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Providers

Senior and Long Term Care

Program Providers

Below are the programs and grants SLTC coordinates.  Choose the appropriate program to view all related information. Contacts for each program are also included in each section.

Community First Choice - Personal Assistance Services

Community First Choice/Personal Assistance Services

The Community First Choice and Personal Assistance Services (PAS) Programs are entitlement programs designed to provide long term supportive care in the home setting. These programs enable thousands of elderly and disabled citizens to remain in their homes. The type of care authorized is tailored to each individual in a person centered manner and dependent upon their needs, living situation, and availability of caregivers.

Services available through the CFC/PAS Program include the Activities of Daily Living: bathing, dressing, grooming, toileting, eating, medication assistance, ambulation and exercising. Medical escort is also available. Under the PAS program there is additional time for limited grocery shopping, housekeeping and laundry. Under the CFC program there is also additional time for community integration, yard hazard removal for the purpose of providing safe access and entry to the home, correspondence assistance and personal emergency response system.

The CFC/PAS Program does not pay for tasks such as yard work other than authorized task to assure health and safety, household repair or modifications, major cleaning, shopping for non-essential items, escort to non-medical services, pet care, or general transportation. Some of these tasks are allowed through the waiver program depending upon an individual’s needs and required level of care.

Self-Direct Service Options

There two options under which CFC/PAS eligible individuals can choose to receive their services: Agency Based CFC/PAS (AB-CFC/PAS) or Self-Direct CFC/PAS (SD-CFC/PAS). The SD-CFC/PAS program was developed for consumers who wish to direct their own care. The consumer or their Personal Representative is responsible for hiring, training, and managing their Personal Care Attendants (PCA). Under the SD-CFC/PAS program only, individuals can be authorized by their health care professional to receive the above mentioned services provided by their PCA as well as any of the following four skilled services: bowel program, catheter care, medication assistance, or wound care. Anytime a consumer chooses Self-Direct CFC/PAS, they must obtain authorization from their health care professional. The consumer or their personal representative must also meet capacity, which means they can demonstrate a thorough understanding of the program requirements.

Eligibility

Eligibility requirements for both AB-CFC/PAS and SD-CFC/PAS include: 1) consumer has a health condition that limits their ability to perform activities of daily living, 2) consumer must participate in the screening process and 3) the consumer must be eligible for Medicaid. In order to qualify for the CFC program a consumer must also meet level of care.

Contact Information

Abby Holm, Program Manager

2030 11th Avenue
PO Box 4210
Helena MT 59604-4210
406-444-4564
406-444-7743 Fax
1-800-551-3191

Micky Brown, Program Specialist

2030 11th Avenue
PO Box 4210
Helena MT 59604-4210
406-444-6064
406-444-7743 Fax
1-800-551-3191

Regional Program Officers

Regional Program Officers can assist with policy clarification, general eligibility questions and provide information on the process for referring an individual to the Community First Choice/Personal Assistance Program.

Policy Manual

CFC/PAS Self-Direct Policy Manual

CFC/PAS Agency Based Policy Manual

Electronic Billing

Fee Schedules

MATH-Montana Access to Health Web Portal

Medicaid Claims Instructions

Provider Enrollment

Quality Assurance Management System (QAMS)

Community First Choice Program Training

Direct Care Wage Program

2016 Direct Care Worker Funding

The 2015 Montana Legislature approved funding in House Bill 2 for a wage initiative/bonus funding for direct care workers for state fiscal year 2016. Additionally, the 64th Montana Legislature appropriated additional funding that will provide up to a 25 cent hourly increase in combined wages and benefits in fiscal year 2016.  The Community Services Bureau was allocated ongoing funding for a total of $968,564 and additional funding of $695,130; which equals total funding of $1,666,694.  The wage initiative for direct care workers will go into effect on July 1, 2015 and funding will be distributed in two phases with the first phase distribution to occur between August-December 2015 and the second phase distribution to occur between January-June 2016. The exact dates of the distribution are based on the information a provider agency documents in their application as their intended distribution date to direct care workers.


