmental Disabilities Program (DDP) approves providers to deliver habilitation, supported living, and day services funded by the 0208 Comprehensive Waiver. Applicants must first secure a DDP Provider Endorsement by submitting a comprehensive agency proposal to the BHDD Division before they can submit a Medicaid enrollment application to Montana Healthcare Programs.

Facility-based services, such as residential group homes, require a Community Home for Persons with Developmental Disabilities license from the DPHHS Quality Assurance Division (QAD) prior to DDP endorsement. Providers must also demonstrate compliance with the federal HCBS Settings Rule through a Provider Self-Assessment (PSA) submitted via the state's designated Google platform.

1. Service Definition and Scope

The 0208 Comprehensive Waiver provides a continuum of home and community-based services to Montanans with intellectual and developmental disabilities. The service array spans residential habilitation, day supports, supported employment, and behavioral intervention, designed to prevent institutionalization in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).

• Residential Habilitation: 24-hour support provided in licensed community homes or supported living environments.
• Day Supports: Facility-based or community-integrated daytime habilitation focusing on socialization and skill acquisition.
• Supported Employment: Individual or small-group job coaching and vocational discovery services.
• Behavioral Support Services: Specialized interventions developed by a Board Certified Behavior Analyst (BCBA) or qualified professional.
• Target Population: Individuals diagnosed with an intellectual or developmental disability prior to age 18 who meet ICF/IID level of care.

2. Regulatory and Oversight Agencies

Multiple divisions within DPHHS govern the approval and oversight of 0208 Comprehensive Waiver providers. The Developmental Disabilities Program (DDP) manages waiver policy and provider endorsement, while the Quality Assurance Division (QAD) handles physical site licensure.

• DPHHS Developmental Disabilities Program (DDP): Manages the 0208 Waiver, issues provider endorsements, and conducts programmatic oversight (https://dphhs.mt.gov/BHDD/DisabilityServices/developmentaldisabilities/).
• DPHHS Quality Assurance Division (QAD): Inspects and licenses physical facilities, including Community Homes for Persons with Developmental Disabilities (https://dphhs.mt.gov/qad/Licensure).
• Montana Healthcare Programs: The state's Medicaid fiscal agent and provider enrollment portal, operated by Conduent (https://medicaidprovider.mt.gov/).
• Mountain Pacific Quality Health (MPQH): Conducts Level of Care determinations and functional needs assessments for waiver participants (https://www.mpqhf.org/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana does not utilize a Certificate of Need (CON) or closed-network RFP procurement for standard 0208 Comprehensive Waiver services. However, structural prerequisites dictate the sequence of application, requiring programmatic endorsement before Medicaid enrollment.

• DDP Provider Endorsement: Applicants must submit a business plan and policy packet to the DDP Regional Manager for approval before applying for Medicaid enrollment.
• Facility Licensure Prerequisite: Providers intending to operate a group home must obtain a QAD Community Home license before DDP will endorse the residential service line.
• HCBS Settings Rule Compliance: New congregate or facility-based settings must pass a DDP Heightened Scrutiny review and submit a Provider Self-Assessment (PSA) prior to approval.
• Corporate Registration: Entities must be registered and in good standing with the Montana Secretary of State.

4. Licensure and Certification Requirements

Montana does not issue a blanket HCBS provider license. Instead, non-residential services rely on DDP certification, while residential group homes require a specific facility license from the QAD Licensure Bureau.

• Community Home License: Required for residential facilities serving 2 to 8 individuals with developmental disabilities, issued by QAD.
• Fire Marshal Clearance: QAD licensure requires a passed inspection from the Montana State Fire Marshal or local authority having jurisdiction.
• Local Zoning Approval: Community Home applicants must provide documentation of compliance with local municipal zoning ordinances for group residences.
• DDP Certification: Non-facility services (e.g., supported employment, in-home supports) are certified directly through the DDP endorsement process rather than a QAD license.

5. Medicaid Provider Enrollment

After securing DDP endorsement and any necessary QAD licenses, agencies must enroll as atypical or typical providers through the Montana Healthcare Programs provider portal. The state utilizes a fiscal agent, Conduent, to process these applications.

