reglab/housing_qa huggingface dataset:
MT Code § 33-35-301 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 3. Enforcement|33-35-301. Reporting

  33-35-301. Reporting. (1) A self-funded multiple employer welfare arrangement shall comply with the reporting requirements of this section.   (2) Within 3 months following the close of the arrangement's year of operations, the arrangement shall file with the commissioner, on forms prescribed by the commissioner:   (a) a statement of financial condition;   (b) a statement of change in financial conditions accompanied by an actuarial opinion that the unpaid claim liability of the arrangement satisfies the standards of 33-2-514. The commissioner may, in the commissioner's discretion, waive the requirement of an actuarial opinion and require a report prepared by an actuarial firm and, upon a showing of good cause, may extend by 30 days the filing date for the report.   (c) a statement of its contribution rates for the ensuing year;   (d) a statement of operations for the previous year;   (e) if the total payments to the arrangement for participation during the prior year of operations exceeded the sum of $2 million, an audit satisfying the requirements of the commissioner's rules governing annual audited reports, except that an arrangement audit may be prepared using generally accepted accounting principles. The audit must be certified by an independent certified public accountant. The filing date for the audit must be extended by the commissioner upon a showing of good cause.   (f) additional information as the commissioner reasonably determines to be necessary to determine the financial integrity of the management.   (3) An arrangement shall file with the commissioner a copy of the arrangement's internal revenue service form 5500 together with all attachments to the form, at the time required for filing the form.   History: En. Sec. 11, Ch. 420, L. 1995; amd. Sec. 32, Ch. 63, L. 2015.
MT Code § 33-35-302 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 3. Enforcement|33-35-302. Failure to comply

  33-35-302. Failure to comply. (1) Pursuant to 33-1-317 and 33-1-318, the commissioner may impose sanctions against a self-funded multiple employer welfare arrangement that fails to comply with the provisions of this chapter. The maximum fine may not exceed $5,000 for each violation.   (2) The commissioner may issue a notice of intent to revoke the certificate of authority of a self-funded multiple employer welfare arrangement that fails to comply with the provisions of 33-35-209, 33-35-210, or 33-35-301. If, within 60 days of receiving notice under this subsection, the arrangement fails to file with the commissioner a plan to bring the arrangement into compliance with 33-35-209, 33-35-210, or 33-35-301, the commissioner may revoke the arrangement's certificate of authority. A revocation of a certificate of authority is a contested case under the Montana Administrative Procedure Act.   (3) The commissioner shall adopt rules to provide sanctions for an arrangement that fails to maintain the level of reserves required by 33-35-209. The rules must be consistent with the provisions of Title 33, chapter 2, part 13.   History: En. Sec. 12, Ch. 420, L. 1995.
MT Code § 33-35-303 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 3. Enforcement|33-35-303. Violation by arrangement failing to obtain or maintain certificate of authority

  33-35-303. Violation by arrangement failing to obtain or maintain certificate of authority. A self-funded multiple employer welfare arrangement organized or maintained in Montana without a certificate of authority is in violation of 33-2-101.   History: En. Sec. 13, Ch. 420, L. 1995.
MT Code § 33-35-304 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 3. Enforcement|33-35-304. and 33-35-305 reserved

  33-35-304 and 33-35-305 reserved.
MT Code § 33-35-306 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 3. Enforcement|33-35-306. Application of insurance code to arrangements

