Montana assisted living facility license: categories A to D, rules and steps

The license and its four categories

Montana law defines an assisted living facility as “a congregate residential setting that provides or coordinates personal care, 24-hour supervision and assistance, both scheduled and unscheduled, and activities and health-related services.”⁠¹ The definition sets no minimum number of residents. Any home that houses residents and provides that mix of care needs this license, or the adult foster care home license described below. Operating a health care facility without a license from DPHHS is prohibited.⁠⁵

Montana does not issue separate licenses for memory care or mental health assisted living. Instead, the statute requires DPHHS to use four licensing categories, each defined by the residents it may admit and keep:⁠⁴⁠³

Scroll the table sideways to see every column.

Category A is the base license. A facility that meets Category A requirements “may additionally be licensed to provide category B or category C services with the approval of the department.”⁠⁴ A facility seeking Category D on top of that must document that it “can keep all residents safe.”⁠⁴ For rule purposes, “mental disorder” includes dementia, Alzheimer’s disease and traumatic brain injury.⁠⁷ Someone found unfit to proceed under MCA 46-14-301 may not be placed in Category D.⁠³

Whatever the category, the statute sets a floor of services. You must provide or arrange personal services such as laundry, housekeeping, food service and local transportation. You must also provide help with ADLs and with self-medication, recreational activities, 24-hour onsite supervision by staff, and help arranging health-related appointments.⁠² An ALF may allow skilled care for a short-term acute illness, but not for more than 30 consecutive days per episode or 120 days in a year.⁠² Residents who need more than that belong in Category B.

Assisted living or adult foster care home?

For a small house, the alternative is Montana’s adult foster care home license. That license covers a home offering “only light personal care or custodial care to four or fewer disabled adults or aged persons” who are not related to the owner or manager.⁠¹ Skilled nursing care is not allowed in an adult foster care home, apart from narrow exceptions for adults in the state developmental disabilities program or adults who lived in the home before turning 18.⁠¹⁸ If you plan to serve five or more residents, or residents who need skilled care, memory care or behavioral care, you need the assisted living license.

No certificate of need, but local approvals first

The Licensure Bureau’s letter to prospective providers says: “Assisted Living Facilities are not required to be reviewed by the Health Planning Program and therefore do not need a Certificate of Need.”⁠⁹ Your gatekeepers are local: the building code authority, the fire marshal, and the county health department if you use a well or septic system.

Zoning. Montana treats an assisted living facility licensed under MCA 50-5-227 as a “community residential facility.”⁠¹⁴ A community residential facility serving eight or fewer persons, with care on a 24-hour basis, counts as a residential use for zoning. It is a permitted use in all residential zones, including single-family zones.⁠¹⁵ State and local safety or sanitary rules that do not apply to residential occupancies in general may not be applied to such a home.⁠¹⁵ The same statute still allows a city or county to require a conditional use permit for a licensed home of that size.⁠¹⁵ Ask your planning office early. The statute’s residential-use protection is written for eight or fewer persons, so a larger facility should expect ordinary local zoning review; confirm with your planning office.

Building and fire codes. Any construction, alteration, addition or renovation must meet the building code and fire marshal requirements of the authorities having jurisdiction.⁠⁷ For health care facilities, ARM 37.106.302 adopts by reference the 2018 AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities, the 2012 edition of NFPA 101 (Life Safety Code), and ANSI A117.1 (2009) for accessibility.⁠⁸ For new construction, an addition or an alteration, plans must go to DPHHS before construction starts.⁠⁵ They must be stamped by an engineer or architect licensed in Montana and cover civil, architectural, structural, mechanical, plumbing, electrical and special systems such as nurse call, fire alarm and secured units.⁠⁸ Plan approval for an alteration or addition lapses after one year, with one six-month extension available on request.⁠⁸

Adding a Category B, C or D endorsement to an existing Category A facility counts as a “change in use.” Licensure then depends on meeting the building and fire code standards in effect at the time of the change.⁠⁷ If you might add memory care later, design for it now.

