The short answer Montana licenses skilled home health agencies through DPHHS; non-medical home care agencies are not licensed.
What Montana requires
Montana
Licensing agency. The Montana Department of Public Health and Human Services (DPHHS) licenses home health agencies under Mont. Code Ann. § 50-5-101 et seq. and its health care facility rules.
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No non-medical license. Montana does not require a state license for non-medical home care agencies providing personal care, companionship, or homemaker services.
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Medicaid oversight. Personal assistance providers serving Montana Medicaid (self-directed or agency-based PAS) must enroll and meet DPHHS program rules, which supplies oversight for that segment.
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Surveys. DPHHS's licensure bureau surveys home health agencies for state licensure and Medicare certification, with initial surveys, periodic recertification, and plan-of-correction requirements.
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The federal baseline (applies in every state)
Federal
No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction.
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Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license.
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Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey.
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State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual.
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