• Enrollment Portal: Applications are submitted electronically via the MATHIS (Montana Access to Health Information Systems) provider portal.
• Provider Type: Agencies typically enroll under Provider Type 74 (Developmental Disabilities Program) or specific waiver taxonomy codes.
• Application Fee: Institutional providers must pay the CMS-mandated application fee (currently $709 for 2024) unless waived by Medicare or another state's Medicaid program.
• Site Visit: DPHHS or its designee conducts a pre-enrollment site visit for moderate and high-risk provider categories.

6. Staffing, Training and Background Checks

DDP establishes strict baseline qualifications for Direct Support Professionals (DSPs) and agency management. Training must be completed within specific timeframes upon hire and documented in the agency's personnel files.

• Background Checks: All staff must clear a Montana Department of Justice criminal history check and the DPHHS Child and Family Services Division abuse registry.
• Initial Training: DSPs must complete DDP-mandated orientation, including abuse/neglect reporting and HCBS Settings Rule training, before working unsupervised.
• Medication Administration: Staff administering medications must complete the DDP-approved Medication Certification course and pass a written and physical practicum.
• CPR and First Aid: All direct care staff must maintain current, in-person CPR and First Aid certification.

7. Documentation, Policies and Records

Approved providers must maintain comprehensive policy manuals that align with DDP administrative rules and the federal HCBS Settings Rule. DDP regional staff review these documents during the initial endorsement phase and subsequent quality assurance audits.

• Incident Management Policy: Must dictate the reporting of critical incidents to the DDP Incident Management System within 24 hours.
• Person-Centered Planning: Policies must mandate provider participation in the participant's Personal Support Plan (PSP) team meetings.
• Rights Restrictions: Documentation procedures for any rights restrictions, which must be approved by the local Human Rights Committee (HRC).
• Financial Records: Agencies managing participant funds must maintain distinct ledgers and policies preventing the commingling of agency and client funds.

8. Billing, Rates and Claims

The 0208 Comprehensive Waiver utilizes a fee-for-service reimbursement model based on a standardized rate schedule published by DPHHS. Claims are adjudicated through the Montana Healthcare Programs MMIS.

• Rate Schedule: DDP publishes the current waiver rate sheet annually on the BHDD website, detailing 15-minute, per diem, and milestone rates.
• Prior Authorization: All waiver services must be prior-authorized in the MMIS based on the participant's approved Personal Support Plan (PSP).
• Claim Submission: Providers submit 837P electronic claims or CMS-1500 forms via the MATHIS provider portal.
• Timely Filing: Montana Medicaid requires claims to be submitted within 365 days of the date of service.

9. Approval Sequence and Timeline

Establishing a new 0208 Waiver agency in Montana is a sequential process that cannot be expedited by submitting concurrent applications. The entire runway from business formation to first billable claim typically spans 6 to 9 months.

• Step 1: Entity formation and acquisition of an NPI and EIN (1-2 weeks).
• Step 2: QAD Licensure application and physical site inspections for residential providers (90-120 days).
• Step 3: Submission of the agency proposal and policy packet to DDP for Provider Endorsement (30-60 days).
• Step 4: Submission of the Medicaid enrollment application via the MATHIS portal (45-90 days).

10. Common Denials and Survey Findings

DDP and QAD conduct routine compliance surveys and initial application reviews. Applications are frequently delayed or denied due to incomplete policy packets or failure to meet physical site requirements.

• Settings Rule Violations: Applications for facility-based day programs or group homes denied for institutional characteristics (e.g., isolating locations).
• Incomplete Background Checks: Citations issued when staff begin providing direct care before fingerprint-based background checks are fully cleared.
• Medication Errors: Survey deficiencies commonly stem from missing signatures on the Medication Administration Record (MAR) or expired staff certifications.
• Zoning Rejections: QAD license applications rejected because the proposed group home location lacks the necessary municipal zoning clearance.

11. Key Contacts and Resources

Prospective providers should utilize the official DPHHS portals and division websites to access current manuals, rate sheets, and application forms. Regional DDP offices serve as the primary point of contact for new agency proposals.

• DPHHS Developmental Disabilities Program (DDP): https://dphhs.mt.gov/BHDD/DisabilityServices/developmentaldisabilities/
• DPHHS Quality Assurance Division (QAD) Licensure Bureau: https://dphhs.mt.gov/qad/Licensure
• Montana Healthcare Programs Provider Portal: https://medicaidprovider.mt.gov/
• Montana DDP 0208 Comprehensive Waiver Document: https://dphhs.mt.gov/assets/Archive/0208ComprehensiveWaiverEffectiveNovember122023.pdf

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