Community Services for Seniors and People with Disabilities
Big Sky Waiver Amendment Stakeholders Memo - 8/27/2021
Draft Appendix I Waiver MT.0148.406 Jan 01, 2022 - 8/27/2021
The mission of the Community Services Bureau is to address the needs of Medicaid eligible Montanans who require assistance and support in meeting their on-going health needs by developing, managing, funding, and ensuring quality in home-based services that foster independence and dignity, contain costs, and provide options to consumers.
A wide range of community-based long term care services have been developed. They are designed to keep people independent and living in their communities for as long as possible.
Many individuals in need of long term care services choose to remain in their own homes or select other community options to meet their needs. The Community Services Bureau administers a number of Medicaid-funded options that enable people who are aged or disabled and have limited income and resources to remain in their homes, rather than receive services in a hospital or nursing facility.
Community Services Bureau staff are located throughout the State. Staff monitor services, provide training for local staff, assist people in accessing services and implement policy.
Montana Big Sky Home and Community Based Services Program
The Big Sky Waiver Program allows people, who would otherwise be institutionalized, to live in their own home and community. The services are made available through the Senior & Long Term Care Division (SLTC) with the Department of Public Health & Human Services (DPHHS)..
Big Sky Waiver Services
Case Management Teams (CMT) consist of a nurse and social worker and provide a holistic approach to care planning. They look at each individual’s medical and psycho-social needs and then develop a plan of care based on the person’s needs and choices. Each Case Management Team has a fixed number of individuals they can serve per year. The following are examples of services that may be available through the Big Sky Waiver Program:
- Adult Residential Living
- Adult Day Health
- Case Management
- Chemical Dependency Counseling
- Environmental Adaptations
- Habilitation Services
- Homemaker Services
- Personal Assistance
- Private Duty Nursing
- Psychosocial Consultation
- Respiratory Therapy
- Respite Care
- Special Child Care
- Therapies (OT, PT, Speech)
- Specially Trained Attendant
- Specialized Medical Equipment and Supplies
- Services for Individuals with Traumatic Brain Injury
To qualify for the Big Sky Waiver Program, a recipient must be financially eligible for Medicaid and meet the minimum level of care requirements for nursing facility placement. Individuals must have an unmet need that can only be resolved through the Big Sky Waiver Program services in order to qualify for the program. Currently, there are waiting lists for the Big Sky Waiver Program.
Where do I find assisted living and other health care facilities?
Regulated Health Care Facilities These facility lists have been compiled by the Licensure Bureau of the Quality Assurance Division. Because the information herein contained is otherwise open to public inspection, dissemination of this list does not violate the provisions of 2-6-109, Montana Code Annotated, which prohibits state agencies from distributing any mailing list without first securing the permission of those who are a part of the list. It is not the intent of the Licensure Bureau that this list be used for any unsolicited commercial activity.
How to apply for the Big Sky Waiver Program?
To make a referral to the Big Sky Waiver Program, contact the Mountain Pacific Quality Health at 1-800-219-7035.
Eligibility specialists at your County Office of Public Assistance (OPA office) can determine Medicaid eligibility.
Community First Choice/Personal Assistance Programs
The Community First Choice and Personal Assistance Services (PAS) Programs are programs designed to provide long term supportive care in a home setting. These programs enable thousands of elderly and disabled citizens to remain in their homes. The type of care authorized is tailored to each individual in a person centered manner and dependent upon their needs, living situation, and availability of caregivers.
Services available through the CFC/PAS Program include the Activities of Daily Living:
- Medication assistance,
- Ambulation and exercising.
- Medical escort is also available.
Under the PAS program there is additional time for limited grocery shopping, housekeeping and laundry. Under the CFC program there is also additional time for community integration, yard hazard removal for the purpose of providing safe access and entry to the home, correspondence assistance and personal emergency response system.
The CFC/PAS Program does not pay for tasks such as yard work other than authorized task to assure health and safety, household repair or modifications, major cleaning, shopping for non-essential items, escort to non-medical services, pet care, or general transportation. Some of these tasks are allowed through the waiver program depending upon an individual’s needs and required level of care.
Self-Direct Service Options
There two options under which CFC/PAS eligible individuals can choose to receive their services: Agency Based CFC/PAS (AB-CFC/PAS) or Self-Direct CFC/PAS (SD-CFC/PAS). The SD-CFC/PAS program was developed for individuals who wish to direct their own care. The person or their Personal Representative is responsible for hiring, training, and managing their Personal Care Attendants (PCA). Under the SD-CFC/PAS program only, individuals can be authorized by their health care professional to receive the above mentioned services provided by their personal care attendant as well as any of the following four skilled services: bowel program, catheter care, medication assistance, or wound care. Anytime a consumer chooses Self-Direct CFC/PAS, they must obtain authorization from their health care professional. The consumer or their personal representative must also meet capacity, which means they can demonstrate a thorough understanding of the program requirements.
Eligibility requirements for both AB-CFC/PAS and SD-CFC/PAS include:
- have a health condition that limits your ability to perform activities of daily living,
- participate in the screening process; and
- be eligible for Medicaid.
In order to qualify for the CFC program a consumer must also meet level of care.
For information on eligibility and member services go to: /MontanaHealthcarePrograms
For more information please contact:
Abby Holm, Program Manager, 406-444-4564
Home Health Program
Who is eligible?
To be eligible for home health services, a beneficiary must meet the following criteria:
- Be Medicaid eligible; and
- Have a medical necessity for home health services to be delivered in the beneficiary's residence, on his or her physician's orders as part of a written plan of care which is reviewed and renewed every 60 days.
What services are available?
Home health services include:
- Nursing services that are provided on a part-time or intermittent basis by a home health agency;
- Physical therapy, occupational therapy, and speech pathology services provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services;
- Home health aide services, when aide services are not available through a Medicaid personal assistance program such as the Community First Choice Program; and
- Medical supplies, equipment and appliances.
Home Health Program Manager
1100 North Last Chance Gulch
PO Box 4210
Helena MT 59604-4210
Hospice is a program of care and support for people who are terminally ill and have chosen not to pursue curative treatment. Hospice is palliative care only, in other words, services are aimed at comfort not curing an illness. (Children under the age of 18 years of age may continue curative treatment while receiving hospice services.) A specially trained team of professionals and caregivers provide care for the "whole person," including his or her physical, emotional, social and spiritual needs. Services include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related condition. Support is given to the individual and his or her family members.
Who is eligible?
A member is eligible for hospice services if he or she meets all of the following conditions:
the individual is eligible for Medicaid;
the individual's doctor and the hospice medical director certify that the individual is terminally ill;and has six months or less to live if the illness runs its normal course;
the individual signs a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. Medicare will pay for covered benefits for any health problems that are not related to the individual's terminal illness; and
treatment is delivered by a Medicare-approved hospice program.
If you are interested in more information about Hospice services, please contact: Micky Brown, Hospice Program Manager, at (406) 444-6064.
The State Unit on aging administers a wide variety of senior based services for Montana residents who are age 60 or older. Programs and services are primarily delivered by a network of 10 Area Agencies on Aging which reach all geographic areas of the state. Our goal is to provide services that allow seniors to remain independent.
Older adults are offered a choice in living and care arrangements. We also have programs to protect their rights and personal autonomy. Please review the column on the left for more information on the programs we provide.
Big Sky Waiver Review Workgroup
Community Services - Independent Living
Home and Living Options
Protective and Legal Services
Service Partners and Providers
Electronic Visit Verification (EVV)
Governor's Conference on Aging
Oversight of State Medicaid Claiming and Program Integrity Expectations