Links to the following are available below:

  • An application with instructions explaining the process for direct care wage funding;
  • Two forms (Part A&B) to report how the provider agency will distribute the funds to direct care workers.
    • Provider agencies have the option to use the funding in either or both forms of distribution to its workers (i.e. as a bonus payment and/or wage increase).
    • Providers that used their FY 2015 direct care worker funding to fund a wage increase, rather than for a bonus distribution, will have the opportunity to sustain the wage increase using their FY 2016 funding. The provider agency  must provide the supporting documentation that the FY 2015 wage increase is sustained in FY 2016.
    • An agency’s portion of the new funding (approximately 25 cent hourly increase in combined wages and benefits) may be used for an increase in wages or to provide bonus payments to workers. This increase will need to be documented separately from the ongoing wage distribution, if applicable.
  • A Direct Care Worker Supplemental form (Part C) for FY 2016.
  • The Direct Care Worker Distribution Summary spreadsheet for FY 2016.

A provider agency that does not return the application or does not wish to participate in this funding will not be entitled to their share of the funds available for wage increases or bonus payments for direct care workers in this fiscal year. Please refer to the attached spreadsheet for the total annual distribution and the amount every provider agency will receive in two disbursements as part of the FY 2016 direct care wage initiative funding. 

The application must be completed and returned with the appropriate signature, along with Part A & B and the Supplemental Form by the deadline provided in this letter. Please read the application’s explanation and instructions for completing the forms provided. Once the application and forms are received, the Department will issue the provider agency an approval letter. A provider agency is required to implement the wage initiative in a timely manner and provide its workers with funds in the form of wages and/or bonuses as identified in the application and forms that were submitted. 

Return completed application and forms by August 7, 2015 to the address listed below:

DPHHS-SLTC – Direct Care Wage Initiative

COMMUNITY SERVICES BUREAU
PO Box 4210
Helena, MT 59604-4210

Please contact Abby Holm at (406) 444-4564 or Micky Brown at (406) 444-6064 if you have specific questions concerning the direct care wage initiative or the applicable forms.

Application Cover Letter

Direct Care Worker Application

Direct Care Worker Application Part A

Direct Care Worker Application Part B

Direct Care Worker Application Part C

Bonus Distribution

Health Care for Health Care Workers

Health Insurance for Health Care Workers 2016 Application

To:       Personal Assistance and Community First Choice Service Health Insurance Funding Participant

From:   Abby Holm, Senior and Long Term Care

RE:      Health Insurance for Health Care Workers 2016 Application – Due Friday, November 27, 2015

The 2015 legislature provided ongoing funding for health insurance through the 2016/2017 biennium. The amount an agency is eligible to receive per month for health insurance is detailed on the attached 2016 allocation summary. The actual monthly allocation will be determined on a quarterly basis. The first quarter monthly payments (January-March) will be based on each agency’s 2016 application. The subsequent quarters will have monthly payments determined based on information contained on the quarterly reports; including monthly utilization and projected worker enrollment. In order to remain eligible for the add-on health insurance reimbursement payments through Medicaid an agency must complete the enclosed application and return it by Friday, November 27, 2015. If an agency is not interested in participating in the funding initiative please notify Abby Holm via email abholm@mt.gov or fax (406) 444-7743.

Please note the following:

