reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.80 - Classification Review Committee › Rule 6.6.8001 - AGENCY ORGANIZATION

Current through Register Vol. 13, July 5, 2024
(1) History. The
				classification review committee is created by statute. The district court held
				in Cause No. BDV-91-1585, state of Montana, first judicial district, entitled
				State Compensation Mutual Insurance Fund v. R/E. Developers, Inc., decided
				August 14, 1992, that the classification review committee is a state agency
				defined by 2-4-102, MCA. As a state agency,
				the classification review committee is required to promulgate procedural rules
				pursuant to the Montana Administrative Procedure Act. In 1993, the legislature
				amended 33-16-1012, MCA, to give the
				committee express rulemaking authority.
(2) Nature of committee. The classification
				review committee is a state agency as defined by
				2-4-102, MCA. Documents and other
				information concerning the classification review committee's actions are made
				available for public review at the office of the commissioner of insurance. The
				classification review committee consists of five members, of whom four are
				appointed by the commissioner of insurance and one is appointed by the
				executive director of the state fund, as provided in
				33-16-1011, MCA. The
				classification review committee is staffed as determined necessary by the
				National Council on Compensation Insurance or each other workers' compensation
				rating organization as the classification review committee may
				designate.
(3) Inquiries and
				submissions. Unless otherwise provided in these rules or by special notice, all
				inquiries and submissions to the classification review committee should be made
				to the Montana Classification Review Committee in care of the National Council
				on Compensation Insurance, 901 Peninsula Corporate Circle, Boca Raton, FL
				33487-1362; Telephone:
				561-893-3820; Email:
				DisputeResolution@ncci.com; Fax:
				561-893-5043.
AUTH:
					 33-16-1012, MCA; IMP:
					 2-4-201,
					 33-16-1011,
					 33-16-1012,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.81 - Procedural Rule › Rule 6.6.8101 - ADOPTION OF MODEL RULES

Current through Register Vol. 13, July 5, 2024
(1) The
				classification review committee adopts and incorporates by reference the
				following of the attorney general's Model Procedural Rules:
(a)1.3.102;
(b)1.3.203 through
				1.3.211;
(c)1.3.216;
(d)1.3.218; and
(e)1.3.222 through
				1.3.233.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.82 - Contested Case Procedures Used by the Classification Review Committee › Rule 6.6.8201 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The following definitions apply to this subchapter, unless
				  context or the particular rule requires otherwise:
(1) "Classification" means a category of risk
				based on the nature of the work performed.
(2) "Classification decision" means the
				classification assigned by the insurer.
(3) "Classification determination" means the
				determination made by the committee of the appropriate
				classification.
(4) "Committee"
				means the classification review committee created under
				33-16-1011, MCA.
(5) "Insurer" means an authorized insurer
				writing workers' compensation coverage in this state, including the state
				compensation insurance fund. For purposes of these rules, "insurer" does not
				include employers electing to be bound by compensation plan No. 1 of the
				Montana Workers' Compensation Act.
Sec.
					 33-16-1012, MCA; IMP,
					 33-16-1011,
					 33-16-1012,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.82 - Contested Case Procedures Used by the Classification Review Committee › Rule 6.6.8202 - ADMINISTRATIVE APPEAL OF CLASSIFICATION DECISION

Current through Register Vol. 13, July 5, 2024
(1) An employer may appeal a classification
				decision by filing a notice of administrative appeal. The notice of
				administrative appeal must contain a short statement of the reasons for the
				appeal and a statement of the general nature of the relief sought. An employer
				must request an in-person hearing simultaneously with the filing of the notice
				of administrative appeal. If a request for an in-person hearing is not made
				when the notice of administrative appeal is filed, the committee may hold a
				hearing pursuant to ARM
				6.6.8206 in lieu of an in-person
				hearing.
(2) The notice of
				administrative appeal must be filed with the classification review
				committee.
(3) The initial hearing
				conducted by the committee must be informal and non-binding upon the parties
				and must be conducted pursuant to the rules of procedure set forth in ARM
				6.6.8203.
(4) A party who is aggrieved by the informal
				and non-binding decision of the committee, or by the refusal of a party to be
				bound by the advisory decision as provided in ARM
				6.6.8202A may initiate an informal
				contested case proceeding pursuant to
				2-4-604, MCA, before the committee
				pursuant to the rules of procedure set forth in ARM
				6.6.8203 - 6.6.8206.
AUTH:
					 33-16-1012, MCA; IMP
					 2-4-201,
					 33-16-1011,
					 33-16-1012,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.82 - Contested Case Procedures Used by the Classification Review Committee › Rule 6.6.8203 - INFORMAL CONTESTED CASE PROCEEDING