The building: rooms, bathrooms and the call system

Subchapter 28 sets specific physical standards. These are the ones that most often decide whether an existing house or building can work:⁠⁷

A resident who uses a wheelchair or walker, or who is a Category B, C or D resident, may not be required to use a bedroom on any floor other than the first floor that is entirely above ground level. The exception is a building where that resident can move between floors, or to an approved fire barrier, without help, and where the local fire marshal has approved the occupancy.⁠⁷ The 2026 amendment adds that a resident who can move only with mechanical assistance must be able to evacuate without an elevator, pass a code-approved smoke or occupancy barrier, or reach an approved area of refuge.⁠⁷⁠¹³

Hallways, stairways, unfinished attics, garages and sheds may never be bedrooms. Neither may a room reached only through another resident’s bedroom.⁠⁷ Bedroom doors may have locks if the service plan allows, but the lock must open from inside with a single motion. Since September 26, 2026, deadbolts are prohibited on every door in the facility, not only on bedroom doors.⁠⁷⁠¹³

The call system needs early attention. Each resident room needs a UL- or FM-listed electric call system that reaches the care staff center or staff pagers and can be silenced only at the point of activation. Every bathroom needs a fixed call device that a resident collapsed on the floor can reach.⁠⁷ In Category D units, call cords longer than 6 inches are not allowed.⁠⁷ The bureau asks for written verification from the installer that the system works and meets AIA section 8.3.7.4, ARM 37.106.2836(1)(d) and ARM 37.106.2838(7).⁠⁹

Secured units

A locked Category C unit, and every Category D unit, must meet ARM 37.106.316. Locking must follow NFPA 101’s special locking arrangements or, where local authorities allow, an alternative of electromagnetic locks with keypad release that open automatically on fire alarm, sprinkler activation or power loss. The unit needs its own nurse station and a nourishment station.⁠⁸ In secured care units, the minimum standards rule requires 35 sq ft per resident for dining, activities and day space, at least 20 of it for dining.⁠⁸ The ALF rule for a locked Category C unit requires separate dining and activity areas at 30 sq ft per resident each, and direct care staff on the unit whenever residents are there.⁠⁷ Category D rooms are single-occupancy, with tamper-proof hardware and lighting and a sight window in each door.⁠⁷

The administrator and staff

Every ALF must employ an administrator who is responsible for operations and for 24-hour supervision. The administrator must either:⁠⁷

• hold a nursing home administrator license in Montana or another state; or
• have completed all self-study modules of “A Management Reference for Executive Directors – Admin Level 1 Certificate Program” from Senior Living University (SLU), or an approved alternative; or
• enroll in and complete that course within six months of hire.

The administrator also needs at least 16 contact hours of continuing education a year. An NHA license or SLU certificate counts as the 16 hours only in the calendar year it was obtained.⁠⁷ The owner may serve as administrator if qualified, but the administrator or designee may not be a resident.⁠⁷ Notify DPHHS within five days when an administrator leaves or a new one starts. Give written notice of the designee if the administrator will be absent for more than 30 continuous days.⁠⁷ With your application you also file an attestation from the prospective administrator that they have reviewed the ALF rules.⁠⁹

Each higher category adds administrator requirements:⁠⁷⁠¹¹⁠¹²

• Category B: one or more years working in geriatrics or caring for disabled residents in a licensed facility.
• Category C: three or more years of that experience, or an equivalent combination of education and training accepted by DPHHS. Eight of the 16 annual CE hours must cover severe cognitive impairment.
• Category D: at least three years in mental health and mental disorders, on top of the Category B requirement. Eight of the 16 CE hours must be in mental health.

Staffing levels

Montana sets no numeric staff-to-resident ratio for Categories A to C. The rule requires “a sufficient number of qualified staff on site 24 hours a day” to meet scheduled and unscheduled needs, respond to emergencies, and handle medication help, meals, housekeeping and laundry.⁠⁷ The words “on site” were added in 2026. DPHHS explained that the earlier “on duty” wording “was argued to mean that a staff member could be on duty but not on site.”⁠¹³ Category C and D staff must stay awake, fully dressed and available on the unit at all times.⁠⁷ Volunteers may not count toward your staffing plan. They may not help with medications, delegated nursing tasks, bathing, toileting or transfers.⁠⁷

Category B facilities must employ or contract with a registered nurse to monitor residents, do nursing assessments, help write health care plans and delegate tasks under the Montana Nurse Practice Act.⁠⁷

