Montana - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Montana Department of Public Health and Human Services (DPHHS), through its Developmental Disabilities Program (DDP), funds Supported Employment services primarily under the 0208 Comprehensive Waiver and the Severe Disabling Mental Illness (SDMI) HCBS Waiver. Providers seeking to deliver job development, placement, and on-site coaching must navigate a dual-approval process requiring both DDP programmatic qualification and Montana Medicaid enrollment.

To enter the network, an agency must either hold an Organized Health Care Delivery System (OHCDS) designation from DDP or subcontract under an existing OHCDS-designated provider. Standalone agencies cannot simply enroll in Medicaid to bill this service; they must first submit a full DDP Qualified Provider Application and secure a direct contract with the state.

1. Service Definition and Scope

In Montana, Integrated Employment is formally categorized as Supported Employment under the state's HCBS waivers. The service is designed to support individuals with developmental disabilities or severe disabling mental illness who need intensive, ongoing support to succeed in competitive employment.

The scope includes job development, placement, and on-site coaching to help members secure and maintain paid employment in integrated community settings at or above minimum wage. Services must align with the member's Personal Supports Plan (PSP) and annual Cost Plan.

• Service Name: Supported Employment (SDMI HCBS 390) and 0208 Comprehensive Waiver Supported Employment.
• Target Population: Adults with developmental disabilities (0208 Waiver) or severe disabling mental illness (SDMI Waiver).
• Setting Requirement: Must be delivered in integrated community settings, fully compliant with the CMS HCBS Final Settings Rule.
• Wage Standard: Employment must result in competitive wages at or above the prevailing minimum wage.
• Service Components: Includes vocational assessment, job development, job placement, and ongoing job coaching.

2. Regulatory and Oversight Agencies

The Montana Department of Public Health and Human Services (DPHHS) is the single state agency responsible for Medicaid. Within DPHHS, the Behavioral Health and Developmental Disabilities Division (BHDD) oversees the policy and administration of HCBS waivers.

The Developmental Disabilities Program (DDP) directly manages provider qualifications, contracting, and quality assurance for the 0208 Comprehensive Waiver. Conduent operates the Montana Access to Health Web Portal, which serves as the state's Medicaid Management Information System (MMIS) for enrollment and claims.

• State Medicaid Agency: Montana Department of Public Health and Human Services (DPHHS) (https://dphhs.mt.gov/).
• Operating Division: Behavioral Health and Developmental Disabilities Division (BHDD) (https://dphhs.mt.gov/BHDD/).
• Program Office: Developmental Disabilities Program (DDP) (https://dphhs.mt.gov/BHDD/DisabilityServices/developmentaldisabilities/).
• Enrollment Portal: Montana Access to Health Web Portal / Conduent (https://medicaidprovider.mt.gov/).
• Rules Promulgation: Montana Secretary of State (Administrative Rules of Montana) (http://www.mtrules.org/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana utilizes a strict contracting and designation model for developmental disability services. An applicant cannot bypass the DDP to enroll directly with Medicaid for Supported Employment.

Agencies must apply to become a DDP Qualified Provider and obtain an Organized Health Care Delivery System (OHCDS) designation. Alternatively, licensed professionals or smaller entities must subcontract under an existing OHCDS-designated DDP qualified provider.

• OHCDS Designation: Agency-based services must be delivered by an Organized Health Care Delivery System (OHCDS) approved by DDP.
• DDP Qualified Provider Application: Required full application submitted to the DDP before Medicaid enrollment is permitted.
• Subcontracting Option: Individuals or agencies without OHCDS status must subcontract with an OHCDS-designated DDP provider.
• Provider Addendum: A mandatory DDP-specific addendum required upon initial enrollment and whenever settings or services change.
• Waiver Selection: Services can only be billed for members who have been selected from the DDP waiting list and enrolled in the 0208 or SDMI waiver.

4. Licensure and Certification Requirements

Montana does not issue a distinct facility or agency license specifically for Supported Employment providers. Instead, authority to operate is granted through DDP certification and adherence to the Administrative Rules of Montana (ARM).

Providers must comply with ARM Title 37, Chapter 34, which outlines the programmatic standards for developmental disabilities services. SDMI Supported Employment providers may also qualify if they are licensed mental health centers or independent living centers.

• Facility Licensure: No specific state facility license exists for Supported Employment; approval is contract-based via DDP.
• Administrative Rules: Must comply with ARM 37.34.101 through 37.34.3005.
• Eligible Entity Types (SDMI): Public/private employment agencies, independent living centers, disability support organizations, or licensed mental health centers.
• HCBS Settings Compliance: Must pass state review for compliance with the HCBS Final Settings Rule prior to approval.
• Insurance Requirements: Must meet all liability insurance and bonding requirements specified in the DDP contract.

5. Medicaid Provider Enrollment

Once approved by DDP, the entity must enroll as a Montana Medicaid Provider through the Montana Access to Health Web Portal. Providers typically enroll under Provider Type 82 for DDP services or Provider Type 74 for Developmental services.

The enrollment process requires submission of the DDP Provider Addendum and verification of the OHCDS contract. Enrollment must be finalized before any services can be prior-authorized in a member's Cost Plan.