  • In an effort to ensure utilization of the health insurance benefit and increase the number of direct care workers who receive the health insurance benefit, the Department will determine payment allocations on a quarterly basis. Funding for health insurance in subsequent quarters will be determined based on the provider agency’s utilization of the health insurance benefit in previous quarter(s). Remaining funds will be disbursed in subsequent quarters to participating providers who demonstrate a need in the quarterly utilization report to fund health insurance coverage for enrolled workers.
  • Section 2 includes the 2016 insurance benchmarks. Similar to last year, this year there are two options for limits related to deductibles and out-of-pocket expenses. The first option provides a lower deductible matched with a higher out-of-pocket maximum. The second option provides a higher deductible matched with a lower out-of-pocket maximum. You must offer a plan that meets or exceeds the criteria in one of the two options.
  • The maximum monthly premium cost remains unchanged at $700. This does not include dental.
  • The employee contribution maximum remains unchanged at $40 per month.
  • The Department will reimburse agencies that provide dental insurance, so long as the total funding requested for health insurance and dental insurance does not exceed the maximum amount your agency is eligible to receive. Once the application process is complete, the Department will determine if there is additional funding available for dental coverage.  If your agency is interested in applying for this potential funding to cover dental indicate this in Section 4 of your application. The Department cannot guarantee additional funding for dental at this time.
  • Sections 1, 2 and 5 of the Application must be completed by all agencies.
  • Section 3 must be completed by agencies requesting approval for a plan that does not meet all of the Department’s benchmark standards and/or is requesting Department funding for a health insurance plan (excluding dental) that exceeds a total monthly premium of $740 per month ($700 employer contribution + $40 worker contribution).
  • The Department will provide reimbursement to workers who work 50% of their time in Medicaid services. The Department will provide a grace period to cover workers who go below this standard. The grace period will be 90-days for non-variable workers. For variable workers the look-back period will coincide with the employer’s measurement and stability period. If a non-variable worker meets the 50% threshold during the measurement period the Department will provide reimbursement for that worker for the stability period. If the employee does not meet the 50% criteria during the measurement period the Department will not provide reimbursement for the worker during the stability period.

For example, if a worker provides 30 hours per week of services to two clients and provides 15 hours of service to a member who is on Medicaid and 15 hours of service to a client who is paying privately, the worker would qualify for reimbursement through the Department because 50% of the worker’s time was spent in Medicaid services.  However, if the same worker spent 20 hours per week with the private pay client and 10 hours with the Medicaid member the worker would not qualify for reimbursement through the Department because the worker did not work 50% of their time in Medicaid services.

The Department must approve an agency’s 2016 application before the agency is eligible to receive funding. A letter of approval will be sent to each agency once the application is approved.

Enclosure

               2016 Application

               2016 Agency Allocation

Big Sky Waiver

Montana Big Sky Home and Community Based Services Program

The Home and Community Based Services program allows people, who would otherwise be institutionalized, to live in their own home and community. The services are made available through the Department of Public Health & Human Services (DPHHS) and the Senior and Long Term Care Division (SLTC).

HCBS Services

Case Management Team (CMT) consist of a nurse and social worker and provide a holistic approach to care planning. They look at each individual’s medical and psychosocial needs and then develop a plan of care based on the person’s needs and choices. Each Case Management Team has a fixed number of individuals they can serve per year. The following are examples of services that may be available through HCBS:

  • Adult Residential Living
  • Adult Day Health
  • Case Management
  • Chemical Dependency Counseling
  • Dietician
  • Environmental Adaptations
  • Habilitation Services
  • Homemaker Services
  • Nutrition
  • Personal Assistance
  • PERS
  • Private Duty Nursing
  • Psychosocial Consultation
  • Respiratory Therapy
  • Respite Care
  • Special Child Care
  • Transportation
  • Therapies (OT, PT, Speech)
  • Specially Trained Attendant
  • Specialized medical equipment and supplies
  • Services for Individuals with Traumatic Brain Injury

Eligibility

To qualify for the HCBS Program, a recipient must be financially eligible for Medicaid and meet the minimum level of care requirements for nursing facility placement. Individuals must have an unmet need that can only be resolved through a home & community based service in order to qualify for the program. Currently, there are waiting lists for HCBS Services.

To make a referral for Home & Community Based Services contact the Mountain Pacific Quality Health Foundation at 1-800-219-7035.

Eligibility specialists at your County Office of Public Assistance (OPA office) can determine Medicaid eligibility.

Where do I find assisted living and other health care facilities?

