Montana home health agency license: DPHHS rules, the 6-month provisional license and Medicare

Montana’s standard is the federal rule book

Most states write their own home health rules on staffing, aide training, patient rights and clinical records. Montana does not. Its entire agency-specific rule, ARM 37.106.1505, is one sentence: “A home health agency shall comply with the Conditions of Participation for Home Health Agencies as set forth in 42 CFR subchapter G part 484.”⁠⁹ The rule dates from 1980 and was last amended effective September 24, 2022.⁠⁹

That has two practical effects:

• A private-pay agency is held to Medicare standards anyway. Even if you never bill Medicare, the Licensure Bureau measures you against the federal rules on patient rights, comprehensive assessment, care planning, QAPI, infection control, aide training and supervision, emergency preparedness, clinical records and personnel qualifications in part 484.⁠⁹⁠¹¹
• Two layers apply, not one. On top of part 484, a home health agency is a “health care facility” under Montana law, so it must also meet ARM 37.106 subchapter 3, the minimum standards for all health care facilities.⁠¹⁠¹⁰

One trap on the DPHHS website: the link labeled “Printable Version of Home Health Agency Rules” opens a copy of ARM 37.106 subchapter 3, not a separate home health rule set (checked October 12, 2026).⁠⁷ There is no separate state home health rule text. The federal regulation is the rule book.

Does your business need this license?

Montana’s definition of a home health agency turns on the services you provide. It is “a public agency or private organization … engaged in providing home health services to individuals in the places where they live,” and those services “must include the services of a licensed registered nurse and at least one other therapeutic service and may include additional support services.”⁠¹ A person may not operate a health care facility without a DPHHS license.⁠²

The Licensure Bureau’s list of licensed types includes Home Health Agency and Home Infusion Therapy Agency but no personal care or companion agency.⁠¹⁷ If you plan to offer nursing visits only, with no second therapeutic service, you fall outside the statutory definition of a home health agency. The statutes and DPHHS pages checked on October 12, 2026 do not say which license, if any, covers a nursing-only agency. Ask the Licensure Bureau (406-444-2676) in writing, describing your exact service list, before you launch.

The definition in MCA 50-5-101 exists in a temporary version and a version effective January 1, 2027. Both versions word the home health agency definition the same way.⁠¹

No certificate of need, but the clock starts with your policies

Montana keeps a certificate-of-need program (ARM 37.106 subchapter 1), but home health agencies are outside it.⁠⁸ The Licensure Bureau’s initial application letter says home health agencies “are not required to be reviewed by the Health Planning Program and therefore a Certificate of Need (CON) review is not required.”⁠⁸

Two dates in the letter set your schedule:

• Not more than 6 months early. “Do not submit an application earlier than 6-months prior to the desired licensure date.” The letter adds that applications showing no progress on uploading required documents will be withdrawn under bureau policy.⁠⁸
• At least 45 days before opening. Your policies and procedures go to the bureau “for review and approval” at least 45 days before the expected opening date.⁠⁸ State law sets the same 45-day minimum for the application itself, and the license fee must come with it.⁠⁴

The 45-day policy review is where most of the work sits. You are writing policies against part 484, and the bureau reviews them before it issues anything.

What the Licensure Bureau wants in the package

The initial application letter lists six items:⁠⁸

1. License application and fee

   File through the DPHHS Bounds portal. Choose “Home Health Agency Application” (the same form handles a change of ownership).⁠⁷⁠¹⁸

2. BFS Plan Submittal Form

   Send it to the Licensure Bureau’s construction consultant. The letter tells applicants to request the form by email from the consultant it names.⁠⁸ Montana law requires plans for any construction, alteration or addition to a health care facility to be approved before work starts.⁠²

3. Policies and procedures,

   at least 45 days before opening.⁠⁸

4. A list of the counties you plan to serve

   ⁠⁸

5. A list of all professional staff, with license numbers

   ⁠⁸ You need your clinical people identified before you apply, not after.

