How to start a skilled nursing facility in Montana

Montana requires a Long-term care facility license (skilled nursing care) from Montana Department of Public Health and Human Services, Office of Inspector General — Licensure Bureau to operate a skilled nursing facility. Processing time: Policies and procedures due at least 45 days before opening; do not apply more than 6 months before the desired licensure date.

License required

Yes

License

Long-term care facility license (skilled nursing care)

Issuing agency

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

Processing time

Policies and procedures due at least 45 days before opening; do not apply more than 6 months before the desired licensure date.

Certificate of need

Required

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

MCA 50-5-301 to 50-5-310 and ARM 37.106.101–140 (CON); ARM 37.106 (health care facility licensing)

1. Obtain a Certificate of Need (long-term care facilities are CON-reviewable) and have the CON program confirm before licensure
2. Submit the license application and fee
3. Submit the BFS Plan Submittal Form to the Licensure Bureau's construction consultant and obtain local building code approval
4. Submit policies and procedures at least 45 days before opening
5. Arrange the fire inspection with the local fire marshal; the license issues after the construction consultant approves
6. For Medicare/Medicaid, complete federal certification and enroll with Montana Medicaid

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

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.

Skilled nursing facilities — active organization NPIs (NPPES)

167 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

61 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

205,414 (as of Jun 1, 2026)

All Montana Skilled nursing Medicaid rates, ranked →