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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

2018 Direct Care Worker Funding

Direct Care Worker Funding for Fiscal Year 2018

The 2017 Montana Legislature approved funding for a direct care worker wage initiative for fiscal years (FY) 2018 and 2019. A total of $1,923,905 for Community First Choice/Personal Assistance services, and $558,004 for Big Sky waiver services were allocated per fiscal year.

Funding for FY 18 will be distributed in two installments as a gross adjustment. Each provider will receive a CFC/PAS amount and a Big Sky waiver amount that is calculated based on their projected percentage of direct care service utilization from FY 17. The gross adjustment will be made in two phases. The distribution phases will occur November 2017 and January 2018. The adjustments will be made to the primary provider number under which the provider bills Medicaid CFC/PAS and/or Big Sky waiver direct care service. For more details please review the attached application.

The application and accompanying forms must be completed and submitted to the Department by Tuesday, October 10, 2017, in order to receive the Direct Care Worker funding. Providers will receive the gross adjustment outlined in the notification letter upon Department approval of the provider application.

The Direct Care Worker Funding application includes:

  1. Direct Care Worker Funding Application Instructions;
  2. Agency Distribution Plan Form;
  3. Part A: Bonus Distribution Form (Excel Workbook);
  4. Part B: Wage and Benefits Payment Form (Excel Workbook);
  5. Part C: Direct Care Worker Supplemental Form: (Excel Workbook). This data is collected to monitor how the funding is used to support direct care workers. Completion is mandatory for application approval.
  6. Direct Care Wage Allocation Summary.

Provider agencies who do not wish to participate in this funding initiative should notify Micky Brown at MBrown2@mt.gov or (406) 444-6064 before October 10, 2017. Applications not submitted by the deadline will not be eligible for funding.

Health Care for Health Care Workers

 

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? Licensure Bureau of Quality Assurance Division .

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 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