KodaComplyHome care rules, state by state, in plain EnglishUpdated September 23, 2026

Montana home care rules

In Montana, the Licensure Bureau of the Department of Public Health and Human Services (DPHHS) licenses home health agencies and hospices.

More about Montana

The documents we hold show no state license for non-medical personal care agencies; they enroll with Montana Medicaid, which pays them directly from state fee schedules through Community First Choice/Personal Assistance Services (CFC/PAS) and the Big Sky Waiver. What is changing now: a new electronic visit verification (EVV) policy for Community First Choice and personal care (July 2026), and, from September 1, 2026, site visits for home health and hospice providers that are newly enrolling or revalidating with Medicaid.

71 official documents·collected September 22, 2026·checked against them September 23, 2026
License for non-medical home care?No state license foundMontana law's list of health care facility types (MCA 50-5-101) names home health agencies and hospices but no personal care or home care agency, and the Big Sky Waiver lists no license for them. You enroll with Montana Medicaid and meet the program rules.
License for home health?YesDPHHS Licensure Bureau · no Certificate of Need · a six-month provisional license comes first
EVVNetsmart, freeClaims not sent through Netsmart have been denied since July 1, 2024 · covers personal care, home health and private duty nursing · live-in caregivers included
Medicaid health plansNone foundMontana Medicaid pays agencies directly (fee-for-service) from state fee schedules

What changed, and what to do about it

Red means act now, amber means read it this month, grey is for the record.

Read this monthAB-CFC/PCS policy 612, July 2026

New EVV policy for Community First Choice and personal care agencies

SLTC published a new EVV policy (612) for the agency-based CFC/PAS manual. It confirms live-in caregivers must use EVV and that IVR needs prior approval, with shifts scheduled ahead. The agency administrator must verify attendant hours before billing, and the agency must verify any manual edits to visits. Agencies that don't fix EVV problems in time can be barred from admitting new members or disenrolled.

What to do: Read the new policy. Check that your administrator verifies attendant hours before billing and reviews manual edits, and that every member using IVR has an approved request.
Read this monthProvider notice, Aug. 31, 2026 · effective Sept. 1, 2026

Site visits for home health and hospice enrollment from September 1

Newly enrolling home health, hospice and nursing facility providers are now "high" risk and revalidating ones "moderate" risk. SLTC will visit them before enrollment or revalidation can be finalized.

What to do: If you are enrolling or your revalidation is coming up, have your records and office ready for a visit. Questions: (406) 444-4077.
Read this monthProvider notice, Aug. 21, 2026

Passport referrals ended June 30, 2026

The Primary Care Montana program began July 1, 2026, and Passport to Health ended June 30. Claims for dates of service after June 30 no longer need a Passport referral ID; earlier dates still do. Other rules on medical orders and prior authorization still apply.

What to do: Tell your billers to stop adding Passport referral IDs for services after June 30, and keep them for older dates of service.
For the recordProvider notices, May 29 and June 30, 2026

No legislatively authorized rate increases for state fiscal year 2027

Because of projected budget shortfalls, DPHHS will not make legislatively authorized provider rate adjustments in state fiscal year 2027, except those required by statute, federal rules or CMS fee schedules. Separately, DPHHS posted proposed July 1, 2026 fee schedules for services including Community First Choice, personal care, the Big Sky Waiver and home health, and pays from them starting July 1.

What to do: Check the July 1, 2026 fee schedule for your service before you budget or change what you bill.
Sources (2)
For the recordNotice Oct. 23, 2025 · EVV service list updated Oct. 28, 2025

EVV claim fixes stay in Mobile Caregiver+; new CG modifier

Paid and partly paid EVV claims must be adjusted inside Mobile Caregiver+, or the visit and claim details fall out of sync. CFC has a new CG modifier for members whose caregiver is a legally responsible individual.

What to do: Make sure billers adjust EVV claims only in Mobile Caregiver+ and use the CG modifier where it applies.
Sources (2)