Current through Register Vol. 13, July 5, 2024
(1)
				This rule sets forth procedural steps that shall be followed in informal
				contested case hearings for administrative appeals involving classification
				determinations.
(2) Classification
				determination hearings must be informal proceedings held pursuant to
				2-4-604, MCA. Classification
				determination hearings are conducted in such a manner as to ascertain the
				substantial rights of the parties. All issues relevant to the classification
				determination are considered and passed upon. Any party and any witness may,
				under oath or affirmation, present pertinent evidence subject to examination by
				the committee and to cross-examination by the opposing party.
(3) With the consent of the committee, the
				parties may stipulate in writing the facts of the case. A hearing may
				nevertheless be held if the committee finds such a stipulation inadequate for
				determination in the administrative appeal.
(4) If any party fails to appear at the
				hearing, and good cause justifying continuance is not shown, the committee may
				decide the issues and make a determination on the best evidence available. The
				hearing may be postponed for good cause upon application to the committee
				orally or in writing before the hearing is concluded.
(5) The committee may continue any hearing
				for a reasonable period of time, in order to secure all the evidence that is
				necessary and to be fair to the parties.
(6) The committee may in its discretion or at
				the request of any party appoint a hearings examiner to decide all pre-hearing
				matters and to conduct the hearing. After the hearings examiner is appointed
				the examiner shall take evidence and prepare proposed findings of fact and
				conclusions of law which the committee may accept or reject or modify in whole
				or in part based upon the evidence produced during the informal contested case
				proceeding.
Sec.
					 33-16-1012, MCA; IMP, Sec.
					 2-4-603,
					 2-4-604,
					 33-16-1012,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.82 - Contested Case Procedures Used by the Classification Review Committee › Rule 6.6.8204 - NOTICE OF HEARING

Current through Register Vol. 13, July 5, 2024
(1) A hearing must
				be scheduled at a regular or special meeting of the committee.
(2) Written notice of a hearing must be
				mailed to the parties at least 20 days before the hearing or
				conference.
(3) A hearing notice
				must comply with
				2-4-601, MCA, except that the
				hearing notice shall not contain a statement
that a formal proceeding may be waived pursuant to
				  2-4-603, MCA. The hearing notice
				  shall contain a statement that the hearing must be an informal proceeding as
				  provided in
				  2-4-604, MCA.
Sec.
					 33-16-1012, MCA; IMP, Sec.
					 2-4-201,
					 2-4-601,
					 2-4-604,
					 33-16-1012,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.82 - Contested Case Procedures Used by the Classification Review Committee › Rule 6.6.8205 - PRE-HEARING EXCHANGE OF INFORMATION

Current through Register Vol. 13, July 5, 2024
(1) At
				least 10 days before a hearing, each party must mail or deliver the following
				information or documents to the committee and to all other parties:
(a) accurate copies of all documentary
				evidence;
(b) the names, addresses
				and telephone numbers of all proposed witnesses; and
(c) the telephone numbers where the parties
				and witnesses may be reached at the time of the hearing.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.82 - Contested Case Procedures Used by the Classification Review Committee › Rule 6.6.8206 - AUDIO, VIDEO, OR OTHER TELECOMMUNICATIONS TECHNOLOGY HEARINGS

Current through Register Vol. 13, July 5, 2024
(1) A hearing may be held by audio, video, or
				other telecommunications technology or media if a request for an in-person
				hearing is not filed with the notice of administrative appeal.
AUTH:
					 33-16-1012, MCA; IMP:
					 2-3-202,
					 2-4-201,
					 33-16-1012,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.83 - Classification Establishment › Rule 6.6.8301 - ESTABLISHMENT OF CLASSIFICATION FOR COMPENSATION PLAN NO. 2 AND PLAN NO. 3

