The Montana PCMH Program



PCMH_Logo_RGB_MT

A group approach, from the very beginning.

The Insurance Commissioner consults with a stakeholder council to administer the Montana Patient-Centered Medical Home Program. The council, comprised of providers, insurance companies, public health officials, the Montana Medicaid program and patient advocates helped write not only the legislation that became the Montana PCMH Program, but the rules under which the current program operates. The work of the stakeholder council is vital to the continued success of the Montana PCMH Program.


Commissioner’s 2017 Annual Public Report

The Commissioner released the Montana Patient-Centered Medical Home Program 2017 Public Report on Thursday, August 31. This report provides data from 2016 (Year 3) on healthcare quality metrics from providers, anecdotal evidence from providers and payors, and utilization (rates of ER visits and hospitalizations) data from payors.

Read the 2017 Report (Year 3)

Read the 2016 Report (Year 2) revised

Read the 2015 Report (Year 1)

Just Released: 2015 Quality Metric Data Feedback Webinar

This webinar took place on September 19, 2016.
Webinar Slides
Webinar Recording


Council Meetings and Resources

The PCMH Act was created by Senate Bill 84, which was passed by the 2013 Montana Legislature. The law requires the insurance commissioner to rely on a council of stakeholders in creating standards for the program, qualifying health care providers and insurers to participate, and promoting the program. The volunteer council consists of representatives of primary care providers, health plans, Medicaid, public health, and consumer advocates.

Council members consult the Insurance Commissioner in qualifying patient-centered medical homes. Stakeholders work with CSI staff to determine which accrediting organizations will be included in our program, develop Montana specific standards and a qualification process for applicants. The council also advises in promotion, education and coordination of the PCMH program. Meetings are typically the third Wednesday of every month at 1:00pm, at the CSI office unless announced otherwise.

Paula Block, Montana Primary Care Association
Dr. Janice Gomersall, Community Physicians Group, Mountain View Family Medicine and Obstetrics
Dr. Rob Stenger, Partnership Health Center
Jessica Cotton, Southwest Community Health Center
Jody Haines, Providence Medical Group
Kristen Schuster, Glacier Medical Associates
Carla Cobb, RiverStone Health
Justin Murgel, PacificSource Health Plans
Erwin Austria, Blue Cross Blue Shield Montana
Mary LeMieux, Montana Medicaid
Todd Harwell, Public Health and Safety Division, Montana Department of Public Health & Human Services
Bill Warden, St. Peter’s, Bozeman Deaconess, and Benefis hospitals
Lara Shadwick, Mountain Pacific Quality Health Foundation
Sen. Mary Caferro, State of Montana
Dr. Michael Temporal, Billings Clinic
Mary Jane Lowrance, Kalispell Regional Healthcare

Upcoming Meetings

The Montana PCMH Stakeholder Council and various subcommittees meet regularly to ensure the smooth operation of the program

PCMH Education Subcommittee
No meetings currently scheduled

(First Wednesday of the month at 12:00 pm.)

PCMH Quality Metrics Subcommittee
No meeting are currently scheduled

(Second Wednesday of the month at 12:00 pm)

PCMH Legislation Work Group
No meetings currently scheduled

PCMH Payor Subcommittee
No meetings currently scheduled

PCMH Stakeholder Council Meeting
February 15, 2017 at 1:00 pm



All meetings are held at the CSI Office :: 840 Helena Ave. :: Helena, Montana
Call-in information for meetings: (712) 432-1212 :: Access Code: 236-818-235

2016-2017 PCMH Stakeholder Council

Date Agenda Materials Minutes
March 15, 2017 Agenda    Minutes
2014-2015 Stakeholder Council