Regulated Health Care Facilities These facility lists have been compiled by the Licensure Bureau of the Quality Assurance Division. Because the information herein contained is otherwise open to public inspection, dissemination of this list does not violate the provisions of 2-6-109, Montana Code Annotated, which prohibits state agencies from distributing any mailing list without first securing the permission of those who are a part of the list. It is not the intent of the Licensure Bureau that this list be used for any unsolicited commercial activity.

Contact Information

Community Services Bureau

2030 11th Avenue
PO Box 4210
Helena MT 59604-4210

406-444-4077
1-800-551-3191

Regional Program Officers

Regional Program Officers can assist with policy clarification, general eligibility questions and provide information on the process for referring an individual to the Montana Big Sky Home and Community Based Services Program.

Policy Manuals

Big Sky Waiver Policy Manual

Fee Schedules

Montana Access to Health Web Portal

Medicaid Claims Instructions

Electronic Billing

Provider Enrollment

Quality Assurance Management System (QAMS)

Home and Community Based Services Training

For more information on Medicaid Home and Community Based Waiver Services go to: http://dphhs.mt.gov/hcbs

Home Health

Home Health Program

Home Health services are part-time nursing and restorative therapy services provided in the home to eligible people who require these services. The goal of the Home Health Services Program is to avoid unnecessary hospital or nursing facility stays by providing skilled nursing or therapy services in the home.

Who is eligible?

To receive Medicare covered home health services, a physician must certify that the member is confined to his/her home (i.e. homebound). The member's condition should be such that there is a normal inability to leave home, and consequently, leaving home would require a considerable and taxing effort.

A patient is considered home bound if the following two criteria are met:

Criteria One: The patient must either:

  • Because of illness or injury, need the aid of supportive devices or the assistance of another person to leave their place of residence

OR

  • Have a condition such that leaving the home is contraindicated.

If the member meets one of the Criteria-One conditions, then the member must ALSO meet the two additional requirements defined in Criteria-Two.

Criteria-Two:

  • There must exist a normal inability to leave home;

AND

  • Leaving home must require a considerable and taxing effort.

If the member does leave home, they may still be considered homebound if the absences are infrequent, for short periods, or to receive health care. These may include:

  • Attendance at adult day care
  • Ongoing outpatient kidney dialysis
  • Receive outpatient chemotherapy or radiation.

Contact Information

Micky Brown, Program Manager

2030 11th Avenue
PO Box 4210
Helena MT 59604-4210
406-444-6064
406-444-7743 Fax
1-800-551-3191

Regional Program Officers

Regional Program Officers can assist with general eligibility questions and provide information on the process for referring an individual to the Home Health Program.

Policy Manual

*Not available electronically. Please contact the Program Manager directly.

Fee Schedules

MATH-Montana Access to Health Web Portal

Medicaid Claims Instructions

Electronic Billing

Provider Enrollment

Home Health - Home and Community Based Services Training

Home Health Prior Authorization Training August 2016

Service Prior Authorization Forms

Hospice

Hospice

Hospice is a program of care and support for people who are terminally ill. Hospice's focus is on comfort, not curing and illness. Hospice is palliative care only. (Children under the age of 18 years of age may continue curative treatment while receiving hospice services.) A specially trained team of professionals and caregivers provide care for the "whole person," including his or her physical, emotional, social and spiritual needs. Services include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related condition. Support is given to the individual and his or her family members.

Eligibility

A member is eligible for hospice services if he or she meets all of the following conditions:

  • the individual is eligible for Medicaid;
  • the individual's doctor and the hospice medical director certify that the individual is terminally ill;and has six months or less to live if the illness runs its normal course;
  • the individual signs a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. (Medicare will pay for covered benefits for any health problems that are not related to the individual's terminal illness; and
  • treatment is delivered by a Medicare-approved hospice program.

Contact Information

Micky Brown, Program Manager

2030 11th Avenue
PO Box 4210
Helena MT 59604-4210
406-444-6064
406-444-7743 Fax
1-800-551-3191

Regional Program Officers

Regional Program Officers can assist with policy guidance, general eligibility questions and provide information on the process of referring an individual to the Hospice Program.

