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Mountain Pacific can help determine if Medicaid members meet the medical level of care for services they may be eligible for nursing homes, other skilled care facilities or other community-based settings.
Our team conducts medical reviews for:
Nursing home care covered by Medicaid
The Big Sky Waiver program supports Medicaid members requiring nursing home level care to receive that care in their home or community
The Severe Disabling Mental Illness (SDMI) waiver program supports Medicaid members with severe disabling mental illness
Pre-Admission Screening and Resident Review (PASRR) Level I for people admitted to a Montana nursing home
We provide Medicaid utilization review/prior authorization and management services for the Montana Department of Public Health and Human Services to ensure that health care services and equipment are medically necessary and appropriate.
Review services include:
Prior authorization of acute- and long-term care in both inpatient and outpatient settings
Transplants
Medical-surgical
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Eyeglasses, contacts, hearing aids, dental, orthodontics, medical equipment
Skilled nursing facility add-on needs
Additionally, we provide peer review of selected medical records for utilization, coding and quality purposes
Personal Assistance Services (PAS)/Community First Choice (CFC)
Our team of registered nurses meet with Montana Medicaid members who need help with activities of daily living (ADLs). Examples of ADLs are bathing, dressing, grooming, toileting, eating and moving around the home. The program also can help with grocery shopping, housekeeping and laundry and some assistance in the community for social activities.
This Montana Department of Public Health and Human Services (DPHHS) Medicaid program strives to support people in their homes so they can stay independent. Our assessments and authorizations are person-centered, empowering Medicaid members to actively participate in their own care. We follow DPHHS policy and work with provider agencies across the state to deliver needed care. Eligible program participants can hire their own caregiver or work with an agency staff member to get the care they need.
Mountain Pacific works with the Wyoming Department of Health to evaluate Medicaid members and then coordinate services and implement care plans to promote the prevention, screening and management of acute and chronic diseases. The program emphasizes prevention and provides education and support, so members can take responsibility for improving and managing their own health. Once participating members achieve their plan of care goals, they “graduate” from the care management program.