Current through Register Vol. 13, July 5, 2024
(1) The committee adopts and incorporates by
				reference the NCCI Basic Manual for Workers Compensation and Employers
				Liability Insurance, as supplemented, including classifications established or
				revised in accordance with (2) below and
				33-16-1023(3),
				MCA, which establish classifications with respect to employers electing to be
				bound by compensation plan No. 2 and plan No. 3 as provided in Title 39,
				chapter 71, part 22 and part 23, MCA. A copy of the Basic Manual for Workers
				Compensation and Employers Liability Insurance is available for public
				inspection at the Office of the Commissioner of Insurance, 840 Helena Ave.,
				Helena, MT 59601. Copies of the Basic Manual for Workers Compensation and
				Employers Liability Insurance may be obtained by writing to the Montana
				Classification Review Committee in care of the National Council on Compensation
				Insurance, Inc., c/o Regulatory Assurance Department, 901 Peninsula Corporate
				Circle, Boca Raton FL 33487-1362. Persons obtaining a copy of the Basic Manual
				for Workers Compensation and Employers Liability Insurance must pay the
				committee's cost of providing such copies.
(2) The committee may amend the definition of
				a rate classification, establish a new rate classification, or delete an
				existing rate classification pursuant to the rulemaking procedures as provided
				in Title 2, chapter 4, part 3, MCA and the applicable Attorney General's Model
				Procedural Rules adopted by the committee.
AUTH:
					 33-16-1012, MCA; IMP:
					 2-4-103,
					 33-1-115,
					 33-16-1012,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8501 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
In addition to the definitions in
				  33-20-1302, MCA, the following
				  definitions apply to this subchapter:
(1) "Advertising" means any written,
				electronic or printed communication or any communication by means of recorded
				telephone messages or transmitted on radio, television, the internet or similar
				communications media, disseminated, circulated or placed before the public,
				directly or indirectly, for the purpose of creating an interest in or inducing
				a person to purchase or sell a life insurance policy or an interest in a life
				insurance policy pursuant to a viatical settlements contract or a viatical
				settlement purchase agreement.
(2)
				"Attending physician" means the insured's physician, as defined in
				33-20-1312(3),
				MCA.
(3) "Chronically ill" means:
(a) being unable to perform at least two
				activities of daily living (i.e., eating, toileting, transferring, bathing,
				dressing or continence) ;
(b)
				requiring substantial supervision to protect the individual from threats to
				health and safety due to severe cognitive impairment; or
(c) having a level of disability similar to
				that described in (3) (a) as determined by the secretary of health and human
				services as of the date the viatical settlement contract was signed.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8502 - LICENSE REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) To obtain a
				license as a viatical settlement provider, a person shall apply to the
				department by filling out an application for a license as a viatical settlement
				provider in a format prescribed by the commissioner and by supplying requested
				information. The application form must be accompanied by:
(a) a registration fee in the amount of
				$1900;
(b) a copy of an executed
				bond as surety; or
(c) a copy of an
				errors and omissions policy in an amount commensurate with a provider's
				exposure.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8503 - ANNUAL FEE AND REPORTING FORMS

Current through Register Vol. 13, July 5, 2024
(1) On or
				before March 1 of each year, viatical settlement providers shall submit to the
				department an annual fee in the amount of $1900.
(2) Forms for annual reporting required in
				33-20-1309, MCA, are available at
				the commissioner's office.
33-20-1315, MCA; IMP,
					 33-2-708,
					 33-20-1309,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8504 - FORMS AND MATERIALS FILINGS, APPROVALS, AND REVISIONS

Current through Register Vol. 13, July 5, 2024
(1) A viatical settlement provider shall file
				and have approved by the commissioner application forms, contracts and other
				forms as required by
				33-1-501 and
				33-20-1308, MCA.
(2) A viatical settlement provider or broker
				shall file with the commissioner information brochures, advertising, and other
				solicitation materials that a provider or broker uses to market viatical
				settlements to viators or prospective viators in this state before using such
				materials.
(3) If a viator, prior
				to effectuating a viatical settlement, requests any changes to a contract form
				previously approved by the commissioner, the provider shall file a letter with
				the commissioner requesting a deviation from the standard contract form. The
				letter must provide:
(a) the name of a
				viatical settlement provider;
(b)
				that the viator requested substantive revision;
(c) the form number of the viatical
				settlement contract that was originally proposed;
(d) the deviations from a standard viatical
				settlement contract; and
(e) that
				the payment was reasonable under ARM
				6.6.8507.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8505 - DISCLOSURE