Fee Schedules

Policy Manual

Medicaid Claims Instructions

Electronic Billing

Provider Enrollment

Hospice Home and Community Based Services Training

Long Term Care Ombudsman

Money Follows the Person

Residency Requirements:

  • Must have lived 90 consecutive days in a qualifying facility
  • Transition work may begin in advance of the 90th day

Medicaid Eligibility:

  • Must be Medicaid eligible for at least one day prior to transition
  • Transition work can begin without Medicaid eligibility

Program Eligibility:

  • Must be eligible for one of the following waiver or state plan programs
    • Big Sky Waiver (elderly and physically disabled)
    • Comprehensive (0208) Waiver (individuals with intellectual or developmental disabilities)
    • Serious Disabling Mental Illness (SDMI) Waiver
    • 1915 (i) serving youth with serious emotional disturbance (SED)
  • Must live:
    • Home owned or leased by a participant or family member
    • Apartment with individual lease, secure access, as well as living, sleeping, bathing & cooking areas where a participant or family has control
    • Community-based residential setting such as a group home with a maximum of 4 unrelated people (excluding caregivers and personal attendants)

Referral Form

Training Manual

Nursing Facilities and Swing Bed Services

Medicaid Rates

Nursing facilities are reimbursed under a case mix price-based system where rates are determined annually, effective July 1. Each nursing facility receives a facility specific rate. The statewide price for nursing facility services is established annually through a public process. Each nursing facility’s payment is comprised of two components, the operating component including capital and the direct resident care component.

Nursing facilities are reimbursed under a case mix price-based system where rates are determined annually, effective July 1. Each nursing facility receives a facility specific rate. The statewide price for nursing facility services is established annually through a public process. Each nursing facility’s payment is comprised of two components, the operating component including capital and the direct resident care component.

Nursing Facility Medicaid Rates by State fiscal year.

Nursing Facility Medicaid Rates for State Fiscal Year 2018

The new nursing facility Medicaid rates for state fiscal year 2018 will be mailed the week of 9/18/17. The Senior and Long Term Care Division will make the claim adjustments for each facility from July 1st forward to account for the change in the nursing facility Medicaid rate..

Nursing Facility Private Pay Rates

Hospital Swing Bed Rates

Level of Care Screens (LOC) for Nursing Facility Residents

The Mountain Pacific Quality Health Foundation (MPQH) has recently seen an increase in inappropriate and incomplete requests for Level of Care (LOC) screens.   Some nursing facilities routinely request a screen for all of their residents to protect the date of Medicaid eligibility when there is no reason to do so.  The problem is compounded by incomplete applications.  These practices cause an increase in costs to MPQH, and if they continue, will result in increased Department costs for this service.

Please review the following:

If you have any questions about LOC(s), please contact Mountain Pacific Quality Health at 443-0320 or 1-800-219-7035. Questions regarding this correspondence can be directed to either Shaunda Hildebrand at (406) 444-4209 or Jill Sark at (406) 444-4544.

Montana MDS 3.0 Section Q - Return to Community

What is MDS 3.0?
Changes to the federal minimum data set (MDS) tool (Version 3.0 assessment), went into effect on October 1, 2010.  One of these changes relates to Nursing Facilities (SNFs/NFs), States, and other qualified entities to identify individuals that are interested in returning to the community.

Civil Money Penalties Program (CMP)

A civil money penalty (CMP) is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against skilled nursing facilities (SNF’s), nursing facilities (NF’s), and dually-certified SNF/NF for either the number of days or for each instance a facility is not in substantial compliance with one or more Medicare and Medicaid participation requirements for Long Term Care Facilities. A portion of CMP’s collected from facilities are returned to the States in which the CMP’s are imposed to provide grant funding to benefit nursing facility residents.

Nursing Facilities Forms

Local Contact Agencies

Nursing Facility Staffing Reports

Online Payments