6. An attestation from your prospective administrator

   that they have reviewed the home health agency rules.⁠⁸ State law requires this attestation for every facility type.⁠⁴

MCA 50-5-203 adds what the application itself must show: the names and addresses of the owners (each partner or member, or each corporate officer), the location, the named administrator, “the number and type of patients” you will serve, staffing information the department asks for, and any ownership, contract or lease arrangement if someone other than the owner runs the agency.⁠⁴ ARM 37.106.310 requires the administrator or a designee to sign the application.⁠¹⁰

The order of steps

1. Confirm your service mix

   You need an RN plus at least one other therapeutic service to be a home health agency.⁠¹

2. Hire or name your administrator and clinical manager,

   and collect professional license numbers for the staff list.⁠⁸⁠¹¹

3. Write your policies to part 484 and ARM 37.106 subchapter 3

   These are the documents the bureau reviews first.⁠⁸⁠⁹⁠¹⁰

4. Open the Bounds application

   no more than 6 months before your target date and upload the six items.⁠⁸⁠¹⁸

5. Submit policies at least 45 days before opening,

   and file the BFS Plan Submittal Form.⁠⁸

6. Receive the six-month provisional license

   You may not accept patients before this.⁠⁸

7. Begin care and host the on-site survey

   during the provisional period.⁠⁸

8. Apply to Medicare and Medicaid,

   if and when federal enrollment reopens (see below).⁠¹²⁠¹³

The fee

Montana’s license fee is set in statute, not by rule. MCA 50-5-202 charges $20 for facilities with 20 beds or fewer and $1 per bed for facilities with 21 or more, paid into the state general fund (as published on October 12, 2026).⁠³ A home health agency has no beds. Neither the DPHHS home health page nor the initial application letter states the amount charged to home health agencies (checked October 12, 2026).⁠⁷⁠⁸ The letter lists only a “License Application and fee” with no amount. Ask the Licensure Bureau at 406-444-2676 what figure applies to an agency with no beds before you submit.⁠⁸

People the federal rules require from day one

Because part 484 is Montana’s licensing standard, its personnel rules apply at licensure:

• Governing body. A governing body must take “full legal authority and responsibility” for the agency’s management, services, budget and QAPI program.⁠¹¹
• Administrator. The administrator is appointed by and reports to the governing body. Administrators hired on or after January 13, 2018 must be a licensed physician, a registered nurse, or hold an undergraduate degree, and must have experience in health service administration, with at least 1 year of supervisory or administrative experience in home health care or a related health care program.⁠¹¹
• Coverage. The administrator, or a pre-designated person authorized in writing, must be available during all operating hours. So must a clinical manager.⁠¹¹
• Clinical manager. A licensed physician, physical therapist, speech-language pathologist, occupational therapist, audiologist, social worker or registered nurse.⁠¹¹
• Home health aides. An aide qualifies by completing a training and competency evaluation program, a competency evaluation program, a state-approved nurse aide program with good standing on the nurse aide registry, or a state licensure program that meets the federal standards. Training totals 75 hours, and at least 16 hours of classroom work must come before at least 16 hours of supervised practical training. Each aide needs at least 12 hours of in-service training every 12 months.⁠¹¹
• Aide supervision. For patients receiving skilled care, an RN or other skilled professional must do a supervisory assessment at least every 14 days and observe each aide on site once a year. For patients receiving only non-skilled care, the RN must make an on-site visit every 60 days and observe each aide semi-annually.⁠¹¹

Montana adds a felony screen through its licensing statute. DPHHS may deny, suspend or revoke a license if the applicant or a manager has a felony conviction, where denial is consistent with MCA 37-1-203. It may also act if staff are “insufficient in number or unqualified,” or if the applicant “does not have the financial ability to operate.”⁠⁶