Date Agenda Materials Minutes
October 21, 2015 Agenda Quality Metric Subcommittee Report
DRAFT5 – 2016 Quality Metric Guidance Packet
Payor Subcommittee Report
DRAFT 3 2016 Payor Utilization Measure Guidance
CrossTx Presentation
Minutes
September 16, 2015 Agenda Quality Metrics Subcommittee Report
DRAFT 2016 QM Guidance Packet
Poster Final Draft
Rack card Final Draft
Talking Points Final Draft
Education Subcommittee Report
DRAFT 2015 PCMH Progress Update (returning clinics)
DRAFT 2015 Comprehensive Application(new clinics)
Payor Subcommittee Meeting Report
DRAFT 2016 Payor Guidance
Minutes
August 19, 2015 Agenda Council Member Use of Proxies
Payor Subcommittee Report
Quality Metrics Subcommittee Report
Education Subcommittee Report
Comprehensive Application Workgroup Report
2014-Year 1 Comprehensive Application
Minutes
July 15, 2015 Agenda Council Timeline Jun-Dec 2015
Quality Metric Subcommittee Report
Payor Subcommittee Report
Minutes
June 17, 2015 Agenda Mathematica Presentation
Council Timeline June – December 2015
Minnesota report
Maryland report
North Carolina report
Draft Montana Public Report Outline
Education Subcommittee Report
Draft Rack Card
Draft Poster
Draft Talking Points
Quality Metrics Subcommittee Report
Minutes
May 20, 2015 Agenda Mathematica Presentation
Partnership Health Center Missoula
Council Timeline Jun-Dec 2015
Draft Rack card
Draft Poster
Draft Talking Points
Education Subcommittee Report
Quality Metrics Subcommittee Report
Payor Subcommittee Report
Minutes
April 15, 2015 Agenda Education Subcommittee Report
Poster and Talking Points
Rack Card
Payor Subcommittee Report
Mathematica Memorandum on Utilization Measure Guidance
Quality Metric Subcommittee Report
Mathematica Memorandum on Quality Metric Guidance
Work Plan
Minutes
March 18, 2014 Agenda Education Subcommittee Report
Education Work Plan
Payor Subcommittee ReportPacificSource Letter of Intent
Blue Cross Blue Shield of Montana Letter of Intent
Allegiance Benefit Plan Management Letter of Intent
Montana Mediciad Letter of Intent
Mathematica February Progress Report
DPHHS Chronic Disease Prevention Bureau Presentation
Minutes
February 18, 2014 Agenda Minutes
January 21, 2014 Agenda Payer Subcommittee Report
Draft Payer Guidance
Quality Metric Subcommittee Report
Draft Quality Metric Guidance Packet
Draft 2015 March Report Template
Revised Work Plan
Minutes
December 17, 2014 Agenda Revised Work Plan
Updated Summary Report of Application Data
Care Team Roles
Quality Metric Subcommittee Report
Payer Subcommittee Report
(1) Draft Reporting Form
(2) Quality Metric Reporting Guidance
(3) Data Dictionary
(4) Sampling Strategy
Minutes
November 19, 2014 Agenda Charter & Mission Statement
Council Work Plan Outline
Summary Report of Application Data
Payer Subcommittee Report
Payer Rule
Quality Metrics Subcommittee Report
Quality Metric Rule
Minutes
2015-2016 Archived PCMH Stakeholder Council