Current through Register Vol. 13, July 5, 2024
(1) A disclosure document containing the
				disclosures required in
				33-20-1311, MCA, and this rule,
				shall be provided when an application for a viatical settlement contract is
				taken.
(2) The disclosure document
				must contain the following language :
(a) "all
				medical, financial, or personal information solicited or obtained by a viatical
				settlement provider or viatical settlement broker about a viator and insured,
				including the viator and insured's identity or the identity of family members
				is confidential."
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8506 - TRADE PRACTICE STANDARDS FOR REGULATING ADVERTISING AND SOLICITATION (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-20-1315, MCA; IMP,
					 33-20-1315,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8507 - STANDARDS FOR EVALUATION OF REASONABLE PAYMENTS

Current through Register Vol. 13, July 5, 2024
(1) In order to assure that viators receive a
				reasonable return for viaticating an insurance policy, the following shall be
				minimum discounts when the insured is terminally ill:
Insured's Life Expectancy
Minimum Percentage of Net Death Benefit
Less than 6 months
80%
At least 6 but less than 12 months
70%
At least 12 but less than 18 months
65%
At least 18 but no greater than 24 months
60%
24 months or more
50%
(2)
				If the insured is not terminally ill or chronically ill, the viator must
				receive at least the greater of the cash surrender value or accelerated death
				benefit of the policy.
(3) If the
				insured is chronically ill but not terminally ill, the viator must receive at
				least 30% of the net death benefit.
(4) Except where the cash surrender value or
				accelerated death benefit is paid, the percentage may be reduced by 5% for
				viaticating a policy for which the insurer of the policy has an A.M. Best
				rating that is at or below a marginal rating.
33-20-1315, MCA; IMP,
					 33-20-1315,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8509 - REGULATION AS A SECURITY

Current through Register Vol. 13, July 5, 2024
(1) A viatical
				settlement broker or a viatical settlement provider may not solicit, enter
				into, or negotiate viatical settlement contracts unless a broker or provider,
				through the exercise of due diligence, ensures that:
(a) the method of funding the financial
				obligations of a viatical settlement provider does not involve, directly or
				indirectly, an offer and sale of a "security", as defined in
				30-10-103(22),
				MCA; or
(b) if the method of
				funding the financial obligations of a viatical settlement provider does
				involve, directly or indirectly, an offer and sale of a "security", as defined
				in 30-10-103(22),
				MCA, a related offer and sale of a security is in compliance with the
				Securities Act of Montana,
				30-10-101, et seq., MCA.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8510 - REPORTING REQUIREMENT

Current through Register Vol. 13, July 5, 2024
(1) On or before
				March 1 of each calendar year, each viatical settlement provider licensed in
				this state shall submit the following related to the licensee's activities for
				the previous calendar year:
(a) a report of
				the viatical settlement transactions in all states and territories, which shall
				be submitted on Form VSP 001;
(b) a
				report of the viatical settlement transactions related to Montana viators,
				which shall be submitted on Form VSP 002;
(c) a report of the individual mortality of
				Montana insureds, which shall be submitted on Form VSP 003; and
(d) a certification of the information
				contained in the reports, which shall be submitted on Form VSPB 001 and shall
				be filed with the reports.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8511 - PROHIBITED PRACTICES

Current through Register Vol. 13, July 5, 2024
(1) A viatical
				settlement provider or viatical settlement broker shall not provide patient
				identifying information to any person, unless the insured provides written
				consent to the release of the information at or before the time the viator
				enters into a viatical settlement contract pursuant to ARM
				6.6.8505(3).
(2) A viatical settlement provider or
				viatical settlement broker shall obtain from a person that is provided with
				patient identifying information a signed affirmation that the person or entity
				will not further divulge the information without procuring the express, written
				consent of the insured for the disclosure. Notwithstanding the foregoing, if a
				viatical settlement provider or viatical settlement broker is served with a
				subpoena and, therefore, is compelled to produce records containing patient
				identifying information, it shall notify the viator and the insured in writing
				at the insured's last known address within five business days after receiving
				notice of the subpoena.
(3) A
				viatical settlement provider shall not act also as a viatical settlement
				broker, whether entitled to collect a fee directly or indirectly, in the same
				viatical settlement.
(4) A viatical
				settlement broker shall not, without the written agreement of the viator
				obtained prior to performing any services in connection with a viatical
				settlement, seek or obtain any compensation from the viator.
(5) A viatical settlement provider shall not
				use a longer life expectancy than is realistic in order to reduce the payout to
				which the viator is entitled.
33-20-1315, MCA; IMP,
					 33-20-1313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.85 - Viatical Settlement Agreements › Rule 6.6.8512 - INSURANCE COMPANY PRACTICES

