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

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
CMS State Innovation Model (SIM) Design Award - Montana	Grant	Statewide	CMS State Innovation Model (SIM)
Online Mental Health Services Program - HealthLinkNow PCMH Montana	Grant	Montana, Wyoming	CMS Health Care Innovation Award (Round 1)

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	Enacted	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.	Enacted	2013