Montana Code 33-1-802. Gag clauses and other action affecting medical communications prohibited — exceptions
33-1-802. Gag clauses and other action affecting medical communications prohibited — exceptions. (1) A health carrier or managed care organization may not by an oral or written contract, by an oral or written direction or requirement, or by a financial inducement or penalty prohibit a provider from making or interfere with a provider making a medical communication to an enrollee. A contract, direction, requirement, or financial inducement or penalty violating this subsection is void.
Terms Used In Montana Code 33-1-802
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: means the individual to whom a health care service is provided or will be provided under a health plan. See Montana Code 33-1-801
- Health carrier: means an entity that is subject to the insurance laws and rules of this state and 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. See Montana Code 33-1-801
- Managed care organization: means an entity that manages, owns, contracts with, or employs health care providers to provide health care services under a health plan. See Montana Code 33-1-801
- Medical communication: means :
(a)a communication made by a health care provider to an enrollee or to the guardian or other legal representative of an enrollee receiving health care services from the provider:
(i)concerning the mental or physical health care needs or treatment of the enrollee and the provisions, terms, or requirements of the health plan or another health plan relating to the needs or treatment of the enrollee; and
(ii)including a communication concerning:
(A)a test, consultation, or treatment option and a risk or benefit associated with the test, consultation, or option;
(B)variation among health care providers and health care facilities, as defined in 50-5-101, in experience, quality of health care services, or health outcomes;
(C)the basis or standard for the decision of the enrollee's health carrier or managed care organization to authorize or deny a health care service;
(D)the process used by the enrollee's health carrier or managed care organization to determine whether to authorize or deny a health care service; or
(E)a financial incentive or disincentive provided by the enrollee's health carrier or managed care organization to a health care provider to authorize or deny a health care service;
(b)a communication made by a health care provider to another health care provider, an employee or contractor of the enrollee's managed care organization, or an employee of the health carrier advocating a particular method of treatment on behalf of an enrollee. See Montana Code 33-1-801
- provider: means a health care professional or facility. See Montana Code 33-1-801
(2)Subsection (1) does not apply to:
(a)an oral or written contract, direction, requirement, or financial inducement or penalty prohibiting a provider from disclosing a trade secret, as defined in 30-14-402, to the same extent as other employees or contractors of the health carrier or managed care organization are prohibited from disclosing the trade secret;
(b)an oral or written contract, direction, requirement, or financial inducement or penalty prohibiting a health care provider from referring an enrollee to another health plan or managed care organization in which the provider making the referral has a direct financial interest; and
(c)the terms of an oral or written contract mutually agreed upon by a health carrier or managed care organization and a provider requiring the provider to participate in and cooperate with all programs, policies, and procedures implemented by the health carrier or managed care organization to ensure, review, or improve the quality of health care.