PCMH Stakeholders | Montana Patient-Centered Medical Homes

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 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

History of the Council

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.

2016-2017 Council Members

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

Meeting Schedule

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

Current PCMH Council Meeting Materials

2016-2017 PCMH Stakeholder Council

Date	Agenda	Materials	Minutes
March 15, 2017	Agenda		Minutes

Education Subcommittee Meeting Materials

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

Quality Metrics Subcommittee Meeting Materials

Date	Agenda	Materials	Minutes
October 12, 2016	Agenda	Draft 3 – 2017 Quality Metric Guidance Packet Summary of changes to 2017 Quality Metric Guidance
September 7, 2016	Agenda	DRAFT 2017 Quality Metric Guidance Packet Summary of changes 2017 Draft Quality Metric Guidance Patient-Level Data Elements
August 10, 2016	Agenda	DRAFT 2017 Guidance Cover Sheet DRAFT 2017 Reporting Form DRAFT 2017 Reporting Guidance 2016 GPRO Flow Chart
July 13, 2016
June 8, 2016	Agenda	Combined Materials for tobacco/depression, CMS version changes, and patient-level detail differences CMS Tobacco Flowchart CMS Depression Flowchart
November 12, 2015	Agenda	DRAFT-5 2016 Quality Metric Guidance Packet 2016 Patient-Level Data Submission Template Mathematica Guidance on Depression Screening Patient Eligibility
October 14, 2015	Agenda	DRAFT Quality Metric Guidance – Mathematica Comments	Meeting Summary
September 23, 2015	Agenda	DRAFT-3 2016 Quality Metric Guidance Packet	Meeting Summary
September 9, 2015		DRAFT 2016 Reporting Form DRAFT 2016 QM-Reporting Guidance DRAFT 2016 Patient-Level Data Elements Dictionary PQRS 2015 Measure List HRSA Childhood Immunizations Specifications Depression PQRS-134 Tobacco PQRS-226 Diabetes PQRS-1 Blood Pressure PQRS-236
July 8, 2015	Agenda	Summary- Post QM Report Survey Mathematica MEMO ON QUALITY OF CARE GUIDANCE Mathematica-Tobacco&ImmunizationSlides PQRS 2015 Measure List (excel) PQRS 2015 Measure List (PDF)

Payor Subcommittee Meeting Materials

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

2014 - 2015 Archived PCMH Council Meeting Materials

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 Report PacificSource 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 Council Meeting Materials

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

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

The Montana Patient-Centered Medical Home Act

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.

Qualified PCMH Practices

Provisionally Qualified PCMH Practices

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.