reglab/housing_qa huggingface dataset:
MT Code § 33-2-2004 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 20. Pharmacy Audit Integrity Act|33-2-2004. Audit of pharmacy records

  33-2-2004. Audit of pharmacy records. (1) An entity conducting an audit of pharmacy records shall audit a pharmacy using the same standards and parameters as used by the entity in auditing other pharmacies on behalf of the same audit client.   (2) An audit that involves clinical or professional judgment must be conducted by or in consultation with a licensed pharmacist who is employed by or working with the entity conducting the audit.   (3) If an audit is conducted onsite at a pharmacy, the entity conducting the audit:   (a) shall give the pharmacy 10 days' advance written notice of the audit, along with the range of prescription numbers or a date range that will be included in the audit; and   (b) may not audit the pharmacy during the first 5 business days of the month unless the pharmacy agrees to the timing of the audit.   (4) An entity may not audit prescription records that exceed 275 selected prescriptions. The period covered by the audit may not exceed 24 months from the date that the prescription was submitted to or adjudicated by the entity unless a longer period is required under state or federal law.   (5) Except as required by state or federal law, an entity conducting an audit may have access to a pharmacy's previous audit report only if the previous report was prepared by that entity.   (6) To validate a pharmacy record, a pharmacy may use documented statements of records in the pharmacy or pharmacy system, including medication administration records of a nursing home, assisted living facility, hospital, physician, surgeon, or other prescriber authorized by the laws of this state.   (7) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy to produce additional claims documentation using any commercially reasonable method, including fax, mail, or e-mail.   History: En. Sec. 4, Ch. 114, L. 2013.
MT Code § 33-2-2005 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 20. Pharmacy Audit Integrity Act|33-2-2005. Prohibitions -- recoupment -- payment -- interest

  33-2-2005. Prohibitions -- recoupment -- payment -- interest. An entity conducting an audit may not:   (1) include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a dispensing error by the pharmacy, or the identified overpayment is based solely on an extra dispensing fee;   (2) recoup funds for prescription clerical or recordkeeping errors, including typographical errors, scrivener's errors, and computer errors, in a required document or record unless the error results in actual financial harm to the entity or to a consumer;   (3) collect any funds, charge-backs, or penalties until the audit and all appeals are final unless the entity is alleging fraud or other intentional or willful misrepresentation that is evidenced by the review of claims data, statements, physical review, or other investigative methods;   (4) use extrapolation or other statistical expansion techniques in calculating the amount of any recoupment or penalty;   (5) pay the agent or employee who conducted the audit based on a percentage of the amount recovered; or   (6) charge interest during the audit period.   History: En. Sec. 5, Ch. 114, L. 2013.
MT Code § 33-2-2006 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 20. Pharmacy Audit Integrity Act|33-2-2006. Onsite audits -- preliminary and final reports -- appeals

  33-2-2006. Onsite audits -- preliminary and final reports -- appeals. For audits conducted onsite, the following provisions apply:   (1) An entity that audits a pharmacy shall provide the pharmacy with a preliminary audit report, delivered to the pharmacy or its corporate office of record within 60 days after completion of the audit.   (2) A pharmacy has 30 days following receipt of the preliminary audit report to respond to questions, provide additional documentation, and comment on and clarify findings of the audit. The date of receipt of the report must be determined by the postmark date or the date of the electronic transmission if transferred electronically.   (3) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy, for 30 days following receipt of the preliminary audit report, to produce additional claims documentation using any commercially reasonable method, including fax, mail, or e-mail.   (4) (a) Within 120 days after the completion of the appeals process under subsection (5), a final audit report must be delivered to the pharmacy or its corporate office of record.   (b) The final audit report must include a disclosure of any money recovered by the entity that conducted the audit.   (5) An entity that audits a pharmacy shall establish a written policy for a pharmacy to appeal a final audit report. If no remedies are specified by contract or in the pharmacy services manual, the pharmacy may seek to resolve the dispute through mediation.   History: En. Sec. 6, Ch. 114, L. 2013.
MT Code § 33-2-2101 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 21. Corporate Governance Annual Disclosure|33-2-2101. Short title