Montana’s own standards on top of part 484

ARM 37.106 subchapter 3 applies to all licensed health care facilities. For a home health agency, these parts matter:⁠¹⁰

• Infection control (ARM 37.106.313). A written infection prevention and control program, with policies reviewed at least annually. The administrator or an infection control officer is responsible for it.
• Records (ARM 37.106.314). Keep each patient’s record for at least six years after discharge or death.
• Employee files (ARM 37.106.315). Each file must hold the employee’s name, a job description and an orientation record, both signed by the employee, and current credentials. A file kept off site must reach the department within 24 hours of a request. Volunteers cannot count toward your staffing plan.
• Policy manual (ARM 37.106.330). Keep a written manual describing all services, reviewed at least every other year with written documentation. As amended effective September 21, 2024, the rule also requires policies protecting medical practitioners who decline services on grounds of conscience or who blow the whistle, and you must train all staff on them.

Part 484 adds its own recurring duties. The emergency plan must be reviewed and updated at least every 2 years, emergency training must be repeated at least every 2 years, and the plan must be tested at least annually. Each patient’s plan of care must be reviewed at least every 60 days.⁠¹¹

Provisional license, survey and license term

Once the bureau approves your package, it issues a six-month provisional license. “A facility may not accept patients until it is licensed.” A Licensure Bureau surveyor then conducts an on-site survey within the provisional period. The letter describes the visit as a compliance check and also a chance to get clarification on the rules.⁠⁸ By statute, once a new facility notifies the department that it is ready, the department must inspect within 45 days.⁠⁵

After the provisional period, ARM 37.106.310 lets the department issue licenses of different lengths:⁠¹⁰

The rule ties the one-year term to agencies in operation less than one year, so a new agency should plan on annual renewal at first.⁠¹⁰

Medicare and Medicaid: why the 2026 freeze hits harder in Montana

State licensure and federal certification are separate. The Licensure Bureau’s letter covers licensing only. For certification it refers you to the DPHHS Certification Bureau at 406-444-2099 or [email protected].⁠⁸

Montana Medicaid will not enroll a home health agency on a state license alone. Home Health Policy 601 says providers “must be: 1. Licensed by the State of Montana; 2. Certified by Medicare; and 3. Enrolled as a Medicaid Provider,” citing ARM 37.40.702.⁠¹²

That makes the federal moratorium decisive. Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare nationwide. Only applications a Medicare contractor received before that date are still being processed.⁠¹³ CMS’s survey memo says initial applications filed during the moratorium are denied and must be filed again after it ends. It allows no individual exceptions. Accreditation will not give a new agency deemed status while the moratorium lasts.⁠¹⁴ Buying a young agency does not work around the freeze: an agency with a non-exempt change in majority ownership within 36 months of its initial enrollment must re-enroll as new, and the moratorium blocks that.⁠¹³

CMS left Medicaid moratoria to each state.⁠¹³ Montana does not need one. Because its Medicaid program requires Medicare certification, a new Montana agency cannot become a Medicaid home health provider until it can enroll in Medicare.⁠¹² Until then, a newly licensed agency can serve only private-pay or other non-Medicare, non-Medicaid clients.

The moratorium runs six months and can be extended in six-month increments through notices in the Federal Register.⁠¹³⁠¹⁵ As of October 12, 2026, no extension had been published, so the first period ends around November 13, 2026.⁠¹⁵ Agencies that apply within 6 months after the freeze lifts are assigned the “high” screening level.⁠¹³

Expect electronic visit verification if you later bill Medicaid. In a 2025 rule proposal on personal care providers, DPHHS notes that the 21st Century Cures Act requires states to use EVV “for Medicaid-funded personal care services and home health care services for in-home visits by a provider.” Under CMS guidance, EVV does not apply when the caregiver lives with the patient.⁠¹⁶

