How to start a private duty nursing agency in Montana

Private duty nursing (EPSDT) — Montana Medicaid (incorporated nursing agency; individual nurses not enrolled).

Issuing agency

Montana Department of Public Health and Human Services (Montana Medicaid)

Regulation

ARM 37.86 (private duty nursing); Montana Medicaid Private Duty Nursing manual

1. Form an incorporated entity that employs or contracts with RNs/LPNs
2. Enroll with Montana Medicaid as a PDN provider
3. Serve children under 21 with skilled nursing (plus patient-specific nurse training) under prior authorization

Staffing

• Registered nurses or licensed practical nurses

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.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

33 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

205,414 (as of Jun 1, 2026)

All Montana Private duty nursing 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 →