Current through Register Vol. 13, July 5, 2024
(1) Life
				insurance companies authorized to do business in this state shall respond to a
				request for verification of coverage from a viatical settlement provider or a
				viatical settlement broker within 30 calendar days of the date a request is
				received, subject to the following conditions:
(a) a current authorization consistent with
				applicable law, signed by the policyowner or certificateholder, accompanies the
				request; and
(b) in the case of an
				individual policy or group coverage where details with respect to the
				certificate holder's coverage are maintained by the insurer, submission of a
				form prescribed by the commissioner, which has been completed by the viatical
				settlement provider or the viatical settlement broker in accordance with the
				instructions on the form.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8601 - PURPOSE AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) These rules are
				intended to establish an expedient and economical process for resolving billing
				disputes between insurers or health plans and air ambulance services. The
				independent reviewer shall conduct all aspects of the dispute resolution
				process in a manner that furthers these objectives while providing for accurate
				determination of fair market price.
(2) The rules in this subchapter apply to
				disputes between:
(a) health insurance
				issuers, as defined in
				33-22-140, MCA, government health
				plans authorized in Title 2, chapter 18, part 7, MCA, or health plans
				established by the Montana university system authorized by Title 20, chapter
				25, part 13, MCA; and
(b)
				out-of-network air ambulance services, which are not owned or controlled by a
				Montana hospital system.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8602 - MAPA INAPPLICABLE

Current through Register Vol. 13, July 5, 2024
(1) A dispute
				resolution process subject to this subchapter:
(a) is not a contested case as defined in
				2-4-102, MCA;
(b) is not a proceeding before the
				commissioner; and
(c) is not
				subject to the Montana Administrative Procedure Act, Title 2, chapter 4, MCA.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8603 - CONFIDENTIALITY

Current through Register Vol. 13, July 5, 2024
(1) The parties and independent reviewer
				shall maintain the confidentiality of all information protected under
				applicable law, including protected health information under the Health
				Insurance Portability and Accountability Act of 1996, trade secret information
				protected by Title 30, chapter 14, part 4, MCA, or personal information
				protected under Title 33, chapter 19, MCA.
(2) The parties are entitled to discovery of
				any documents or information relevant to the determination of fair market
				value. However, the parties shall limit disclosure of protected information,
				including to the independent reviewer, to the minimum necessary to effectuate
				the dispute resolution process.
AUTH: 2-18-720, 20-25-1320, 33-2-2306,
					 33-19-106, MCA; IMP: 2-18-718,
					 2-18-719, 2-18-720, 20-25-1318, 20-25-1319, 20-25-1320, 33-2-2304, 33-2-2305,
					 33-2-2306,
					 33-19-306,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8604 - NOTICE OF DISPUTE - CONTENT

Current through Register Vol. 13, July 5, 2024
(1) After
				determining that an insurer or health plan and an air ambulance service cannot
				resolve a billing dispute, either party may communicate in writing to the other
				party its intent to submit the dispute to this arbitration process. Within 30
				days of that communication, the parties shall file a notice of dispute with the
				commissioner. The notice shall be mailed to: Office of the Montana State
				Auditor, c/o Chief Legal Counsel, 840 Helena Avenue, Helena, MT
				59601.
(2) The notice must specify:
(a) the parties to the dispute;
(b) the date(s) of service;
(c) the insured and (if different) the
				individual transported by the air ambulance service;
(d) the amount in controversy after insurer
				or health plan payment;
(e) whether
				the parties have agreed upon an independent reviewer, and if so, his or her
				contact information; and
(f) the
				contact information of each party's representative for purposes of the
				dispute.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8605 - INDEPENDENT REVIEWER SELECTION - SUBSTITUTION

