Managing Healthcare Compliance in Montana

Sarah Jones

Managing healthcare compliance in Montana can differ from those in other states due to a combination of factors, including the state’s rural nature, its unique demographics, and its political climate. The state has a shortage of healthcare providers, especially in rural areas. Telemedicine has also been a focus, with regulations designed to expand access to medical care through virtual means.

It’s important to note that healthcare regulations can evolve over time, influenced by changes in federal policy, state priorities, and public health challenges. Therefore, the specifics of healthcare regulations in Montana may continue to shift, both in comparison to other states and in response to local needs and political dynamics. To effectively manage compliance, healthcare organizations must monitor and interpret these changes and swiftly implement necessary adjustments. This article provides an overview of key factors you’ll want to know about healthcare compliance in Montana.

Montana Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

  • The Montana Montana Department of Public Health and Human Services (DPHHS) is the state agency responsible for promoting and protecting the health and well-being of Montana residents by overseeing a wide range of public health and human services programs, including Medicaid, public assistance, and healthcare licensing.
  • The Montana Hospital Association (MHA) is a nonprofit organization that serves as an advocate and resource for hospitals and healthcare providers in Montana, working to improve healthcare delivery, promote patient safety, and address healthcare policy issues within the state. 
  • Montana Medicaid within the DHHS provides essential healthcare coverage to eligible low-income individuals and families, offering services ranging from preventive care to long-term care options.
  • The Montana Board of Medical Examiners is the state regulatory body responsible for licensing and regulating physicians and physician assistants to ensure they meet the highest standards of medical practice and patient care in Montana.
  • Montana Board of Behavioral Health is the state agency responsible for licensing and regulating behavioral health professionals, including counselors, social workers, and therapists, to ensure the quality and ethics of mental health and substance abuse services provided in Montana.

These agencies help maintain the integrity and quality of healthcare services in Montana, protecting the public and promoting patient safety. The resources provided by these Montana state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Montana.

Regulations Unique to Montana

To meet the standards of healthcare compliance in Montana, there are a few additional regulations. 

State-Based Health Insurance Marketplace

Montana operates a state-based health insurance marketplace, as opposed to relying on the federal exchange. This allows the state to have more control over its healthcare regulations, including the types of insurance plans available and the enrollment process. The patient mix for healthcare providers may shift as a result of the marketplace. Providers may see a decrease in uninsured or underinsured patients and an increase in those with marketplace-based coverage, which can affect the provider’s revenue mix and billing practices. Healthcare organizations need to be sure their administrative practices match with the marketplace requirements. These can include coding and billing practices, claims submission procedures, and data reporting to the marketplace and relevant state agencies.

Nurse Practitioner Law

Montana allows Practice Agreements for Advanced Practice Registered Nurses (APRNs), such as nurse practitioners, to practice with a Collaborative Practice Agreement (CPA) rather than requiring physician oversight. This regulation gives APRNs more autonomy in their practice compared to states where physician supervision is mandated. The specific conditions for CPAs in Montana may differ from those in states with different collaborative practice regulations, so credentialers need to verify that each nurse practitioner meets regulatory requirements.

Certificate of Need Required for Certain Facilities

In Montana, the Certificate of Need (CON) program, governed by Montana Code Annotated (MCA) Title 50, Chapter 5, Part 3, requires healthcare providers to obtain state approval for certain healthcare facility projects or services. However, it’s important to note that Montana’s CON program does not apply to ambulatory surgical centers (ASCs). This exemption means that ASCs in Montana do not need to go through the CON process for expansion, establishment, or acquisition of equipment or services. This exemption acknowledges the importance of ASCs in providing convenient and efficient surgical care and encourages their growth and development within the state.

Tips To Manage Healthcare Compliance in Montana

Effectively managing healthcare compliance in Montana is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

  • Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Montana-approved training.
  • Organize Policies By Requirement: Including “MT” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
  • Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
  • Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Montana

Medical credentialing in Montana, as in other states, involves a rigorous process where healthcare providers’ qualifications, experience, and credentials are thoroughly reviewed and verified before they can practice within the state. A unique aspect of Montana’s credentialing process is its reliance on the Montana Professional Assistance Program (MPAP), which helps healthcare professionals who may have substance abuse or mental health issues. Instead of disciplinary actions, Montana often encourages providers to seek assistance through MPAP, emphasizing rehabilitation and support over punitive measures. This approach reflects Montana’s commitment to promoting the well-being of healthcare professionals and ensuring the delivery of high-quality patient care.

Meet Montana Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Montana

MedTrainer’s all-in-one compliance platform can streamline management of Montana] healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!