How to start an IDD waiver provider in Montana

Montana requires a Enrolled DDP 0208 Comprehensive Waiver provider (Montana Medicaid enrollment plus DDP Provider Addendum); residential habilitation homes must be licensed under ARM 37.100.301-340 from Montana DPHHS Developmental Disabilities Program (DDP); Montana Medicaid provider enrollment; DPHHS licensure for group homes to operate an IDD waiver provider.

License required

Yes

License

Enrolled DDP 0208 Comprehensive Waiver provider (Montana Medicaid enrollment plus DDP Provider Addendum); residential habilitation homes must be licensed under ARM 37.100.301-340

Issuing agency

Montana DPHHS Developmental Disabilities Program (DDP); Montana Medicaid provider enrollment; DPHHS licensure for group homes

Insurance and bonds

DDP requires commercial general liability, automobile (if transporting participants) and business interruption insurance.

Regulation

ARM 37.34 (DD program services, incl. 37.34.702 and 37.34.114); ARM 37.100.301-340 (group home licensure)

1. Enroll as a Montana Medicaid provider (medicaidprovider.mt.gov)
2. Submit the DDP Provider Addendum for review by DDP
3. Complete the HCBS settings Provider Self-Assessment in the HCBS Provider Portal; DDP may do an on-site validation visit
4. For residential habilitation, obtain group home licensure under ARM 37.100.301-340
5. Contact the DDP Regional Office to set up staff training access and meet staff qualification requirements

Training

• Staff: background check, age 17+, abuse/incident reporting, first aid/CPR and confidentiality training within 30 days
• College of Direct Supports Tier 1 within six months (residential habilitation)
• 12 hours of annual training after the first year (residential habilitation)

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 →

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 →

Model

hybrid

State vendor

Netsmart (Mobile Caregiver+)

Services in scope

• personal care
• home health
• other applicable HCBS

Alternate EVV allowed

Yes

Program

https://dphhs.mt.gov/SLTC/EVV

Montana EVV requirements →

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.

Intellectual/developmental disability residential facilities — active organization NPIs (NPPES)

24 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

205,414 (as of Jun 1, 2026)

All Montana IDD / waiver Medicaid rates, ranked →

• MT Big Sky Waiver (BSW) (1915(c))
• MT Home and Community Based Waiver for Individuals with Developmental Disabilities (1915(c))
• MT Severe and Disabling Mental Illness Home and Community Based Services Waiver (1915(c))

Montana waivers and waiting lists →