Current through Register Vol. 13, July 5, 2024
(1) If the parties to a dispute agree upon an
				independent reviewer, the independent reviewer is presumed to be qualified
				without further verification by the commissioner.
(2) If a party believes an assigned
				independent reviewer has a conflict of interest, the party may request
				assignment of a different independent reviewer. Upon receipt of the request,
				the commissioner shall randomly appoint a replacement independent reviewer.
(3) Each party may request
				assignment of a different independent reviewer under (2) only once per dispute.
(4) A request under (2) must be
				made either within 10 calendar days after the commissioner notifies the parties
				of assignment of the independent reviewer or replacement independent reviewer,
				or within 10 calendar days of discovering new facts demonstrating that the
				reviewer has a conflict of interest.
(5) In addition to the one request for a
				replacement independent review allowed by (3), a party may make a request to
				the commissioner to assign a different independent reviewer if a conflict of
				interest exists. If the commissioner has good cause to believe reassignment of
				the independent reviewer is necessary, the commissioner may grant the request.
				Any request for reassignment must follow the timing requirements in (4).
(6) An independent reviewer may
				recuse himself or herself if an actual conflict of interest exists.
AUTH: 2-18-720, 20-25-1320, 33-2-2306, MCA ;IMP: 2-18-719,
					 2-18-720, 20-25-1319, 20-25-1320, 33-2-2305, 33-2-2306,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8606 - PRELIMINARY CONFERENCE

Current through Register Vol. 13, July 5, 2024
(1) Unless
				otherwise ordered by the independent reviewer or agreed to by the parties,
				within 30 days of appointment the independent reviewer shall hold a telephonic
				preliminary conference .
(2) During
				the preliminary conference, the parties and independent reviewer shall address
				any issues precedent to the hearing, including as applicable:
(a) establishing a scheduling
				order;
(b) whether the parties
				intend to call experts, and if so, whether the parties will exchange expert
				reports;
(c) procedures for
				maintaining confidentiality of documents, information, or testimony;
(d) whether the hearing will be conducted
				telephonically, in person, or by written submissions;
(e) any dispositive issues, including any
				assertion that the dispute is not properly subject to the dispute resolution
				process;
(f) coordinating document
				exchanges; and
(g) any mechanisms
				to streamline the dispute resolution process, such as the use of pre-filed
				testimony.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8607 - DISCOVERY

Current through Register Vol. 13, July 5, 2024
(1) Within 14 days after the preliminary
				conference, the parties shall exchange all documents upon which they intend to
				rely at hearing, a list of all witnesses they intend to call, and a summary of
				the expected testimony from each identified witness. The parties shall promptly
				supplement the disclosures as additional documents or witnesses become
				known.
(2) Each party is limited to
				one deposition except as agreed otherwise, or as ordered by the independent
				reviewer.
(3) A party may request
				additional documentation from the other party that it reasonably believes to be
				relevant and material to any factor in 33-2-2305(6), MCA. If a party refuses to
				comply, the requesting party may petition the independent reviewer, who shall
				require production if the request is for documentation reasonably believed to
				meet the standards of relevance and materiality, and would not be overly
				burdensome for the refusing party to produce.
(4) Parties may not propound discovery in the
				form of requests for admission or interrogatories.
AUTH: 2-18-720, 20-25-1320, 33-2-2306, MCA ;IMP: 2-18-718,
					 2-18-719, 2-18-720, 20-25-1318, 20-25-1319, 20-25-1320, 33-2-2304, 33-2-2305,
					 33-2-2306, MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8608 - EVIDENCE AND PROCEDURE

Current through Register Vol. 13, July 5, 2024
(1) The Montana
				Rules of Evidence and Montana Rules of Civil Procedure do not apply to the
				independent dispute resolution process.
(2) The parties may offer such evidence as is
				relevant and material to the dispute.
(3) The independent reviewer shall determine
				the admissibility of evidence. The independent reviewer may exclude evidence
				that is cumulative or irrelevant, or if the evidence cannot be sufficiently
				authenticated.
(4) The independent
				reviewer may render any necessary procedural determinations not set forth by
				statute or this subchapter.
AUTH: 2-18-720, 20-25-1320, 33-2-2306, MCA; IMP: 2-18-718,
					 2-18-719, 2-18-720, 20-25-1318, 20-25-1319, 20-25-1320, 33-2-2304, 33-2-2305,
					 33-2-2306, MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8609 - PREPARATION FOR HEARING

Current through Register Vol. 13, July 5, 2024
(1) No less than 14
				days prior to the adjudicatory hearing, the parties shall jointly submit a
				stipulation identifying all facts not in dispute, including as applicable:
(a) distance and method of transportation;
(b) actual rates of air ambulance
				billing and insurer or health plan reimbursement;
(c) characteristics of the transport vehicle
				and personnel;
(d) services
				provided during transport that were billed to the insured; and
(e) each party's calculation of the fair
				market price for the services provided.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8610 - HEARING