  33-2-2101. Short title. This part may be cited as the "Corporate Governance Annual Disclosure Act".   History: En. Sec. 1, Ch. 9, L. 2017.
MT Code § 33-2-2102 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 21. Corporate Governance Annual Disclosure|33-2-2102. Purpose -- scope

  33-2-2102. Purpose -- scope. (1) The purpose of this part is to:   (a) provide to the insurance commissioner a summary of an insurer or insurance group's corporate governance structure, policies, and practices to permit the commissioner to gain and maintain an understanding of the insurer's corporate governance framework;   (b) outline the requirements for completing a corporate governance annual disclosure with the insurance commissioner; and   (c) provide for the confidential treatment of the corporate governance annual disclosure and related information that will contain confidential and sensitive information related to an insurer or insurance group's internal operations and proprietary and trade secret information and that, if made public, could potentially cause the insurer or insurance group competitive harm or disadvantage.   (2) (a) Nothing in this part may be construed to prescribe or impose corporate governance standards and internal procedures beyond that which is required under applicable state corporate law.   (b) Notwithstanding subsection (2)(a), nothing in this part may be construed to limit the commissioner's authority or the rights or obligations of third parties under Title 33.   (3) The requirements of this part apply to all insurers domiciled in the state.   History: En. Sec. 2, Ch. 9, L. 2017.
MT Code § 33-2-2103 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 21. Corporate Governance Annual Disclosure|33-2-2103. Definitions

  33-2-2103. Definitions. As used in this part, the following definitions apply:   (1) "CGAD" means a corporate governance annual disclosure, a confidential report filed by the insurer or insurance group made in accordance with the requirements of this part.   (2) "Commissioner" means the insurance commissioner of the state of Montana.   (3) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in 33-2-1101.   (4) "Insurer" has the meaning provided in 33-1-201, except that it may not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.   (5) "NAIC" means the national association of insurance commissioners.   History: En. Sec. 3, Ch. 9, L. 2017.
MT Code § 33-2-2104 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 21. Corporate Governance Annual Disclosure|33-2-2104. Disclosure requirement

  33-2-2104. Disclosure requirement. (1) An insurer or the insurance group of which the insurer is a member shall, no later than June 1 of each calendar year, submit to the commissioner a CGAD that contains the information described in 33-2-2106. Notwithstanding any request from the commissioner made pursuant to subsection (3), if the insurer is a member of an insurance group, the insurer shall submit the report required by this section to the commissioner of the lead state for the insurance group, in accordance with the laws of the lead state, as determined by the procedures outlined in the financial analysis handbook adopted by rule by the commissioner.   (2) The CGAD must include a signature of the insurer or insurance group's chief executive officer or corporate secretary attesting to the best of that individual's belief and knowledge that the insurer has implemented the corporate governance practices and that a copy of the disclosure has been provided to the insurer's board of directors or the appropriate committee of the board of directors.   (3) An insurer not required to submit a CGAD under this section shall do so upon the commissioner's request.   (4) For purposes of completing the CGAD, the insurer or insurance group may provide information regarding corporate governance at the ultimate controlling parent level, an intermediate holding company level, or the individual legal entity level, depending on how the insurer or insurance group has structured its system of corporate governance. The insurer or insurance group is encouraged to make the CGAD disclosures at the level at which the insurer's or insurance group's risk appetite is determined, or at which the earnings, capital, liquidity, operations, and reputation of the insurer are overseen collectively and at which the supervision of those factors are coordinated and exercised, or the level at which legal liability for failure of general corporate governance duties would be placed. If the insurer or insurance group determines the level of reporting based on these criteria, it shall indicate which of the three criteria was used to determine the level of reporting and explain any subsequent changes in the level of reporting.   (5) The review of the CGAD and any additional requests for information must be made through the lead state as determined by the procedures within the financial analysis handbook referenced in subsection (1).   (6) Insurers providing information substantially similar to the information required by this part in other documents provided to the commissioner, including a proxy statement filed in conjunction with form B requirements, or other state or federal filings provided to the commissioner may not be required to duplicate that information in the CGAD but may only be required to cross-reference the document in which the information is included.   History: En. Sec. 4, Ch. 9, L. 2017.
MT Code § 33-2-2105 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 21. Corporate Governance Annual Disclosure|33-2-2105. Rulemaking authority

