Montana Code 33-36-105. Commissioner — general powers and duties — rulemaking
33-36-105. Commissioner — general powers and duties — rulemaking. (1) The commissioner shall:
Terms Used In Montana Code 33-36-105
- Contract: A legal written agreement that becomes binding when signed.
- Health carrier: means an entity subject to the insurance laws and rules of this state that contracts, offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a disability insurer, health maintenance organization, or health service corporation or another entity providing a health benefit plan. See Montana Code 33-36-103
- Managed care plan: means a health benefit plan that either requires or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with, or employed by a health carrier, but not preferred provider organizations or other provider networks operated in a fee-for-service indemnity environment. See Montana Code 33-36-103
- Network: means the group of participating providers that provides health care services to a managed care plan. See Montana Code 33-36-103
- Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
- Quality assurance: means quality assessment and quality improvement. See Montana Code 33-36-103
- 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
(a)adopt rules pursuant to the Montana Administrative Procedure Act establishing minimum state standards for network adequacy and quality assurance and procedures for ensuring compliance with those standards; and
(b)if appropriate, initiate action against a health carrier whose managed care plan does not comply with standards for network adequacy and quality assurance adopted by the commissioner.
(2)Quality assurance standards adopted by the commissioner must consist of some but not all of the health plan employer data and information standards. The commissioner shall select and adopt only standards appropriate for quality assurance in Montana.
(3)The state may contract, through a competitive bidding process, for the development of network adequacy and quality assurance standards.