Renewal, ownership changes and enforcement

• Renewal. File renewal applications through the separate renewal link on the DPHHS page, no later than the license expiration date.⁠⁴⁠⁷ The department inspects before expiration without notice to you or your staff.⁠⁵
• Ownership changes. A license is valid only for the person and premises named on it and may not be sold, assigned or transferred. When ownership transfers, return the license to the department or destroy it.⁠² The new owner files a change-of-ownership application in Bounds.⁠¹⁸ Expect a one-year license after the change.⁠¹⁰
• Display and access. Display the license in a conspicuous place. Your premises and records must be open to the department at all reasonable times.⁠²⁠⁵
• Enforcement. DPHHS may deny, suspend or revoke a license for failing to meet the minimum standards, cruelty or indifference, misappropriating patients’ property or funds, or violating the licensing statutes. It may reduce a license to provisional status after an inspection finds noncompliance, when it cannot survey the facility for lack of patients, or when it needs more time to finish its review.⁠⁶

Rule changes to watch

• MCA 50-5-101 changes on January 1, 2027. A new version of the definitions statute takes effect that day. The home health agency definition reads the same in both versions.⁠¹
• Federal changes now reach state licensure. Because ARM 37.106.1505 adopts part 484, a federal change to the Conditions of Participation becomes, in practice, a change to what Montana surveyors check. Watch the eCFR text, not just Montana’s register.⁠⁹⁠¹¹
• The Medicare moratorium decision due around November 13, 2026.⁠¹³⁠¹⁵

For other Montana care licenses, see the adult day-care center guide and the Montana state page.

Sources

1. 1
   Montana Legislature, MCA 50-5-101, Definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   Montana Legislature, MCA 50-5-201, License requirements Checked 12 Oct 2026 · Back to text ↑
3. 3
   Montana Legislature, MCA 50-5-202, License fees Checked 12 Oct 2026 · Back to text ↑
4. 4
   Montana Legislature, MCA 50-5-203, Application for license Checked 12 Oct 2026 · Back to text ↑
5. 5
   Montana Legislature, MCA 50-5-204, Issuance and renewal of licenses, inspections Checked 12 Oct 2026 · Back to text ↑
6. 6
   Montana Legislature, MCA 50-5-207, Denial, suspension, or revocation of health care facility license Checked 12 Oct 2026 · Back to text ↑
7. 7
   Montana DPHHS, Office of Inspector General, Licensure Bureau, Home Health Agency (licensure page) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Montana DPHHS, Office of Inspector General, Licensure Bureau, Initial Application Letter for Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
9. 9
   Montana Secretary of State, Administrative Rules of Montana, ARM 37.106.1505, Minimum standards for a home health agency Checked 12 Oct 2026 · Back to text ↑
10. 10
    Montana DPHHS, ARM 37.106 subchapter 3, Minimum Standards for All Health Care Facilities (printable, 2025 update) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Electronic Code of Federal Regulations, 42 CFR part 484, Home Health Services Checked 12 Oct 2026 · Back to text ↑
12. 12
    Montana DPHHS, Senior and Long Term Care Division, Home Health Policy 601, Provider Eligibility Checked 12 Oct 2026 · Back to text ↑
13. 13
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies and Hospices Checked 12 Oct 2026 · Back to text ↑
14. 14
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA & Hospice: Six-Month National Moratoria on Hospice and HHA Enrollment Checked 12 Oct 2026 · Back to text ↑
15. 15
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
16. 16
    Montana DPHHS, MAR Notice No. 2025-280.1, Community First Choice Provider Enrollment (proposed amendment) Checked 12 Oct 2026 · Back to text ↑
17. 17
    Montana DPHHS, Office of Inspector General, Licensure Bureau, Health Care Facility Licensure: Facility Applications Checked 12 Oct 2026 · Back to text ↑
18. 18
    Montana DPHHS, Bounds licensing portal: license types Checked 12 Oct 2026 · Back to text ↑

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