  33-35-306. (Subsection (1)(l) effective on occurrence of contingency) Application of insurance code to arrangements. (1) In addition to this chapter, self-funded multiple employer welfare arrangements are subject to the following provisions:  (a) 33-1-111;   (b) Title 33, chapter 1, part 4, but the examination of a self-funded multiple employer welfare arrangement is limited to those matters to which the arrangement is subject to regulation under this chapter;   (c) Title 33, chapter 1, part 7;   (d) Title 33, chapter 2, parts 23 and 24;   (e) 33-3-308;   (f) Title 33, chapter 7;   (g) Title 33, chapter 18, except 33-18-242;   (h) Title 33, chapter 19;   (i) 33-22-107, 33-22-128, 33-22-131, 33-22-134, 33-22-135, 33-22-138, 33-22-139, 33-22-141, 33-22-142, 33-22-152, and 33-22-153;   (j) 33-22-512, 33-22-515, 33-22-525, and 33-22-526;   (k) Title 33, chapter 22, part 7; and   (l) 33-22-707.   (2) Except as provided in this chapter, other provisions of Title 33 do not apply to a self-funded multiple employer welfare arrangement that has been issued a certificate of authority that has not been revoked. (Subsection (1)(l) effective on occurrence of contingency--sec. 5, Ch. 323, L. 2021.)   History: En. Sec. 14, Ch. 420, L. 1995; amd. Sec. 7, Ch. 410, L. 1997; amd. Sec. 32, Ch. 416, L. 1997; amd. Sec. 5, Ch. 434, L. 1999; amd. Sec. 49, Ch. 380, L. 2003; amd. Sec. 8, Ch. 384, L. 2003; amd. Sec. 2, Ch. 249, L. 2007; amd. Sec. 9, Ch. 356, L. 2007; amd. Sec. 6, Ch. 390, L. 2007; amd. Sec. 26, Ch. 399, L. 2007; amd. Sec. 5, Ch. 359, L. 2009; amd. Sec. 5, Ch. 97, L. 2013; amd. Sec. 4, Ch. 164, L. 2013; amd. Sec. 10, Ch. 363, L. 2013; amd. Sec. 4, Ch. 256, L. 2015; amd. Sec. 10, Ch. 231, L. 2017; amd. Sec. 8, Ch. 245, L. 2017; amd. Sec. 4, Ch. 209, L. 2021; amd. Sec. 4, Ch. 277, L. 2021; amd. Sec. 3, Ch. 323, L. 2021; amd. Sec. 19, Ch. 501, L. 2021.
MT Code § 33-35-307 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 3. Enforcement|33-35-307. Disclosure

  33-35-307. Disclosure. Each policy issued by a self-funded multiple employer welfare arrangement must contain, in 10-point type on the front page and the declaration page, the following notice:   "NOTICE   This policy is issued by a self-funded multiple employer welfare arrangement. A self-funded multiple employer welfare arrangement may not be subject to all of the insurance laws and regulations of your state. State insurance insolvency guaranty funds are not available for a self-funded multiple employer welfare arrangement."   History: En. Sec. 15, Ch. 420, L. 1995.
MT Code § 33-36-101 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 1. General Provisions|33-36-101. Short title

  33-36-101. Short title. This chapter may be cited as the "Managed Care Plan Network Adequacy and Quality Assurance Act".   History: En. Sec. 8, Ch. 413, L. 1997.
MT Code § 33-36-102 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 1. General Provisions|33-36-102. Purpose

  33-36-102. Purpose. The purpose and intent of this chapter are to:   (1) establish standards for the creation and maintenance of networks by health carriers offering managed care plans and to ensure the adequacy, accessibility, and quality of health care services offered under a managed care plan by establishing requirements for written agreements between health carriers offering managed care plans and participating providers regarding the standards, terms, and provisions under which the participating provider will provide services to covered persons;   (2) provide for the implementation of state network adequacy and quality assurance standards in administrative rules, provide for monitoring compliance with those standards, and provide a mechanism for detecting and reporting violations of those standards to the commissioner;   (3) establish minimum criteria for the quality assessment activities of a health carrier issuing a closed plan or a combination plan and to require that minimum state quality assessment criteria be adopted by rule;   (4) enable health carriers to evaluate, maintain, and improve the quality of health care services provided to covered persons; and   (5) provide a streamlined and simplified process by which managed care network adequacy and quality assurance programs may be monitored for compliance through coordinated efforts of the commissioner and the department. It is not the purpose or intent of this chapter to apply quality assurance standards applicable to medicaid or medicare to managed care plans regulated pursuant to this chapter or to create or require the creation of quality assurance programs that are as comprehensive as quality assurance programs applicable to medicaid or medicare.   History: En. Sec. 9, Ch. 413, L. 1997.
MT Code § 33-36-104 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 1. General Provisions|33-36-104. Applicability and scope

  33-36-104. Applicability and scope. This chapter applies to all health carriers that offer managed care plans. This chapter does not exempt a health carrier from the applicable requirements of federal law when providing a managed care plan to medicare recipients or from the applicable requirements of federal law or Title 53, chapter 6, when providing a managed care plan to medicaid recipients.   History: En. Sec. 11, Ch. 413, L. 1997.
MT Code § 33-36-105 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 1. General Provisions|33-36-105. Department -- general powers and duties -- rulemaking