Background checks and training

The statute requires a background check on everyone who accepts employment, and a name-based check is allowed.⁠² Under the rule, if an applicant has lived outside Montana in the past five years, you must check every state they lived in. The alternatives are a name-based check with nationwide results or an FBI fingerprint check.⁠⁷ You may not employ anyone with a court finding of abuse, neglect, exploitation, mistreatment or misappropriation of property, or with a matching board discipline or nurse aide registry finding.⁠² Staff may work provisionally while results are pending.⁠² DPHHS may deny, suspend or revoke a license for “a demonstrated pattern of noncompliance” with these checks.⁠⁴ Category D staff must be at least 18 and must have an FBI fingerprint check at hire.⁠⁷

New staff orientation must cover your policy manual, the Montana Vulnerable Adult Prevention of Abuse Act and the Long-Term Care Resident Bill of Rights Act. Staff who assist with self-administration need training on medication administration records and the “five rights.”⁠⁷ All direct care staff need at least two hours of dementia care training at hire and every year after, plus training in the abdominal thrust maneuver and basic first aid. If you offer CPR, at least one person per shift must hold a valid CPR certificate.⁠⁷ Category C staff need additional documented training in areas such as wandering, hallucinations, therapeutic programming and medication side effects. Category D staff need four hours of mental health training each year and training in de-escalation.⁠⁷ DPHHS can ask for employee files, including background check results, and you must produce them within 24 hours.⁠⁷

The application packet

The initial and change-of-ownership application is filed online through the Licensure Bureau’s portal, linked from the DPHHS assisted living page.⁠¹⁰ The 2026 rule amendments confirmed that “the application process is now online and no longer requires a mailed-in application.”⁠¹³ The application must identify the corporate officers and directors or general partners, the administrator and their qualifications, any management company, and the maximum number of A, B, C and D beds.⁠⁷

The Licensure Bureau’s letter to new providers lists what to submit:⁠⁹

• the completed license application and fee;
• a BFS Plan Submittal Form, sent to the bureau’s construction consultant;
• a floor plan showing the size of every room residents use. It may be hand-drawn if dimensioned. Measure from the front of any closet or built-in, and leave door-swing areas out of the square footage;
• local building code approval, and a certificate of occupancy for new construction;
• policies and procedures, at least 45 days before the expected opening date, with additional policies for Category B and C;
• the resident agreement, which must meet ARM 37.106.2823;
• for a well, a certified laboratory potability report dated within the past year;
• for a septic system, a county health department inspection based on the number of bedrooms, not residents;
• installer verification of the call system, and of any electronic security system that monitors or restricts resident movement;
• a fire inspection report. If exit doors will be locked, “only single-motion locks will be approved”;
• the administrator’s attestation.

Category B and C applicants also file a supplemental form.⁠¹¹⁠¹² Both supplements require proof of the administrator’s experience, a copy of the license of the licensed health care professional who will do on-site assessments and certify care levels, and the category’s policies and procedures. The Category C supplement adds a Category C resident agreement. For a locked unit, it also requires a floor plan showing the locking type, plus approval of the locking system from either the latest local building code approval or a fire marshal inspection within the past 12 months.⁠¹² A Category B endorsement is issued only after DPHHS approves the Category B policies, staff qualifications are shown, and building and fire authorities approve in writing.⁠⁷

Your policy manual must include an organizational chart. It must be reviewed every other year, and new policies must go to DPHHS for review.⁠⁷ A Category D facility that plans to use restraint or seclusion needs prior approval of those policies before using them.⁠³

The application fee is paid with the online application. MCA 50-5-227(5) authorizes DPHHS to set license fees by rule, but the ALF rules, the initial application letter and the bureau’s ALF page do not publish an amount. Ask the Licensure Bureau (406-444-2676) for the current amount before you file; the portal shows it when you start the application.