  33-2-2105. Rulemaking authority. The commissioner may, upon notice and opportunity for all interested persons to be heard, issue rules and orders necessary to carry out the provisions of this part.   History: En. Sec. 5, Ch. 9, L. 2017.
MT Code § 33-2-2106 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 21. Corporate Governance Annual Disclosure|33-2-2106. Contents of corporate governance annual disclosure

  33-2-2106. Contents of corporate governance annual disclosure. (1) The insurer or insurance group has discretion over the responses to the CGAD inquiries provided that the CGAD contains the material information necessary to permit the commissioner to gain an understanding of the insurer's or group's corporate governance structure, policies, and practices. The commissioner may request additional information that the commissioner deems material and necessary to provide a clear understanding of the corporate governance policies, the reporting or information system, or controls implementing those policies.   (2) Notwithstanding subsection (1), the CGAD must be prepared consistent with any rules adopted by the commissioner. Documentation and supporting information must be maintained and made available upon examination or upon request of the commissioner.   History: En. Sec. 6, Ch. 9, L. 2017.
MT Code § 33-2-2109 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 21. Corporate Governance Annual Disclosure|33-2-2109. Sanctions -- penalties

  33-2-2109. Sanctions -- penalties. Any insurer failing, without just cause, to timely file the CGAD as required in this part shall, after notice and hearing, pay a penalty of $100 for each day's delay to the commissioner. The penalty must be collected by the commissioner in the name of the state of Montana and deposited in the general fund. The maximum penalty under this section is $1 million. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.   History: En. Sec. 9, Ch. 9, L. 2017.
MT Code § 33-2-2201 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2201. Certificate of authority required

  33-2-2201. Certificate of authority required. (1) A private air ambulance service subject to this part shall obtain a certificate of authority from the commissioner prior to selling, soliciting, or negotiating a membership agreement in Montana.   (2) A private air ambulance service applying for a certificate of authority shall submit an application on a form prescribed by the commissioner.   (3) The commissioner may issue a certificate of authority if the private air ambulance service has complied with the applicable provisions of Title 50 and this title unless the commissioner finds that issuance of the certificate of authority is contrary to the public interest.   (4) A private air ambulance service may renew its certificate of authority upon payment of the annual fee specified in 33-2-2202 on or before March 1 of each year and upon continued compliance with the applicable provisions of Title 50 and this title.   (5) The requirements of this section are in addition to any other licensing or registration requirements that apply to the private air ambulance service.   History: En. Sec. 1, Ch. 210, L. 2017.
MT Code § 33-2-2202 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2202. Fees

  33-2-2202. Fees. A private air ambulance service subject to this part shall pay the following fees to the commissioner for services rendered:   (1) issuance of a certificate of authority, $300;   (2) annual renewal fee, $300; and   (3) filing of a membership agreement or other forms, $50.   History: En. Sec. 2, Ch. 210, L. 2017.
MT Code § 33-2-2203 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2203. Suspension or revocation

  33-2-2203. Suspension or revocation. (1) The commissioner may suspend or revoke a private air ambulance service certificate of authority if the private air ambulance service:   (a) no longer meets the requirements for the certificate of authority;   (b) materially fails to comply with a membership agreement issued to residents of Montana;   (c) is in unsound fiscal condition or is demonstrated to be using methods or practices in the conduct of its business that render its further transaction of insurance in this state injurious or hazardous to its members or to the public; or   (d) violates an applicable provision of law.   (2) Unless otherwise provided in the order of suspension or revocation, the private air ambulance service shall continue to honor membership agreements that are in force at the time of revocation or suspension.   History: En. Sec. 4, Ch. 210, L. 2017.
MT Code § 33-2-2204 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2204. and 33-2-2205 reserved

  33-2-2204 and 33-2-2205 reserved.
MT Code § 33-2-2206 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2206. Membership agreement -- contents