  33-36-105. Department -- general powers and duties -- rulemaking. (1) The department shall:   (a) adopt rules pursuant to the Montana Administrative Procedure Act establishing minimum state standards for network adequacy and quality assurance and procedures for ensuring compliance with those standards; and   (b) recommend action to the commissioner against a health carrier whose managed care plan does not comply with standards for network adequacy and quality assurance adopted by the department.   (2) Quality assurance standards adopted by the department must consist of some but not all of the health plan employer data and information standards. The department shall select and adopt only standards appropriate for quality assurance in Montana.   (3) The state may contract, through a competitive bidding process, for the development of network adequacy and quality assurance standards.   History: En. Sec. 12, Ch. 413, L. 1997.
MT Code § 33-36-203 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-203. Selection of providers -- professional credentials standards

  33-36-203. Selection of providers -- professional credentials standards. (1) A health carrier shall adopt standards for selecting participating providers who are primary care professionals and for each health care professional specialty within the health carrier's network. The health carrier shall use the standards to select health care professionals, the health carrier's intermediaries, and any provider network with which the health carrier contracts. A health carrier may not adopt selection criteria that allow the health carrier to:   (a) avoid high-risk populations by excluding a provider because the provider is located in a geographic area that contains populations or providers presenting a risk of higher than average claims, losses, or use of health care services; or   (b) exclude a provider because the provider treats or specializes in treating populations presenting a risk of higher than average claims, losses, or use of health care services.   (2) Subsection (1) does not prohibit a health carrier from declining to select a provider who fails to meet the other legitimate selection criteria of the health carrier adopted in compliance with this part and the rules implementing this part.   (3) This part does not require a health carrier, its intermediary, or a provider network with which the health carrier or its intermediary contract to employ specific providers or types of providers who may meet their selection criteria or to contract with or retain more providers or types of providers than are necessary to maintain an adequate network.   (4) A health carrier may use criteria established in accordance with the provisions of this section to select health care professionals allowed to participate in the health carrier's managed care plan. A health carrier shall make its selection standards for participating providers available for review by the department and by each health care professional who is subject to the selection standards.   History: En. Sec. 15, Ch. 413, L. 1997.
MT Code § 33-36-205 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-205. Emergency services

  33-36-205. Emergency services. (1) A health carrier offering a managed care plan shall provide or pay for emergency services screening and emergency services and may not require prior authorization for either of those services. If an emergency services screening determines that emergency services or emergency services of a particular type are unnecessary for a covered person, emergency services or emergency services of the type determined unnecessary by the screening need not be covered by the health carrier unless otherwise covered under the health benefit plan. However, if screening determines that emergency services or emergency services of a particular type are necessary, those services must be covered by the health carrier. A health carrier shall cover emergency services if the health carrier, acting through a participating provider or other authorized representative, has authorized the provision of emergency services.   (2) A health carrier shall provide or pay for emergency services obtained from a nonnetwork provider within the service area of a managed care plan and may not require prior authorization of those services if use of a participating provider would result in a delay that would worsen the medical condition of the covered person or if a provision of federal, state, or local law requires the use of a specific provider.   (3) If a participating provider or other authorized representative of a health carrier authorizes emergency services, the health carrier may not subsequently retract its authorization after the emergency services have been provided or reduce payment for an item or health care services furnished in reliance on approval unless the approval was based on a material misrepresentation about the covered person's medical condition made by the provider of emergency services.   (4) Coverage of emergency services is subject to applicable coinsurance, copayments, and deductibles.   (5) For postevaluation or poststabilization services required immediately after receipt of emergency services, a health carrier shall provide access to an authorized representative 24 hours a day, 7 days a week, to facilitate review.   History: En. Sec. 17, Ch. 413, L. 1997; amd. Sec. 11, Ch. 325, L. 2003.
MT Code § 33-36-206 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-206. through 33-36-208 reserved

  33-36-206 through 33-36-208 reserved.
MT Code § 33-36-209 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-209. Use of intermediaries -- responsibilities of health carriers, intermediaries, and providers