• System: Montana Access to Health Web Portal operated by Conduent.
• Provider Type: Provider Type 82 (DDP) or Provider Type 74 (Developmental).
• Required Form: DDP Provider Addendum submitted alongside the standard Medicaid application.
• Revalidation: Providers must revalidate their Medicaid enrollment periodically as directed by the MMIS.
• Out-of-State Providers: Generally restricted unless specifically contracted by DDP for border-state services.

6. Staffing, Training and Background Checks

Direct care staff providing Supported Employment must meet specific educational and certification standards, particularly under the SDMI waiver. Providers must document all training in personnel files in accordance with ARM 37.34.2102.

All staff must clear background checks as mandated by the DDP Criminal History Background Check Policy before having direct contact with waiver participants.

• Education (SDMI): Associate degree in vocational rehabilitation, career development, or disability services education.
• Certification Alternative: Individual Placement Services (IPS) certification, or two years of experience plus IPS certification within 6 months of hire.
• Background Check: Mandatory compliance with the DDP Criminal History Background Check Policy (effective 8/06).
• Training Documentation: Must record date, trainer name/title, staff signature, training type, agenda, and hours (ARM 37.34.2102).
• Driver Requirements: Staff providing transportation must be 17+ years old, hold a valid driver's license, and have adequate vehicle insurance.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that align service delivery with the member's Personal Supports Plan (PSP) and annual Cost Plan. Documentation must prove that employment supports are leading toward or maintaining competitive community employment.

Agencies must also maintain current policies regarding HCBS Settings Rule compliance, incident reporting, and staff competency tracking.

• Personal Supports Plan (PSP): All employment services must be explicitly identified and justified in the member's PSP.
• Cost Plan: Services must match the approved annual Cost Plan developed by the Targeted Case Manager (TCM).
• Personnel Files: Must contain verified background checks, IPS certifications, and ARM 37.34.2102 training logs.
• Settings Documentation: Must maintain records proving the employment setting is integrated and not institutional.
• Retention: Records must be retained in accordance with the Montana Medicaid Provider Agreement and DDP contract terms.

8. Billing, Rates and Claims

Supported Employment is reimbursed on a Fee-for-Service basis through the Montana MMIS. Providers cannot bill until the DDP Regional Manager (RM) has approved the specific service lines in the member's Cost Plan, which generates the prior authorization.

Claims are submitted electronically via the Montana Access to Health portal or via paper to the Claims Processing Unit in Helena. Providers are responsible for verifying Medicaid eligibility prior to service delivery.

• Billing System: Montana Access to Health Web Portal (MMIS).
• Reimbursement Model: Medicaid Fee-for-Service based on DDP published rate schedules.
• Prior Authorization: Generated automatically when the DDP Regional Manager approves the service line in the Cost Plan.
• Eligibility Verification: Providers must verify active Medicaid status via the portal before delivering services.
• Paper Claims Address: Claims Processing Unit, P.O. Box 8000, Helena, MT 59604.

9. Approval Sequence and Timeline

The approval sequence begins with the DDP Qualified Provider Application and OHCDS designation process. This programmatic review ensures the agency meets state administrative rules and waiver standards.

Following DDP approval, the agency submits the Medicaid enrollment application and Provider Addendum to Conduent. Once the MMIS issues a Medicaid ID, the provider can be added to member Cost Plans by Targeted Case Managers.

• Step 1: Submit DDP Qualified Provider Application and OHCDS request to the local DDP Office.
• Step 2: Complete DDP programmatic review and execute the DDP contract.
• Step 3: Submit Medicaid enrollment application via Montana Access to Health portal.
• Step 4: Submit the DDP Provider Addendum to finalize Medicaid enrollment.
• Step 5: Receive Medicaid Provider ID and begin accepting prior authorizations via approved Cost Plans.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied if the agency attempts to enroll in Medicaid without first securing OHCDS designation or a direct DDP contract. Missing the Provider Addendum is another common administrative failure.

During audits, DDP often cites providers for failing to maintain IPS certifications for staff within the required 6-month window, or for billing services that do not strictly align with the authorized Cost Plan.

• Gatekeeping Failure: Applying to Medicaid without prior DDP OHCDS approval.
• Missing Addendum: Failure to submit the required Provider Addendum during initial enrollment or when settings change.
• Staffing Violations: Lapsing IPS certifications or failing to document training per ARM 37.34.2102.
• Billing Errors: Submitting claims for dates of service before the DDP Regional Manager approved the Cost Plan.
• Settings Violations: Delivering services in segregated environments that violate the HCBS Final Rule.

11. Key Contacts and Resources

Prospective providers should begin by contacting their local DDP Regional Office to discuss the OHCDS application process and current waiver needs. The DPHHS BHDD website hosts the provider manuals and administrative rules.

For Medicaid enrollment and claims technical assistance, providers must contact Montana Provider Relations, operated by Conduent.

• DDP Program Office: Behavioral Health and Developmental Disabilities Division (https://dphhs.mt.gov/BHDD/).
• Medicaid Enrollment Portal: Montana Access to Health (https://medicaidprovider.mt.gov/).
• Provider Relations Phone: (800) 624-3958 or (406) 442-1837 (Helena local).
• Provider Relations Address: Montana Provider Relations Unit, P.O. Box 4936, Helena, MT 59604.
• Administrative Rules: Montana Secretary of State (http://www.mtrules.org/).

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