Current through Register Vol. 13, July 5, 2024
(1) Unless otherwise requested by either
				party, all hearings during the independent dispute resolution process should be
				held telephonically.
(2) Each party
				shall present evidence, which may include witness testimony in support of its
				fair market price determination. Witnesses shall be subject to examination by
				the adverse party and independent reviewer. Evidence may only be presented if
				it was provided to all parties at least 21 days prior to the hearing.
(3) The parties may consent to waive a
				telephonic or in-person hearing and proceed by filing opening and rebuttal
				briefs, with supporting affidavits and evidence, under terms established by the
				independent reviewer.
AUTH: 2-18-720, 20-25-1320, 33-2-2306, MCA ;IMP: 2-18-718,
					 2-18-719, 2-18-720, 20-25-1318, 20-25-1319, 20-25-1320, 33-2-2304, 33-2-2305,
					 33-2-2306, MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8611 - NON-COMPLIANCE WITH ORDER

Current through Register Vol. 13, July 5, 2024
(1) An independent
				reviewer may order sanctions as necessary to address a party's willful or
				repeated non-compliance with its obligations under statute, these rules, or an
				order of the independent reviewer.
(2) Sanctions may include:
(a) disallowing testimony or admission of
				evidence;
(b) drawing adverse
				inferences;
(c) a determination
				that the other party's calculation accurately reflects the fair market price of
				the services provided;
(d) if
				requested by the party not subject to the sanction, dismissal of the
				arbitration proceeding; and
(e) any
				other sanction appropriate for regulation of the proceedings not otherwise
				disallowed by law.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.86 - Air Ambulance Arbitration › Rule 6.6.8612 - FINAL DETERMINATION

Current through Register Vol. 13, July 5, 2024
(1) An independent
				reviewer shall issue a written final determination of the fair market price of
				the services provided no later than 60 days following the hearing.
(2) The final determination must provide a
				reasoned basis for the fair market price with supporting factual findings and
				legal conclusions.
(3) The final
				determination must be held confidential by all parties and the independent
				reviewer. However, upon the request of the commissioner any party or
				independent reviewer shall provide information necessary to review the
				efficiency, effectiveness, or outcomes of this process.
AUTH: 2-18-720, 20-25-1320, 33-2-2306, MCA ; IMP: 2-18-718,
					 2-18-719, 2-18-720, 20-25-1318, 20-25-1319, 20-25-1320, 33-2-2304, 33-2-2305,
					 33-2-2306, MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.87 - Corporate Governance Annual Disclosure › Rule 6.6.8701 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of these rules is to set
				forth the procedures for filing and the required contents of the CGAD necessary
				to carry out the provisions of the Corporate Governance Disclosure Act,
				33-2-2101 through
				33-2-2109, MCA.
AUTH:
					 33-2-2105, MCA IMP:
					 33-2-2101,
					 33-2-2102,
					 33-2-2103,
					 33-2-2104,
					 33-2-2105,
					 33-2-2106,
					 33-2-2107,
					 33-2-2108,
					 33-2-2109,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.87 - Corporate Governance Annual Disclosure › Rule 6.6.8702 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The following definitions apply to this subchapter:
(1) "CGAD" means the corporate governance
				annual disclosure required under Title 33, chapter 2, part 21, MCA.
(2) "Insurance group" means those insurers
				and affiliates included within an insurance holding company system as defined
				in 33-2-1101, MCA.
(3) "Senior management" means any corporate
				officer responsible for reporting information to the board of directors at
				regular intervals or providing this information to shareholders or regulators.
				"Senior management" includes the chief executive officer, chief financial
				officer, chief operations officer, chief procurement officer, chief legal
				officer, chief information officer, chief technology officer, chief revenue
				officer, chief visionary officer, or any other "C" level executive.
AUTH:
					 33-2-2105, MCA IMP:
					 33-2-2101,
					 33-2-2102,
					 33-2-2103,
					 33-2-2104,
					 33-2-2105,
					 33-2-2106,
					 33-2-2107,
					 33-2-2108,
					 33-2-2109,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.87 - Corporate Governance Annual Disclosure › Rule 6.6.8703 - FILING PROCEDURES

