How to start a hospice in Montana

Montana requires a Hospice license — hospice program (in-home), in-patient hospice, or residential hospice from Montana Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau to operate a hospice. Fee: A license fee must accompany the application; amount not stated in the Licensure Bureau letter. Processing time: Do not apply more than 6 months before the desired licensure date; submit policies and procedures at least 45 days before opening. A 6-month provisional license is issued first, with an on-site survey during that period.

License required

Yes

License

Hospice license — hospice program (in-home), in-patient hospice, or residential hospice

Issuing agency

Montana Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau

Fee

A license fee must accompany the application; amount not stated in the Licensure Bureau letter.

Processing time

Do not apply more than 6 months before the desired licensure date; submit policies and procedures at least 45 days before opening. A 6-month provisional license is issued first, with an on-site survey during that period.

Certificate of need

Not required

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

ARM Title 37, Chapter 106 (hospice rules incl. ARM 37.106.2305 in-patient hospice, 37.106.2311 residential hospice, 37.106.302 general facility standards)

1. Download and complete the hospice License Application and pay the fee (no earlier than 6 months before desired licensure)
2. Submit policies and procedures for approval at least 45 days before opening
3. Submit an attestation from the prospective administrator that the hospice rules were reviewed
4. Inpatient/residential hospices: submit a floor plan and local building code approval (certificate of occupancy for new construction) and pass an on-site physical compliance inspection by the Bureau construction consultant
5. Receive a 6-month provisional license
6. Pass the on-site licensure survey during the provisional period

Program

Montana Healthcare Programs (Montana Medicaid, HELP/Medicaid expansion, Healthy Montana Kids Plus)

Enrollment portal

MPATH Provider Services Portal

Fiscal agent

Conduent (Montana Provider Relations handles enrollment and claims); DPHHS says claims move to Gainwell Technologies' new Montana Healthcare Claims System in 2027

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Montana's own pages do not list a separate state enrollment fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. Montana's screening and enrollment disclosure form restates these federal rules; it does not list which provider types are high risk.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. Montana's screening and enrollment disclosure form restates these federal rules.

Revalidation

Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. Montana's enrollment page says sole-proprietor revalidations filed under a tax ID shared with another provider are denied.

Full Montana Medicaid enrollment guide →

For this business

Not required (licensing source)

CON program

Yes

Program

Certificate of Need (long-term care)

Agency

Montana Department of Public Health and Human Services

Services covered

• long-term care facilities (skilled nursing, intermediate nursing and intermediate developmental disability care to 2+ individuals): new or replacement facilities, bed increases or relocations above 10 beds / 10%, acquisitions of 50%+ ownership
• new long-term care health services adding $150,000+ in annual operating and amortization expense
• hospital use of more than five beds for nursing-level care and hospital long-term care services

Montana certificate of need details →

State minimum wage

$10.85 an hour

Effective

2026-01-01

Scheduled increases

Adjusted each January 1 for inflation (calculated by September 30); the 2027 rate was not found in the sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

63 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

32 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

205,414 (as of Jun 1, 2026)