Montana

The Patient Centered Medical Home Act was created by Senate Bill 84, which was passed by the 2013 Montana Legislature. This law requires the insurance commissioner to rely on a council of stakeholders to create standards for the program, qualify health care providers and insurers to participate, and promote the program. The volunteer council consists of representatives of primary care providers, health plans, Medicaid, public health, and consumer advocates. Council members consult the Montana Commissioner of Securities and Insurance (CSI) in qualifying patient-centered medical homes (PCMH).  Stakeholders work with CSI staff to develop Montana-specific PCMH standards and a qualification process for applicants.  The council also advises on the promotion, education and coordination of the PCMH program by providing guidance concerning medical home activities. Recently the CSI approved of PCMH designation of practices from NCQA, AAAHC, and the Joint Commission.  Primary care practices are in the process of being qualified for the Montana PCMH program

Primary Care Innovations and PCMH Activity

Dual Eligible 2703 SPA CPC CPC+ PCMH QHP PCMH Legislation Private Payer

Multi-Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Montana Comprehensive Primary Care Plus Multi-Payer Statewide CMS Comprehensive Primary Care Plus (CPC+)
Montana Patient-Centered Medical Home Initiative Multi-Payer Statewide

Private Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Blue Cross and Blue Shield of Montana Patient-Centered Medical Home Commercial Statewide Blue Cross Blue Shield Value-Based Care Program

State Legislation

Legislation Status Year
Montana Health and Economic Livelihood Partnership (HELP) Act

This law expands Medicaid eligibility for low-income individuals in Montana. The legislation also strengthens existing programs that manage the way members obtain approval for medical services and establishes additional programs designed to reduce costs and improve medical outcomes. The efforts may include but are not limited to patient-centered medical homes and ACOs. [This act] terminates June 30, 2019

Active 2015
The Patient-Centered Medical Home Act

This law requires the insurance commissioner to rely on a council of stakeholders to create standards for the program, qualify health care providers and insurers to participate, and promote the program.

Active 2013

State Facts:

Population:
1,002,200
Uninsured Population:
15%
Total Medicaid Spending FY 2013: 
$1,007,145,361
Overweight/Obese Adults:
61.4%
Poor Mental Health among Adults: 
32.1%
Medicaid Expansion: 
Yes

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