Terms Used In Montana Code > Title 33 > Chapter 31 > Part 1 - General Provisions

• Accountable care organization: means a group of health care providers that are willing and capable of accepting accountability for the total cost and quality of care for a defined population. See Montana Code 33-31-102
• Basic health care services: means :

  (a)consultative, diagnostic, therapeutic, and referral services by a provider;

  (b)inpatient hospital and provider care;

  (c)outpatient medical services;

  (d)medical treatment and referral services;

  (e)accident and sickness services by a provider to each newborn infant of an enrollee pursuant to 33-31-301(3)(e);

  (f)care and treatment of mental illness, alcoholism, and drug addiction;

  (g)diagnostic laboratory and diagnostic and therapeutic radiologic services;

  (h)preventive health services, including:

  (i)immunizations;

  (ii)well-child care from birth;

  (iii)periodic health evaluations for adults;

  (iv)voluntary family planning services;

  (v)infertility services; and

  (vi)children's eye and ear examinations conducted to determine the need for vision and hearing correction;

  (i)minimum mammography examination, as defined in 33-22-132;

  (j)outpatient self-management training and education for the treatment of diabetes along with certain diabetic equipment and supplies as provided in 33-22-129; and

  (k)treatment and medical foods for inborn errors of metabolism. See Montana Code 33-31-102

• Commissioner: means the commissioner of insurance of the state of Montana. See Montana Code 33-31-102
• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Enrollee: means a person:

  (a)who enrolls in or contracts with a health maintenance organization;

  (b)on whose behalf a contract is made with a health maintenance organization to receive health care services; or

  (c)on whose behalf the health maintenance organization contracts to receive health care services. See Montana Code 33-31-102

• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Health care services: means :

  (a)the services included in furnishing medical or dental care to a person;

  (b)the services included in hospitalizing a person;

  (c)the services incident to furnishing medical or dental care or hospitalization; or

  (d)the services included in furnishing to a person other services for the purpose of preventing, alleviating, curing, or healing illness, injury, or physical disability. See Montana Code 33-31-102

• Health care services agreement: means an agreement for health care services between a health maintenance organization and an enrollee. See Montana Code 33-31-102
• Health maintenance organization: means a person who provides or arranges for basic health care services to enrollees on a prepaid basis, either directly through provider employees or through contractual or other arrangements with a provider or a group of providers. See Montana Code 33-31-102
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• PACE organization: means an organization, as defined in 42 C. See Montana Code 33-31-102
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: means :

  (a)an individual;

  (b)a group of individuals;

  (c)an insurer, as defined in 33-1-201;

  (d)a health service corporation, as defined in 33-30-101;

  (e)a corporation, partnership, facility, association, or trust; or

  (f)an institution of a governmental unit of any state licensed by that state to provide health care, including but not limited to a physician, hospital, hospital-related facility, or long-term care facility. See Montana Code 33-31-102

• Provider: means a physician, hospital, hospital-related facility, long-term care facility, dentist, osteopath, chiropractor, optometrist, podiatrist, psychologist, licensed social worker, registered pharmacist, or advanced practice registered nurse, as specifically listed in 37-8-202, or registered nurse first assistant as defined by the board of nursing under Title 37, chapter 8, who treats any illness or injury within the scope and limitations of the provider's practice or any other person who is licensed or otherwise authorized in this state to furnish health care services. See Montana Code 33-31-102
• Provider panel: means those providers with whom a health maintenance organization contracts to provide health care services to the health maintenance organization's enrollees. See Montana Code 33-31-102
• 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
• Statute: A law passed by a legislature.