From filing to license

1. Do not file too early

   Do not file more than six months before your target licensure date. Applications with no provider activity are withdrawn under bureau policy.⁠⁹

2. Settle construction and local approvals

   For new construction or alterations, get DPHHS plan approval before building. Then obtain the local building approval or certificate of occupancy, the fire inspection, and any water or septic reports.⁠⁵⁠⁸⁠⁹

3. Submit policies and the resident agreement

   These must reach the bureau at least 45 days before opening.⁠⁹

4. Pass the physical compliance inspection

   Schedule an on-site physical compliance inspection with the bureau’s construction consultant. You need document approval and the consultant’s approval before a license issues.⁠⁹ By statute, the initial inspection happens within 45 days after DPHHS receives the application and notice that the facility is ready.⁠⁶

5. Get the provisional license

   The bureau issues a six-month provisional license. Until then, “you may not admit residents.”⁠⁹

6. Get surveyed

   A Licensure Bureau surveyor conducts an on-site survey during the provisional period to check compliance with the ALF rules.⁠⁹

Questions during the process go to the Licensure Bureau at 406-444-2676.⁠⁹

License terms, renewal and ownership changes

Montana licenses run one to three years.⁠⁵ Under ARM 37.106.310, a facility open for less than a year, a facility after a change of ownership, and a facility with serious deficiencies in the past 12 months may be offered a one-year license. A facility with only minor deficiencies may get two years. A three-year license requires a deficiency-free survey, accreditation by a CMS-approved accrediting body, or another qualifying department survey.⁠⁸ Renewal surveys are unannounced and happen before the license in force expires.⁠⁶ Renewals are filed through the provider login on the same portal.⁠¹⁰

Besides the licensing survey, plan for these recurring obligations: an annual fire inspection, with records kept three years; two resident fire drills a year, at least four months apart; yearly testing of a non-municipal water source; and yearly inspection and tagging of fire extinguishers.⁠⁷

A license cannot be sold or transferred and covers only the premises it names.⁠⁷ A buyer files a new application with the fee. The buyer also submits a fire inspection from the past year, policies and procedures (or a written statement adopting the existing ones), the resident agreement, and proof that the administrator qualifies.⁠⁷ Give DPHHS written notice at least 30 days before a name change or relocation. Changes in location, use or bed count need written DPHHS approval.⁠⁷

Category D and the new D1 level

The 2025 Legislature passed Senate Bill 524, revising the Category D law, and Senate Bill 516, which updated facility licensing.⁠¹³ Category D facilities can be standalone or share a building with another licensed facility, and are limited to 15 residents.⁠³ Courts may order a diversion to a Category D facility instead of commitment to Montana State Hospital or the Montana Mental Health Nursing Care Center.⁠³

The rules effective September 26, 2026 add Category D1 (ARM 37.106.2899I). A facility that admits or keeps Category D residents with practitioner orders for restraint or seclusion, or residents admitted involuntarily, must apply as a D1 facility. A D1 facility must:⁠⁷

• be either a standalone secured facility, or a separate secured unit with its own entrance and impenetrable doors if attached to an A, B or C facility;
• have at least one seclusion room per 24 residents. Each room needs at least 60 sq ft (80 sq ft with restraint beds), walls 7 to 11 ft long, a ceiling at least 9 ft high, and an anteroom with direct access to a toilet room;
• have an RN on duty or on call and able to reach the facility within one hour, a site-based licensed mental health professional, and certified nursing assistants as direct care staff;
• give a licensed nurse’s constant one-on-one supervision to any resident in seclusion.

A Category D resident who cannot or will not self-administer medications must have all medications given by a licensed nurse, and becomes a Category B resident.⁠⁷ That ties Category D to the five-resident Category B cap.⁠⁴

MCA 50-5-226 also directed DPHHS to adopt a Category D reimbursement model by April 1, 2026. The model must include enhanced payments for higher-acuity needs and higher rates for facilities serving fewer than 15 residents.⁠³ A DPHHS status handout dated May 7, 2026 says the Senior and Long-Term Care Division set Category D rates with provider focus groups and submitted a Big Sky Waiver amendment to CMS in February 2026, and that it was still awaiting federal approval.⁠¹⁹ The sources do not publish the rates. Before you build a business plan around Category D, ask the Senior and Long Term Care Division whether CMS has approved the amendment and what the rates are.

