Montana Code 53-6-706. Requirements relating to enrollees
53-6-706. Requirements relating to enrollees. (1) All individuals enrolled in the program must be provided with a full written explanation of all fee-for-service and managed health care plan options as provided by rule. The department shall provide to enrollees, upon enrollment in the program and at least annually, notice of the process for requesting an appeal under the department’s administrative appeal procedures. The department shall maintain a toll-free telephone number for program enrollees’ use in reporting problems with managed health care entities.
Terms Used In Montana Code 53-6-706
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Department: means the department of public health and human services. See Montana Code 53-6-702
- Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
- Program: means an element of the integrated health care system created by this part. See Montana Code 53-6-702
(2)If an individual becomes eligible for participation in the program while the individual is hospitalized, the department may, but is not required to, enroll the individual in the program prior to the individual’s discharge from the hospital. This subsection does not apply to a newborn infant whose mother is enrolled in the program.
(3)The department shall, by rule, establish rates for managed health care entities that:
(a)are in accordance with federal requirements and with the department’s current payment system;
(b)take into account any difference of cost to provide health care to different populations based on age and eligibility category. The rates for managed health care entities must be determined on a capitated basis.
(c)are based on treatment settings reasonably available to enrollees.