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Montana - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Montana, Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) for waiver participants are overseen by the Department of Public Health and Human Services (DPHHS) and enrolled through the Montana Healthcare Programs provider portal. Providers must enroll under the specific waiver program, such as the Severe and Disabling Mental Illness (SDMI) Home and Community Based Services (HCBS) waiver, using HCBS provider type code 28.

To become an approved Medical Supply Service provider, applicants must first meet all facility, licensing, and insurance requirements applicable to the service offered. The state contracts with a fiscal agent to process the full enrollment application, verify provider qualifications, and screen against exclusion lists before DPHHS authorizes procedure codes and rates.

1. Service Definition and Scope

Durable medical equipment and disposable supplies furnished, fitted, and serviced for waiver participants in Montana fall under the broader category of DMEPOS. These services are designed to support individuals in home and community-based settings, preventing institutionalization.

The service includes the provision of equipment and supplies that are medically necessary, prescribed by an authorized practitioner, and meet Medicare criteria outlined in the Region D Medicare Supplier Manual.

2. Regulatory and Oversight Agencies

The primary oversight agency for Medicaid HCBS waivers in Montana is the Department of Public Health and Human Services (DPHHS), specifically the Behavioral Health and Disabilities Division (BHDD) for the SDMI waiver. DPHHS sets the rules, authorizes procedure codes, and establishes rates.

Provider enrollment and claims processing are managed through the Montana Access to Health Web Portal, operated by the state's fiscal agent, Conduent.

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana does not require a Certificate of Need (CON) for DMEPOS providers. However, providers must meet all facility, licensing, and insurance requirements applicable to the service offered before applying for Medicaid enrollment.

There are no closed networks or moratoria currently in place for DMEPOS providers in Montana. Providers must be established businesses capable of meeting Medicare and Medicaid accreditation standards.

4. Licensure and Certification Requirements

Montana does not issue a specific state license solely for DMEPOS providers. Instead, providers must comply with general business licensing requirements and obtain any necessary federal certifications, such as a National Provider Identifier (NPI).

Providers billing for laboratory services or specific medical supplies may need additional certifications, such as a CLIA number or DEA registration, depending on the scope of their offerings.

5. Medicaid Provider Enrollment

Providers must submit a full enrollment application through the Montana Access to Health Web Portal or via paper forms submitted to the fiscal agent. The application requires detailed information on ownership, managing employees, and tax reporting status.

The fiscal agent verifies provider information, screens against exclusion lists, and forwards the completed application to DPHHS for final approval and assignment of procedure codes and rates.

6. Staffing, Training and Background Checks

DMEPOS providers must ensure that their staff are qualified to fit and service the equipment provided. While Montana does not specify distinct training hours for DME staff under the waiver, providers must adhere to standard industry practices and Medicare guidelines.

The fiscal agent screens all enrolled providers and their managing employees monthly against state and federal exclusion lists to ensure compliance and safety.

7. Documentation, Policies and Records

Providers must maintain original prescriptions and orders in accordance with ARM 37.85.414. Prescriptions must include specific details such as the member's name, order date, HCPCS code, and treating practitioner's signature.

For items requiring prior authorization, a copy of the prescription must be submitted with the request. Providers must also report any status changes, such as a change in ownership or address, immediately in writing to the fiscal agent.

8. Billing, Rates and Claims

Reimbursement for DMEPOS is based on procedure codes and rates authorized by DPHHS and listed in the provider's charge file in the Medicaid Management Information System (MMIS). Rates are updated by the department when increases occur.

Certain items, such as oxygen, are reimbursed on a monthly basis regardless of actual usage. Providers must use Electronic Funds Transfer (EFT) for payments unless a waiver is granted for extenuating circumstances.

9. Approval Sequence and Timeline

The enrollment process begins with the submission of a complete application to the fiscal agent. The fiscal agent reviews the application, verifies credentials, and conducts exclusion screenings.

Once verified, the application is forwarded to DPHHS. DPHHS then approves the enrollment, authorizes procedure codes, and sets rates based on provider qualifications and information from the Case Management Team (CMT).

10. Common Denials and Survey Findings

Applications are commonly delayed or denied if the enrollment form is incomplete or if required documentation, such as CMS designation letters for provider-based facilities, is missing.

Claims may be denied if prior authorization was not obtained for required items, or if the prescription lacks necessary details such as the HCPCS code or practitioner's signature.

11. Key Contacts and Resources

Providers should utilize the Montana Healthcare Programs provider portal for enrollment forms, manuals, and updates. The fiscal agent, Conduent, handles the processing of applications and claims.

For specific waiver information, providers can contact the Behavioral Health and Disabilities Division (BHDD) of DPHHS.

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