Adult Day Care Regulations in Montana

Who regulates adult day care in Montana

Montana licenses adult day-care centers as health care facilities. Under MCA 50-5-201, a person may not operate a health care facility unless the Montana Department of Public Health and Human Services (DPHHS) licenses it. DPHHS's Office of Inspector General lists licensing of health care and residential services among its functions.

The operating standards are in ARM 37.106 subchapter 26 (Adult Day Care), along with the general licensure rules in ARM 37.106 subchapter 3. Several adult day care rules were amended effective January 11, 2025. For Medicaid, the DPHHS Senior and Long Term Care Division makes adult day health available through the Big Sky Waiver.

Types of adult day programs in Montana

• Adult day-care center: MCA 50-5-101 defines this as a facility, freestanding or connected to another health care facility, that provides adults with the care needed to meet the needs of daily living on a regular schedule, without overnight care. The statute lists adult day-care centers among residential care facilities.
• Adult Day Health: the Big Sky Waiver service name. DPHHS policy describes it as a broad range of health, nutritional, recreational and social services provided outside the person's home, with no overnight stays.

How to get licensed in Montana

1. Make sure any construction, alteration or renovation meets local building and fire codes and is approved by the official with jurisdiction over building codes and by the State Fire Marshal or designee (ARM 37.106.2606).
2. Get the license application from DPHHS, have the administrator or a designee sign it, and submit it to the department (ARM 37.106.310).
3. Prepare for an inspection. DPHHS or its authorized agent inspects each new or renewal applicant against the minimum standards.
4. Receive your license. Licenses run up to three years, and a facility in operation for less than one year may be offered a one-year license.
5. Schedule an annual fire inspection by local authorities and keep the record for at least one year.

Key requirements

• Services: help with activities of daily living, recreational and social activities on a posted calendar, a rest area and client access to a telephone (ARM 37.106.2602).
• Staffing: employ an administrator who is responsible for the center at all times. At least one employee must be present whenever a client is present, and staffing must match the number and needs of clients. The rule does not set a numeric ratio.
• Training: document orientation for all employees, including emergency procedures such as basic first aid.
• Limits: no overnight service, and clients who walk only with mechanical help may stay only on the ground floor.
• Meals: at least one meal a day for clients who stay up to 10 hours, two meals for longer stays, and snacks between meals (ARM 37.106.2616).
• Medications: clients must be able to take their own medications with limited staff help. Medications stay in locked storage, and the center keeps a medication administration record (ARM 37.106.2621).

Medicaid funding for adult day in Montana

Adult Day Health is a service of the Big Sky Waiver, Montana's Medicaid home and community-based services waiver for elderly and physically disabled people. It serves Medicaid-eligible people who meet nursing facility level of care and have an unmet need the waiver can resolve. DPHHS notes that waiting lists currently exist.

Case Management Teams, each with a nurse and a social worker, assess needs and build care plans. Under the Big Sky Waiver policy manual (sections dated 2011 and 2016), adult day health providers must be licensed by DPHHS and must have a written agreement with each member covering cost of care and services. The team should check that agreement before approving admission.

Billing basics

The Big Sky Waiver fee schedule effective July 1, 2026 lists adult day care as procedure code S5100 with modifier UA, billed in 15-minute units, with prior authorization marked as required. Big Sky Waiver policy section 703 (August 2011) allows the cost of transportation to be included in the rate; confirm with the Community Services Bureau.

Big Sky Waiver policy section 603 (April 2017) says providers enroll in Medicaid through the department's contractor using the Home and Community Based Services provider type. The Community Services Bureau then approves the enrollment and authorizes procedure codes and rates.

A June 2024 EVV notice applies electronic visit verification to providers billing personal care or home health services, including Big Sky Waiver providers. It does not mention adult day health.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• DPHHS Office of Inspector General
• ARM 37.106 Subchapter 26: Adult Day Care
• ARM 37.106.310: Licensing Procedure
• MCA 50-5-101: Definitions
• MCA 50-5-201: License Requirements
• DPHHS Community Services Bureau (Big Sky Waiver)
• Big Sky Waiver Policy Manual
• Montana Healthcare Programs: Big Sky Waiver Providers
• Big Sky Waiver Fee Schedule (July 2026)
• VA Adult Day Health Care
• National Adult Day Services Association

Frequently asked questions

Do I need a license to open an adult day center in Montana?

Yes. Montana law treats adult day-care centers as health care facilities, and a health care facility may not operate without a DPHHS license. The standards are in ARM 37.106 subchapter 26.

Does Montana Medicaid pay for adult day care?

Yes, through the Big Sky Waiver's Adult Day Health service. The provider must be licensed by DPHHS and enrolled with Montana Healthcare Programs, and the fee schedule bills S5100 UA in 15-minute units with prior authorization.

Who inspects adult day centers in Montana?

DPHHS or its authorized agent inspects a center when it applies for a new or renewal license. Local authorities also conduct an annual fire inspection.