Date Agenda Materials Minutes
November 16, 2016 Agenda 2016 PCMH Progress Update – Preliminary Summary
PCMH Council Charter
PCMH Payor 2017 Annual Report (Draft)
PCMH Provider 2017 Annual Report (Draft)
Manatt CPC+ Montana Updates PPT
Manatt MACRA PPT
Minutes
October 19, 2016 Agenda Quality Metrics Subcommittee Report
Draft 2017 Quality Metrics Reporting Guidance Packet
Draft 2017 Payor Utilization Measures Reporting Guidance
Draft 2017 Provider Annual Report
Draft 2017 Payor Annual Report
Draft 2016 Progress Update
Minutes
September 14, 2016 Agenda Quality Metrics Subcommittee Report
Legislation Work Group Report
PCMH Talking Points by manatt and DPHHS
Draft PCMH bill
Draft PCMH Rules Amended
Health Technology Services and DPHHS eCQI Progress
White Paper on Montana Community Health Workers
MT CHW Policy and Reimbursement Committee
Mountain Pacific Quality Health Super Utilizer Project
manatt slides on MACRA
Minutes
August 17, 2016 Agenda Montana CPC+ Webpage
Quality Metrics Subcommittee Report
DRAFT2 – 2017 Guidance Cover Sheet
DRAFT2 – 2017 Reporting Form
DRAFT2 – 2017 Reporting Guidance
Montana PCMH Law
Administrative Rules of Montana – PCMH Program
Final Independent Study Report
Health Technology Services PCMH and eCQI Progress Update
PCMH Program Timeline
Minutes
July 20, 2016 Agenda Quality Metrics Subcommittee Report
Legislation Work Group Report
Administrative Rules of Montana – PCMH Program
July 12th Governor’s Council on Healthcare Innovation Meeting Slides
PCMH Program Timeline 2016 Updates
Minutes
June 15, 2016 Agenda Quality Metrics Subcommittee Report
Education Subcommittee Report
DRAFT webinar slides
Minutes
May 18, 2016 Agenda Quality Metric Subcommittee Report
Payor Subcommittee Report
Education Subcommittee Report
Provider Survey Results
Legislative Work Group Report
Project ECHO presentation by Dr. Eric Arzubi
PCMH Program Timeline 2016 Updates
Minutes
April 21, 2016 Agenda Education Subcommittee Report
Primary Care Provider Survey
Proposed PCMH Education Webinar Series
Legislative Work Group Report
RiverStone Health Presentation
Southwest CHC Presentation
St. Vincents Absarokee Clinic Presentation
Montana Healthcare Foundation Presentation
Integrated Behavioral Health in Montana Issue Brief
PCMH Program Timeline 2016 Updates
Minutes
March 16, 2016 Agenda Education Subcommittee Report
Independent Study Progress Update Memo
Minnesota Presentation
Minnesota Health Care Homes Report
Governor’s Council on Healthcare Innovation and Reform March 8th slides
Minutes
February 17, 2016 Agenda “Where Your Health Happens” Education Tool Kit Survey Summary Report
Education Subcommittee Report
Independent Study Work Group Report
Research for Independent Study from Dr. Morrow
PCMH Program Timeline – 2016 updates
Health Technology Services Technical Assistance Update
Minutes
January 20, 2016 Agenda Education Subcommittee Meeting Report
Education Subcommittee Work Plan
Independent Study Work Group Report
PCMH Independent Study Memo – updated
PCMH Work Plan
Minutes
December 16, 2015 Agenda Payor Subcommittee Meeting Report
2016 Payor Annual Report – Draft Template
PCMH Independent Study Memo
2015 Progress Update – Summary of Results
Amended Quality Measures Rule
2015-16 Council Timeline
PCMH Work Plan
Montana State Innovation Model Design
Minutes
November 18, 2015 Agenda Quality Metrics Subcommittee Report
Final Draft – 2016 Quality Metrics Guidance Packet
2016 Patient-Level Data Submission Template
Draft 2016 Provider Annual Report
Draft 2016 Payor Annual Report
Final Draft – 2016 Payor Annual Report
Final Draft – 2016 Provider Annual Report
Summary of Preliminary Results of the 2015 Progress Update
Minutes



Montana PCMH Program Governance

The Montana PCMH Program falls under the jurisdiction of three layers of authority: official orders from the Montana Insurance Commissioner, the Administrative Rules of Montana, and the state law that created the Montana PCMH Program. The Commissioner has the rule-making authority to set certain requirements for the program and program participants. The PCMH Stakeholder Council helps draft rules for the program to be adopted in accordance with the Administrative Rules of Montana. Finally, the 2013 law that created the program established the structure and standards for the program.

Orders From the Commissioner

Administrative Rules

Montana Law


Participants in the Montana PCMH Program

There are two kinds of official participants in the Montana PCMH Program: medical clinics and payors.

Medical clinics must be accredited by one of the three national accrediting agencies approved by the Commissioner for inclusion in the Montana program.

Montana has dozens of qualified PCMH practices and many others that are working toward full qualification in the program, known as “provisionally qualified” practices. These practices treat many thousands of Montanans in all corners of our state.


Primary health care clinics interested in applying to the Montana PCMH Program must complete and submit the Preliminary Application to Marissa Stockton at marissa.stockton@mt.gov. She will then follow-up with you to complete a Comprehensive Application.

Payors are defined in Montana law as the entities who pay the medical costs of patients, other than the patients themselves. In essence, these are insurance companies or government healthcare programs, like Medicaid. Montana has four payors participating in our program. Approved payors must submit a letter of intent to the Commissioner for each year they wish to participate in the program. Montana’s approved payors are below:



Need more help?
Call Marissa Stockton at 406-444-2006.