  33-36-209. Use of intermediaries -- responsibilities of health carriers, intermediaries, and providers. (1) A health carrier is responsible for complying with applicable provisions of this chapter, and contracting with an intermediary for all or some of the services for which a health carrier is responsible does not relieve the health carrier of responsibility for compliance.   (2) A health carrier may determine whether a subcontracted provider participates in the provider's own network or a contracted network for the purpose of providing covered benefits to the health carrier's covered persons.   (3) A health carrier shall maintain copies of all intermediary health care subcontracts at the health carrier's principal place of business in this state or ensure that the health carrier has access to all intermediary subcontracts, including the right to make copies of the contracts, upon 20 days' prior written notice from the health carrier.   (4) If required in a contract or otherwise by a health carrier, an intermediary shall transmit utilization documentation and claims-paid documentation to the health carrier. The health carrier shall monitor the timeliness and appropriateness of payments made to providers and health care services received by covered persons. This duty may not be delegated to an intermediary by a health carrier.   (5) If required in a contract or otherwise by a health carrier, an intermediary shall maintain the books, records, financial information, and documentation of services provided to covered persons at its principal place of business in the state and preserve them for 5 years in a manner that facilitates regulatory review.   (6) An intermediary shall allow the commissioner and the department access to the intermediary's books, records, claim information, billing information, and other documentation of services provided to covered persons that are required by any of those entities to determine compliance with this part and the rules implementing this part.   (7) A health carrier may, in the event of the intermediary's insolvency, require the assignment to the health carrier of the provisions of a participating provider's contract addressing the participating provider's obligation to furnish covered benefits.   History: En. Sec. 18, Ch. 413, L. 1997.
MT Code § 33-36-210 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-210. Contract filing requirements -- material changes -- state access to contracts

  33-36-210. Contract filing requirements -- material changes -- state access to contracts. (1) On October 1, 1999, a health carrier offering a managed care plan shall file with the department sample contract forms proposed for use with its participating providers and intermediaries.   (2) A health carrier shall file with the department a material change to a contract. The change must be filed with the department at least 60 days before use of the proposed change. A change in a participating provider payment rate, coinsurance, copayment, or deductible or other plan benefit is not considered a material change for the purpose of this subsection.   (3) A health carrier shall maintain participating provider and intermediary contracts at its principal place of business in this state, or the health carrier must have access to all contracts and provide copies to the department upon 20 days' prior written notice from the department.   History: En. Sec. 19, Ch. 413, L. 1997.
MT Code § 33-36-211 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-211. General contracting requirements

  33-36-211. General contracting requirements. (1) The execution of a contract for health care services with an intermediary by a health carrier does not relieve the health carrier of its duty to provide health care services to a person with whom the health carrier has contracted and does not relieve the health carrier of its responsibility for compliance with this chapter or the rules implementing this chapter.   (2) All contracts by a health carrier for the provision of health care services by a managed care plan must be in writing and are subject to review by the department and the commissioner.   History: En. Sec. 20, Ch. 413, L. 1997.
MT Code § 33-36-212 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-212. Contract compliance dates

  33-36-212. Contract compliance dates. (1) A contract between a health carrier and a participating provider or intermediary in effect on October 1, 1999, must comply with this part and the rules implementing this part by October 1, 1999. The department may extend the October 1 date for an additional period of up to 6 months if the health carrier demonstrates good cause for an extension.   (2) A contract between a health carrier and a participating provider or intermediary issued or put into effect on or after October 1, 1999, must comply with this part and the rules implementing this part on the day that it is issued or put into effect.   (3) A contract between a health carrier and a participating provider or intermediary not described in subsection (1) or (2) must comply with this part and the rules implementing this part by October 1, 1999.   History: En. Sec. 21, Ch. 413, L. 1997.
MT Code § 33-36-213 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 2. Network Adequacy|33-36-213. Department rules

  33-36-213. Department rules. The department may adopt rules to implement this part.   History: En. Sec. 22, Ch. 413, L. 1997.
MT Code § 33-36-301 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 36. Managed Care Plan Network Adequacy and Quality Assurance|Part 3. Quality Assurance|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 department.   (2) If the department 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 department shall approve the quality assurance standards of the health carrier.   (3) The department shall maintain a list of accrediting organizations whose standards have been determined by the department 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 department from monitoring a health carrier's compliance with this part.   History: En. Sec. 23, Ch. 413, L. 1997.