MPQH Level of Care Screening in Montana: How the Care Assessment Works

Before Montana will authorize Medicaid-funded long-term care — whether in a nursing home or through the Big Sky Waiver for home and community-based services — your parent must pass a clinical screening that proves they need nursing-facility-level care. This isn't optional. Without this determination, the state won't pay for any long-term care placement, regardless of your parent's financial eligibility.

What Is the MPQH Assessment?

Mountain Pacific Quality Health (MPQH) is the state-contracted agency that conducts Montana's Nursing Facility Level of Care (NFLOC) determinations. An MPQH registered nurse performs an on-site clinical evaluation to assess whether your parent meets the state's threshold for long-term care.

The assessment uses Form DPHHS-SLTC-61, completed by the preadmission screening team. It evaluates your parent's functional abilities across Activities of Daily Living (ADLs) — bathing, dressing, toileting, transferring, eating — and Instrumental Activities of Daily Living (IADLs) — medication management, meal preparation, housekeeping, transportation, and finances.

The nurse also evaluates cognitive status, behavioral health needs, and clinical complexity. The goal is to determine whether your parent requires the level of continuous supervision and skilled care that a nursing facility provides — even if the actual plan is to receive that care at home through the Big Sky Waiver.

When You Need This Screening

Before nursing home admission: The NFLOC determination is a mandatory prerequisite. A nursing home cannot bill Medicaid for your parent's care without it.

Before Big Sky Waiver enrollment: The BSW funds nursing-facility-level care in home and community settings (including assisted living). Your parent must demonstrate they would otherwise require a nursing home, making the NFLOC screening the gateway to waiver services.

After a hospitalization: When a parent is being discharged from a hospital — especially one of Montana's 46 Critical Access Hospitals — the screening determines whether they qualify for skilled nursing placement or can receive equivalent care at home. In hospitals operating under the Medicaid Swing Bed Program, the screening intersects with the 25-mile bed availability rule under ARM 37.40.405.

How to Request an Assessment

Call MPQH directly at 1-800-219-7035 to initiate the process. You can also ask your parent's primary care physician or the hospital social worker to submit a referral.

Your regional Area Agency on Aging can help coordinate the request and may have a working relationship with the MPQH nurse assigned to your area — useful in rural Montana where scheduling an on-site visit requires planning around travel distances.

What to prepare before the visit:

• Your parent's current medication list with dosages and prescribing physicians
• A log of recent falls, hospitalizations, or emergency room visits
• Documentation of any cognitive changes (wandering episodes, medication errors, safety incidents)
• Names and contact information for all current healthcare providers
• Any existing home care or personal assistance services your parent receives

The more documented evidence you provide, the more accurate the assessment will be. An MPQH nurse who sees a well-organized clinical history can make a stronger NFLOC determination than one working from a brief interview alone.

What the Results Mean

If your parent meets NFLOC: They qualify for the clinical prerequisite of both nursing home Medicaid and the Big Sky Waiver. The next step is the financial eligibility determination through the DPHHS Office of Public Assistance.

If your parent doesn't meet NFLOC: They don't qualify for Medicaid-funded long-term care at this time. This doesn't mean they don't need help — it means the state has determined their needs can be met through lower levels of support. Community First Choice (CFC) and Personal Assistance Services (PAS) may still be available for Medicaid-eligible individuals who need help with ADLs but don't meet the nursing facility threshold.

If your parent's condition changes: The NFLOC determination isn't permanent. If your parent's health deteriorates after an initial denial, request a reassessment. Progressive conditions like dementia, Parkinson's disease, or post-stroke complications frequently push a borderline case past the NFLOC threshold within months.

Timeline Expectations

Initiate the MPQH screening as soon as you observe persistent ADL limitations. The clinical screening and assessment process can take 14 to 30 days to finalize, depending on scheduling availability and the nurse's geographic coverage area. In rural and frontier counties, expect the longer end of that range.

If your parent is in a hospital and facing discharge pressure, communicate the urgency to MPQH. Post-hospitalization screenings can sometimes be expedited, especially when the hospital social worker documents an unsafe discharge without the assessment.

What Comes After the Screening

The NFLOC determination unlocks the next phase of care planning: selecting a care setting (nursing home vs. assisted living vs. home care through the BSW), structuring your parent's finances for Medicaid eligibility, and submitting the formal application to the Office of Public Assistance.

The Montana Care Decision Guide walks you through the entire sequence — from requesting the MPQH assessment through Medicaid application, facility vetting, and care placement — with checklists that track each step and the documents you need at every stage.

See more Montana guides →