Nursing Facility

Prior Authorization Forms Claim Jumper Newsletters

General Information for Providers  
Medicaid manual with general information for all provider type

Nursing Facility and Swing Bed Services 
This manual has information specific to your provider type.

2022

06/15/2022 Medicaid Medical Transportation Services for Nursing Facilities
05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered
05/13/2022 Revalidation Extended REVISED
05/13/2022 National Drug Code (NDC) Denial Errors
04/26/2022 Health Behavior Assessment and Intervention Billing Codes REVISED
03/29/2022 Nurse First Advice Line Services Ending
03/16/2022 Revalidation Extended to June 2022 REVISED Rev. 05/13/2022
02/23/2022 Revalidation Extended to June 2022 Rev. 03/16/2022
02/23/2022 Standing Orders and Medicaid Reimbursement
01/14/2022 Montana Healthcare Programs Support Services Holiday Closures

2021

12/15/2021 Health Behavior Assessment and Intervention Billing Codes Rev. 04/26/2022
12/13/2021 MPATH Provider Services Portal Nursing Facilities Enrollment Information
12/10/2021 New Provider Services Portal
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
07/06/2021 Adoption Of Temporary Emergency Rule To Allow for COVID-19-Related
Regulatory Discretion Beyond The Expiration Of The Governor-Declared State Of Emergency
06/11/2021 COVID-19 Vaccine Administration Billing Guidance
05/17/2021  Process to Enter PASRR requests through the Qualitrac portal
04/02/2021 
New Provider Type – Licensed Marriage and Family Therapist
01/28/2021  Montana Healthcare Programs Support Services Holiday Closures
01/11/2021  Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021

2020

12/07/2020  Medicaid Expansion Extended Through December 31, 2021 
10/28/2020  Provider Relief Fund General Allocation
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020

08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020

07/24/2020 Provider Relief Fund General Allocation

07/17/2020  Medicaid Reimbursement and Court Ordered Services
06/17/2020  National Correct Coding Initiative Announcement
05/15/2020  Temporary Revision to Case Management General Provisions
04/30/2020  National Correct Coding Initiative Announcement
04/28/2020  Temporary Suspension of the PCP Referral Requirement
04/27/2020  Non-Covered Services Agreement Policy Change

04/22/2020  Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs


04/07/2020  Requirements and Billing for Telehealth Services by Nursing Facilities
04/01/2020  Suspension of Face to Face Requirements for Some Medicaid Programs
03/19/2020  Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth  rev 03/27/2020

01/10/2020  Co-Payment Assessed in Error for January 6, 2020 Payment

Level of Care Screens (LOC) for Nursing Facility Residents

Level of care screening must be completed for Medicaid patients in order to receive Medicaid payments for nursing facility stays.  The level of care screening must be requested prior to admission or Medicaid coverage as they may only be backdated 30 days if the individual meets level of care and has completed a Level I screen. Please review the information below regarding level of care.

Please review the following:

LOC Level of Care Screening Information
LOC Cover letter
LOC Flow Chart
LOC Determination form

If you have any questions about LOC(s), please contact Mountain Pacific Quality Health at (406) 443-0320 or (800) 219-7035. Questions regarding this correspondence can be directed to either Shaunda Hildebrand at (406) 444-4209 or Jill Sark at (406) 444-4544.

What is MDS 3.0?

Changes to the federal minimum data set (MDS) tool (Version 3.0 assessment), went into effect on October 1, 2010.  One of these changes relates to Nursing Facilities (SNFs/NFs), States, and other qualified entities to identify individuals that are interested in returning to the community.

Frequently Asked Questions
Letter to Nursing Facilities
Community Alternatives
Your Discharge Planning Check List

Civil Money Penalties Program (CMP)

A civil money penalty (CMP) is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against skilled nursing facilities (SNF’s), nursing facilities (NF’s), and dually-certified SNF/NF for either the number of days or for each instance a facility is not in substantial compliance with one or more Medicare and Medicaid participation requirements for Long Term Care Facilities. A portion of CMP’s collected from facilities are returned to the States in which the CMP’s are imposed to provide grant funding to benefit nursing facility residents.

Civil Money Penalty (CMP) Reinvestment Application Template

Civil Money Penalties (CMP) Reinvestment Application Instructions and Information rev. 03/22/2022

CMS CMP Toolkits and other helpful resources

Civil Monetary Penalties (CMP) Awardees