  33-2-2206. Membership agreement -- contents. A membership agreement issued under this part must contain:   (1) the effective dates of the membership agreement;   (2) a grace period of 30 days for payment of a renewal membership fee;   (3) a description of what constitutes acceptable insurance coverage if eligibility for the membership agreement is conditioned on the member's current and continuing health insurance coverage;   (4) a statement that, except for decisions made as provided in 33-1-102(6), individuals enrolled in medicare, medicaid, or the healthy Montana kids plan under Title 53, chapter 4, part 11, are not subject to charges billed by a private air ambulance service in excess of applicable deductibles, coinsurance, and copayments;   (5) a statement that the membership agreement is an insurance contract;   (6) a description and graphic illustration of the base locations and effective coverage area of the private air ambulance service;   (7) a list of other private air ambulance services with which reciprocity exists under 50-6-320;   (8) a statement that:   (a) participation in a membership program does not guarantee that in the event of a transport, the private air ambulance service will provide the transport; and   (b) unless reciprocity exists under 50-6-320, if another private air ambulance service provides the transport, the individual will not receive the benefits provided under the membership agreement; and   (9) a definition of "medical necessity" if membership coverage of a transport is conditioned on a finding of medical necessity.   History: En. Sec. 6, Ch. 210, L. 2017.
MT Code § 33-2-2207 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2207. Filings

  33-2-2207. Filings. (1) Pursuant to Title 33, chapter 1, part 5, a private air ambulance service subject to this part shall file for approval any membership agreement, including any rider or endorsement.   (2) A filing under subsection (1) must include all fee schedules associated with the membership agreement.   History: En. Sec. 3, Ch. 210, L. 2017.
MT Code § 33-2-2208 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2208. Trade practices

  33-2-2208. Trade practices. (1) A private air ambulance service subject to this part may not use health status as a reason to:   (a) refuse to issue or renew a membership agreement;   (b) assess a differing rate or charge for the membership agreement; or   (c) exclude a specific individual for a membership agreement issued for a household or other group of individuals.   (2) A private air ambulance service subject to this part may not sell, solicit, negotiate, or advertise a membership program in a geographic area for which the private air ambulance does not routinely provide service.   (3) Except as provided in subsection (4)(b), if membership coverage of a transport is conditioned on a finding of medical necessity, a qualified medical professional shall render the determination.   (4) A membership agreement requirement of medical necessity is satisfied if:   (a) the treating physician requesting the transport certifies that the transport is medically necessary; or   (b) the member's insurer determines that the transport is medically necessary.   History: En. Sec. 5, Ch. 210, L. 2017.
MT Code § 33-2-2209 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2209. and 33-2-2210 reserved

  33-2-2209 and 33-2-2210 reserved.
MT Code § 33-2-2211 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2211. Recordkeeping requirements

  33-2-2211. Recordkeeping requirements. (1) A private air ambulance service subject to this part shall keep records of:   (a) all insurance transactions conducted in Montana; and   (b) all transports provided to individuals entering into membership agreements.   (2) A private air ambulance service subject to this section shall make the records under subsection (1) available to the commissioner on request.   History: En. Sec. 7, Ch. 210, L. 2017.
MT Code § 33-2-2212 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2212. Relationship to other laws

  33-2-2212. Relationship to other laws. (1) Except as provided in subsection (2), the chapters and provisions of this title do not apply to a private air ambulance service.   (2) Title 33, chapter 1, parts 3, 4, 5, 12, and 13, chapter 18, parts 2 and 10, and chapter 19 as well as this part apply to a private air ambulance service that offers a membership program covering out-of-pocket expenses in excess of deductibles, copays, and coinsurance incurred for out-of-network services using the private air ambulance service or to private air ambulance services that are out-of-network and with which the membership program has reciprocity.   (3) A membership program of the type described in subsection (2) is insurance as defined in 33-1-201.   History: En. Sec. 8, Ch. 210, L. 2017.
MT Code § 33-2-2213 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 2. Regulation of Insurance Companies|Part 22. Private Air Ambulance Services|33-2-2213. Rulemaking authority

  33-2-2213. Rulemaking authority. The department shall adopt rules necessary to implement this part.   History: En. Sec. 9, Ch. 210, L. 2017.