The Montana PCMH Program
Please note: the Insurance Commissioner’s office is no longer involved in the Montana PCMH program following the sunset of legislation. This page is in the process of being updated.
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 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
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.
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
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
| Date | Agenda | Materials | Minutes |
| March 15, 2017 | Agenda | Minutes |
| Date | Agenda | Materials | Minutes |
| June 1, 2016 | PCMH webinar-Draft Slides | ||
| May 4, 2016 | Agenda | ||
| April 6, 2016 | Agenda | Provider Recruitment Draft Survey Draft Webinar Series Outline |
Minutes |
| March 2, 2016 | Agenda | Provider Recruitment Draft Survey Proposed Provider Webinar Series Outline MT Hospital List |
Minutes |
| February 3, 2016 | Agenda | PCMH Education Subcommittee Work Plan | Minutes |
| January 6, 2016 | Agenda | DRAFT PCMH Clinics Locator Map PCMH Education Subcommittee Work Plan |
Minutes |
| Date | Agenda | Materials | Minutes |
| December 10, 2015 | Agenda | Draft – Payor 2016 Annual Report | |
| October 15, 2015 | Agenda | Mathematica Feedback on 2016 Draft Utilization Guidance DRAFT2- 2016 Payor Guidance |
|
| September 10, 2015 | Agenda | DRAFT 2016 Payor Guidance Swing Bed Definitions |
Meeting Summary |
| July 23, 2015 |
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
- 2017 Required reporting on uniform set of health care quality and performance measures
- 2017 Required reporting by PCMH insurers on cost and utilization measures
Administrative Rules
- All PCMH rules can be found under Rule Subchapter 6.6.4901 to 6.6.4909 on the Secretary of State website. Click on the rule number to see the specific rule detail.
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.
- National Committee for Quality Assurance (NCQA)
- The Accrediting Agency for Ambulatory Health Care (AAAHC)
- The Joint Commission
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:
- PacificSource Health Plans
- Blue Cross Blue Shield of Montana
- Allegiance Benefit Plan Management
- Montana Medicaid