Medicaid payment through the Big Sky Waiver

Assisted living facilities take part in Montana Medicaid through the Big Sky Waiver, a home and community-based services program run by the DPHHS Senior and Long Term Care Division. Under the waiver policy manual (section 603, dated April 1, 2017), every provider of waiver services must enroll in the waiver. Enrollment is done electronically through the MATH web portal, using the Home and Community Based Services provider type. The enrollment contractor forwards the forms to the Community Services Bureau, which approves the provider and assigns procedure codes and rates.⁠¹⁶ Changes in ownership, address or licensure must be reported to the contractor in writing right away.⁠¹⁶ Montana Medicaid’s January 2025 provider newsletter announced that the waiver’s Level II Support Services let ALFs request extra reimbursement for members with challenging or disruptive behaviors who are at risk of losing their placement.⁠¹⁷

If your residents need nursing visits or therapy at the facility from an outside agency, that agency needs its own license; ask the Licensure Bureau which license applies. Daytime-only programs for adults are licensed separately from assisted living.

Rule changes effective September 26, 2026

DPHHS amended most of subchapter 28 under MAR Notice 2026-323 to carry out SB 516 and SB 524. The changes took effect September 26, 2026.⁠⁷⁠¹³ Besides Category D1, the changes that affect a new facility are:⁠¹³

• staff must be on site 24 hours a day, not merely on duty;
• resident rooms, bathrooms and common areas may not exceed 85°F;
• deadbolt locks are prohibited on all doors;
• bedroom call systems may be silenced only at the point of activation;
• evacuation rules for residents who move only with mechanical assistance are spelled out;
• practitioners must be notified of a resident weight loss of 5% or more;
• applications are filed online, and an ended license may be disposed of rather than mailed back.

The rule booklet posted on the DPHHS assisted living page carries these amendments. Check that your policies and floor plan are based on that version rather than earlier copies.⁠⁷⁠¹⁰

Sources

1. 1
   Montana Legislature, MCA 50-5-101, Definitions (Hospitals and Related Facilities) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Montana Legislature, MCA 50-5-225, Assisted living facilities: services to residents, employee background checks Checked 12 Oct 2026 · Back to text ↑
3. 3
   Montana Legislature, MCA 50-5-226, Placement in assisted living facilities Checked 12 Oct 2026 · Back to text ↑
4. 4
   Montana Legislature, MCA 50-5-227, Licensing assisted living facilities Checked 12 Oct 2026 · Back to text ↑
5. 5
   Montana Legislature, MCA 50-5-201, License requirements Checked 12 Oct 2026 · Back to text ↑
6. 6
   Montana Legislature, MCA 50-5-204, Issuance and renewal of licenses: inspections Checked 12 Oct 2026 · Back to text ↑
7. 7
   Montana Department of Public Health and Human Services, ARM 37.106, subchapter 28: Assisted Living Facilities (printable version, amended effective 9/26/2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Montana Department of Public Health and Human Services, ARM 37.106, subchapter 3: Minimum Standards for All Health Care Facilities Checked 12 Oct 2026 · Back to text ↑
9. 9
   Montana DPHHS, Office of Inspector General, Licensure Bureau, Letter to prospective assisted living facility providers (initial application letter) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Montana Department of Public Health and Human Services, Assisted Living Facilities (Licensure Bureau facility applications page) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Montana DPHHS, Office of Inspector General, Licensure Bureau, Assisted Living Facility License Application: Category B Supplemental (Rev. 06/2021) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Montana DPHHS, Office of Inspector General, Licensure Bureau, Assisted Living Facility License Application: Category C Supplemental (Rev. 06/2021) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Montana Department of Public Health and Human Services, MAR Notice No. 2026-323.1, proposed amendment of assisted living facility rules (Issue No. 4, February 20, 2026) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Montana Legislature, MCA 76-2-411, Definition of community residential facility Checked 12 Oct 2026 · Back to text ↑
15. 15
    Montana Legislature, MCA 76-2-412, Community residential facilities and zoning Checked 12 Oct 2026 · Back to text ↑
16. 16
    Montana DPHHS, Senior and Long Term Care Division, Big Sky Waiver Policy Manual, section 603: Provider Enrollment Checked 12 Oct 2026 · Back to text ↑
17. 17
    Montana Department of Public Health and Human Services, Montana Medicaid Claim Jumper, January 2025 Checked 12 Oct 2026 · Back to text ↑
18. 18
    Montana Legislature, MCA 50-5-216, Limitation on care provided in adult foster care home Checked 12 Oct 2026 · Back to text ↑
19. 19
    Montana DPHHS, Senior and Long-Term Care Division, Category D Assisted Living status update handout (May 7, 2026) Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF