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.
Dual Eligible | 2703 SPA | CPC | CPC+ | PCMH QHP | PCMH Legislation | Private Payer |
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Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Montana Comprehensive Primary Care Plus | Multi-Payer | Statewide | CMS Comprehensive Primary Care Plus (CPC+) | |
Montana Patient-Centered Medical Home Initiative | Multi-Payer | Statewide |
Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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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) |
Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Blue Cross and Blue Shield of Montana Patient-Centered Medical Home | Commercial | Statewide | Blue Cross Blue Shield Value-Based Care Program |
Legislation | Status | Year |
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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 |