Montana Code 53-6-702. Definitions
53-6-702. Definitions. As used in this part, the following definitions apply:
Terms Used In Montana Code 53-6-702
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the department of public health and human services. See Montana Code 53-6-702
- Health maintenance organization: means a health maintenance organization as defined in 33-31-102. See Montana Code 53-6-702
- 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)”Department” means the department of public health and human services.
(2)”Health maintenance organization” means a health maintenance organization as defined in 33-31-102.
(3)(a) “Managed health care entity” or “entity” means a health maintenance organization or an insurer regulated under Title 33 that:
(i)contracts for an estimated annual value of $1 million or more of state and federal medicaid funds; or
(ii)operates statewide or covers 20% or more of the medicaid population.
(b)The term does not include:
(i)a provider of health care services under a contract with the department on a fee-for-service basis;
(ii)a medicaid primary care case management service within the meaning of 42 CFR 438; or
(iii)a PACE organization as defined in 42 C.F.R. § 460.6 or an accountable care organization as defined in 33-31-102 that has received a waiver under 33-31-201.
(4)”Program” means an element of the integrated health care system created by this part.