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Montana - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Montana Department of Public Health and Human Services (DPHHS) funds Community Transition Services through the Big Sky Waiver and the Severe Disabling Mental Illness (SDMI) Waiver to cover one-time set-up expenses for members leaving institutions. Providers must enroll under Provider Type 28 (HCBS) and coordinate directly with regional Case Management Teams (CMT) to facilitate these transitions.

Approval requires submitting a complete enrollment application through the Montana Access to Health ICAP portal and securing an active service authorization from a CMT before any transition expenses are incurred. Montana does not require a Certificate of Need for this service, but providers cannot bill for transition costs without prior authorization documented in the member's person-centered service plan.

1. Service Definition and Scope

Community Transition Services in Montana cover non-recurring set-up expenses for individuals transitioning from an institutional or another provider-operated living arrangement to a living arrangement in a private residence where the person is directly responsible for their own living expenses. This service is available under the Big Sky Waiver and the SDMI Waiver.

Allowable expenses include security deposits, essential household furnishings, set-up fees or deposits for utility or service access, and services necessary for the individual's health and safety such as pest eradication and one-time cleaning prior to occupancy.

2. Regulatory and Oversight Agencies

The Montana Department of Public Health and Human Services (DPHHS) oversees the administration of HCBS waivers. The Senior and Long Term Care (SLTC) Division manages the Big Sky Waiver, while the Behavioral Health and Developmental Disabilities (BHDD) Division manages the SDMI Waiver.

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

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana does not require a Certificate of Need (CON) or a competitive procurement (RFP) process to become a Community Transition Services provider. However, an applicant must be legally authorized to conduct business in Montana and must be capable of purchasing and invoicing the allowable transition goods and services.

The structural precondition for delivering this service is authorization from a designated Case Management Team (CMT). A provider cannot independently initiate this service; they must receive a referral and prior authorization from the CMT managing the transitioning member's care plan.

4. Licensure and Certification Requirements

Montana does not issue a specific facility or agency license for entities that solely provide Community Transition Services, as this is primarily an administrative and purchasing function rather than direct medical care. Providers must instead meet the general qualifications for HCBS waiver providers.

Providers must maintain standard business credentials, including general liability insurance, and must agree to the terms of the Montana Medicaid Provider Agreement.

5. Medicaid Provider Enrollment

Prospective providers must submit a full enrollment application through the Montana Access to Health ICAP portal. The provider must enroll using Provider Type 28 (HCBS) to be eligible to bill for waiver services.

All status changes, such as changes in ownership, address, or licensure, must be immediately reported to the fiscal agent. Providers are also subject to periodic revalidation requirements to maintain active billing status.

6. Staffing, Training and Background Checks

Because Community Transition Services often involve purchasing and coordinating logistics rather than providing direct hands-on personal care, the staffing requirements focus on administrative competence and financial integrity. However, any staff member who has direct contact with waiver participants must pass background checks.

Providers must ensure that no staff or subcontractors are on the OIG List of Excluded Individuals/Entities (LEIE).

7. Documentation, Policies and Records

Providers must maintain exhaustive financial records for all transition expenses. This includes original receipts, invoices, and proof of payment for every item or deposit funded through the service.

Documentation must clearly link the purchased items to the authorized service plan provided by the CMT. Records must be retained for a minimum of five years and be available for audit by DPHHS or its designees.

8. Billing, Rates and Claims

Community Transition Services are billed using specific HCPCS procedure codes designated by DPHHS in the HCBS fee schedule. Reimbursement is strictly limited to the actual cost of the authorized items and deposits, up to the lifetime or per-transition cap established by the waiver.

Claims must be submitted electronically through the Montana Access to Health portal. Providers cannot bill for administrative markup or time spent shopping for items unless explicitly allowed by the current fee schedule.

9. Approval Sequence and Timeline

The approval process begins with the submission of the provider enrollment application via the ICAP portal. The fiscal agent reviews the application for completeness and verifies all business credentials.

Once the fiscal agent completes the initial screening, the application is forwarded to DPHHS for final approval and assignment of procedure codes. The entire process typically takes 30 to 60 days, provided all documentation is accurate.

10. Common Denials and Survey Findings

Enrollment applications are frequently delayed or denied if the provider selects the wrong enrollment type or fails to provide matching IRS documentation for their Tax ID. Sharing a tax ID improperly between individual and organizational NPIs will trigger automatic denials.

During audits, the most common finding for transition services is the lack of original receipts or purchasing items that were not explicitly authorized in the member's service plan, resulting in recoupment of funds.

11. Key Contacts and Resources

Providers should utilize the Montana Access to Health portal for all enrollment and billing inquiries. The DPHHS website hosts the official waiver manuals, fee schedules, and provider notices.

For specific questions regarding service authorizations, providers must contact the regional Case Management Team assigned to the member.

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