Montana Code 33-36-301. Quality assurance — national accreditation
33-36-301. Quality assurance — national accreditation. (1) A health carrier whose managed care plan has been accredited by a nationally recognized accrediting organization shall annually provide a copy of the accreditation and the accrediting standards used by the accrediting organization to the commissioner.
Terms Used In Montana Code 33-36-301
- 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
- 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
(2)If the commissioner finds that the standards of a nationally recognized accrediting organization meet or exceed state standards and that the health carrier has been accredited by the nationally recognized accrediting organization, the commissioner shall approve the quality assurance standards of the health carrier.
(3)The commissioner shall maintain a list of accrediting organizations whose standards have been determined by the commissioner to meet or exceed state quality assurance standards.
(4)Section 33-36-302 does not apply to a health carrier’s managed care plan if the health carrier maintains current accreditation by a nationally recognized accrediting organization whose standards meet or exceed state quality assurance standards adopted pursuant to this part.
(5)This section does not prevent the commissioner from monitoring a health carrier’s compliance with this part.