Montana Code 33-22-702. Definitions
33-22-702. Definitions. For purposes of this part, the following definitions apply:
Terms Used In Montana Code 33-22-702
- Health insurance coverage: means benefits consisting of medical care, including items and services paid for as medical care, that are provided directly, through insurance, reimbursement, or otherwise, under a policy, certificate, membership contract, or health care services agreement offered by a health insurance issuer. See Montana Code 33-22-140
- Medical care: means :
(a)the diagnosis, cure, mitigation, treatment, or prevention of disease or amounts paid for the purpose of affecting any structure or function of the body;
(b)transportation primarily for and essential to medical care referred to in subsection (19)(a); or
(c)insurance covering medical care referred to in subsections (19)(a) and (19)(b). See Montana Code 33-22-140
- Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Montana Code 1-1-201
(1)”Inpatient benefits” are as set forth in 33-22-705.
(2)”Mental health benefits” means benefits with respect to items or services for mental health conditions, as defined under the terms of the plan or health insurance coverage and in accordance with applicable federal and state law. Any condition defined by the plan or coverage as being or as not being a mental health condition must be defined to be consistent with generally recognized independent standards of current medical practice, including but not limited to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
(3)”Mental health treatment center” means a treatment facility organized to provide care and treatment for mental illness or severe mental illness through multiple modalities or techniques pursuant to a written treatment plan approved and monitored by a qualified health care provider and a treatment facility that is:
(a)licensed as a mental health treatment center by the state;
(b)funded or eligible for funding under federal or state law; or
(c)affiliated with a hospital under a contractual agreement with an established system for patient referral.
(4)(a) “Mental illness” means a clinically significant behavioral or psychological syndrome or pattern that occurs in a person and that is associated with:
(i)present distress or a painful symptom;
(ii)a disability or impairment in one or more areas of functioning; or
(iii)a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
(b)Mental illness must be considered as a manifestation of a behavioral, psychological, or biological dysfunction in a person.
(c)Mental illness does not include:
(i)a developmental disorder;
(ii)a speech disorder;
(iii)a psychoactive substance use disorder;
(iv)an eating disorder, except for bulimia and anorexia nervosa; or
(v)an impulse control disorder, except for intermittent explosive disorder and trichotillomania.
(5)”Outpatient benefits” are as set forth in 33-22-705.
(6)”Primary care behavioral health model” means an evidence-based, integrated behavioral health care service delivery model delivered in primary or specialty care settings that recognizes licensed psychologists as consultants as well as direct service providers.
(7)”Psychiatric collaborative care model” means the evidence-based, integrated behavioral health service delivery method in which care:
(a)is delivered by a primary care team consisting of a primary care provider and a care manager who work in collaboration with a psychiatric consultant, including but not limited to a psychiatrist;
(b)is directed by the primary care team;
(c)includes structured care management with regular assessments of clinical status using validated tools and modification of treatment as appropriate; and
(d)involves regular consultations between the psychiatric consultant and the primary care team to review the clinical status and care of patients and to make recommendations.
(8)”Qualified health care provider” means a person licensed as a physician, psychologist, social worker, clinical professional counselor, marriage and family therapist, or addiction counselor or another appropriate licensed health care practitioner.
(9)”Severe mental illness” means the following disorders as defined by the American psychiatric association:
(a)schizophrenia;
(b)schizoaffective disorder;
(c)bipolar disorder;
(d)major depression;
(e)panic disorder;
(f)obsessive-compulsive disorder; and
(g)autism.
(10)”Substance use disorder” means the uncontrollable or excessive use of an addictive substance, including but not limited to alcohol, morphine, cocaine, heroin, opium, cannabis, barbiturates, amphetamines, tranquilizers, or hallucinogens, and the resultant physiological or psychological dependency that develops with continued use of the addictive substance and that requires medical care or other appropriate treatment as determined by a licensed addiction counselor or other appropriate medical practitioner.
(11)”Substance use disorder benefits” means benefits with respect to items or services for substance use disorders, as defined under the terms of the plan or health insurance coverage and in accordance with applicable federal and state law. Any disorder defined by the plan as being or as not being a substance use disorder must be defined to be consistent with generally recognized independent standards of current medical practice, including but not limited to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
(12)”Substance use disorder treatment center” means a treatment facility that:
(a)provides a program for the treatment of substance use disorders pursuant to a written treatment plan approved and monitored by a qualified health care provider; and
(b)is licensed or approved by the department of public health and human services under 53-24-208 or is licensed or approved by the state where the facility is located.