Montana

Montana

Montana requires CONs within four broad categories—hospital beds, beds outside hospitals, facilities and services. Montana’s 23 CONs primarily regulate home health agencies, long-term care facilities and inpatient chemical dependency facilities. Mont. Code § 50-5-301(2)(b)(ii). Under Montana’s CON application process, whenever an applicant submits a proposed application, direct competitors are invited to submit competing applications for the same facility or service. Mont. Code § 50-5-302(5), (12).

COVID-19 Response

As of May 15, 2020, Montana had not suspended any CON requirements in response to COVID-19.

Application Process

In Montana, the CON application process takes at least six months. See Department of Public Health and Human Services(DPHHS), How Does The Process Work? Applications can be submitted at any time. The fee for a CON application is $500 or 0.3% of the project’s capital expenditure, whichever is greater. Mont. Code § 50-5-310(2). Competitors can intervene in the application process by submitting a competing letter of intent and application, requesting a public hearing or requesting a “contested case hearing” after DPHHS renders its decision. Mont. Code §§ 50-5-302(5), (11), (12), 50-5-306(1). They can also offer evidence or argument during the hearing as to why an application should be denied. Mont. Code § 50-5-306(1); Mont. Admin. R. 37.106.115.

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 3 – No action
Beds Outside Hospitals Yes 3 – No action
Equipment No – – –
Facilities/ Buildings Yes 6 – No action
Services Yes 11 – No action
Emergency Medical Transport No – – –

Note: these citations are accurate as of May 2020.

Montana CONs in Detail

Category

Types of CONs

Mont. Code

Hospital Beds

1.Converting five or more hospital beds to skilled nursing beds.

2.Converting five or more hospital beds to intermediate nursing care beds.

3.Converting five or more hospital beds to intermediate developmental disability care beds.

§ 50-5-301(1)(g)

Beds Outside Hospitals

1.Changes in bed capacity through an increase in number or relocation of beds in home health agencies.

2.Changes in bed capacity through an increase in number or relocation of beds in long-term care facilities.

3.Changes in bed capacity through an increase in number or relocation of beds in inpatient chemical dependency facilities.

§ 50-5-301(1)(b), (2)

Equipment

No CONs in this category.

Facilities/Buildings

Capital expenditures over $1.5 million (other than acquiring an existing health care facility) by or on behalf of:

1.Long-term care facilities.

2.Inpatient chemical dependency facilities.

§ 50-5-301(1)(a), (2)

Incurring an obligation for a capital expenditure of any amount by a person to acquire 50% or more of:

3.Existing long-term care facilities.

4.Existing chemical dependency facilities.

§ 50-5-301(1)(d), (2)

Construction, development, or other establishment of the following facilities that are being replaced or that did not previously exist:

5.Long-term care facilities.

6.Inpatient chemical dependency facilities.

§ 50-5-301(1)(e), (2)

Services

1.Addition of a health service offered by a home health agency that was not offered within the previous year and will result in additional annual operating and amortization expenses of $150,000 or more.

2.Addition of a health service offered by a long-term care facility that was not offered within the previous year and will result in additional annual operating and amortization expenses of $150,000 or more.

§ 50-5-301(1)(c), (2)

Category

Types of CONs

Mont. Code

Services

3.Addition of a health service offered by an inpatient chemical dependency facility that was not offered within the previous year and will result in additional annual operating and amortization expenses of $150,000 or more.

§ 50-5-301(1)(c), (2)

4.Expansion of the geographical service area of a home health agency.

§ 50-5-301(1)(f)

The provision by a hospital of services for:

5.Home health care,

6.Long-term care, or

7.Inpatient chemical dependency treatment.

§ 50-5-301(1)(h)

8.Captital expenditures over $1.5 million by or on behalf of a home health agency.

9.Incurring an obligation for a capital expenditure of any amount by a person to aquire 50% or more of a home health agency.

10.Construction, development or establishment of a home health agency that is being replaced or did not previously exist.

§ 50-5-301(1)(a), (2)

11.Construction, development or other establishment of a facility for ambulatory surgical care through an outpatient center for surgical services in a county with a population of 20,000 or less.

§ 50-5-301(1)(i)

Emergency Medical Transport

No CONs in this category.

Montana CON Exceptions

No CON Required For:

Mont. Code

1.Capital expenditures over $1.5 million for acquiring an existing healthcare facility.

§ 50-5-301(1)(a)

2.A change in the bed capacity, through an increase in number or relocation of beds from one facility to another, of a home health agency, long-term care facility or inpatient chemical dependency facility if (1) the number of beds is 10 or less or 10% or less, (2) no beds have been added or relocated during the two years prior, (3) a letter of intent is submitted to the Department of Health and (4) the Department determines the proposal will not significantly increase the cost of care or exceed bed need projected in the state healthcare facilities plan.

§ 50-5-301(1)(b), (2)

3.Incurring an obligation for a capital expenditure by a person to acquire 50% or more of an existing home health agency, long-term care facility or inpatient chemical dependency facility, if (1) the person submits a letter of intent and (2) the Department finds that the acquisition will not significantly increase the cost of care provided or increase bed capacity.

§ 50-5-301(1)(d), (2)

4.Use of five or fewer hospital beds to provide nursing care, intermediate nursing care or intermediate developmental disability care.

§ 50-5-301(1)(g)

5.Hospitals (except to the extent they offer home health care, long-term care or inpatient chemical dependency treatment services).

§ 50-5-301(2)(a)(i)

6.Offices of private physicians, dentists or other physical or mental healthcare professionals, including licensed addiction counselors.

§ 50-5-301(2)(a)(ii)

7.The CON requirements for long-term care facilities do not apply to residential care facilities.

8.The CON requirements for long-term care facilities do not apply to community homes for persons with developmental disabilities.

9.The CON requirements for long-term care facilities do not apply to community homes for persons with severe disabilities.

10.The CON requirements for long-term care facilities do not apply to boarding or foster homes for children.

11.The CON requirements for long-term care facilities do not apply to hotels, motels, boardinghouses, roominghouses, or similar accommodations for transients, students, or individuals not requiring institutional health care.

12.The CON requirements for long-term care facilities do not apply to juvenile and adult correctional facilities operating under the authority of the Department of Corrections.

13.Construction of a state-owned facility.

14.Repair or replacement of a facility damaged in a natural disaster if the use of the facility after repair or replacement is within the scope of the facility’s original license.

§ 50-5-301(2)(b)(ii)

§ 50-5-309(1)

§ 50-5-309(2)

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