Current through Register Vol. 13, July 5, 2024
(1) An insurer, or
				the insurance group of which the insurer is a member, required to file a CGAD
				by Title 33, chapter 2, part 21, MCA, shall, no later than June 1 of each
				calendar year, submit to the commissioner a CGAD that contains the information
				described in ARM 6.6.8704 for the prior calendar year.
(2) The CGAD must include a signature of the
				insurer's or insurance group's chief executive officer or corporate secretary
				attesting to the best of that individual's belief and knowledge that:
(a) the insurer or insurance group has
				implemented the corporate governance practices; and
(b) a copy of the CGAD has been provided to
				the insurer's or insurance group's board of directors or the appropriate
				committee of the board of directors.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.87 - Corporate Governance Annual Disclosure › Rule 6.6.8704 - CONTENTS OF CORPORATE GOVERNANCE ANNUAL DISCLOSURE

Current through Register Vol. 13, July 5, 2024
(1) The insurer or insurance group shall be
				as descriptive as possible in completing the CGAD, and shall include any
				relevant attachments or example documents that are used in the governance
				process.
(2) The CGAD shall
				describe the insurer's or insurance group's corporate governance framework and
				structure. Its description shall include consideration of:
(a) the board of directors, including the
				rationale for the current board size and structure, the committees ultimately
				responsible for overseeing the insurer or insurance group, and the levels at
				which that oversight occurs, such as the ultimate control, intermediate holding
				company, or legal entity level; and
(b) the duties of the board and each of its
				significant committees and how they are governed, such as bylaws, charters, or
				informal mandates, as well as how the board's leadership is structured,
				including a discussion of the roles of chief executive officer and chairman of
				the board within the organization.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.87 - Corporate Governance Annual Disclosure › Rule 6.6.8705 - ADOPTION OF NAIC FINANCIAL ANALYSIS HANDBOOK

Current through Register Vol. 13, July 5, 2024
(1)
				For purposes of review of holding company systems and corporate governance
				disclosures, the commissioner adopts the financial analysis handbook, volumes
				one and two, most recently published on January 2, 2017 by the National
				Association of Insurance Commissioners. Copies of both volumes of the financial
				analysis handbook are available at:
www.naic.org/prod_serv_publications.htm
.
AUTH:
					 33-2-2105,
					 33-2-1117, MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.88 - Network Adequacy for Managed Care Plans › Rule 6.6.8801 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The following definitions, in addition to those contained in
				  33-36-103, MCA, apply to this
				  chapter:
(1) "Access plan" means a
				document filed by a health carrier with the commissioner that complies with the
				standards set forth in ARM
				6.6.8805 through
				6.6.8807 and
				33-36-201, MCA.
(2) "Advanced practice registered nurse"
				means a nurse midwife, a nurse anesthetist, a nurse practitioner, or a clinical
				nurse specialist.
(3) "Geographic
				service area" means a geographic area of Montana in which a health carrier has
				a network that has been deemed adequate by the commissioner.
(4) "Mid-level provider" means a physician
				assistant-certified or an advanced practice registered nurse.
(5) "Non- urgent care with symptoms" means
				care required for an illness, injury, or condition with symptoms that do not
				require care within 24 hours to prevent a serious risk of harm but do require
				care that is neither routine nor preventive in nature.
(6) "Primary care provider (PCP)" means a
				physician, mid-level provider, federally qualified health center or rural
				health clinic as defined in ARM
				37.86.4401, migrant health center,
				or other community-based provider that is designated by a health carrier to
				supervise, coordinate, or provide initial or continuing care to an enrollee,
				and if required by the health carrier, initiate a referral for specialty care
				services rendered to the enrollee.
(7) "Specialty provider" or "specialist"
				means a physician or other provider whose area of specialization is an area
				other than general medicine, family medicine, general internal medicine, or
				general pediatrics. A provider whose area of specialization is obstetrics
				and/or gynecology may be either a PCP or a specialist within the meaning of
				this rule.
(8) "Urgent care" means
				those health care services that are not emergency services but that are
				necessary to treat a condition or illness that could reasonably be expected to
				present a serious risk of harm if not treated within 24 hours.
AUTH:
					 33-36-105, MCA; IMP:
					 33-36-103,
					 33-36-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.88 - Network Adequacy for Managed Care Plans › Rule 6.6.8805 - ACCESS PLAN FILING AND REVIEW GUIDELINES

Current through Register Vol. 13, July 5, 2024
(1)
				When a health carrier submits a proposed access plan to the commissioner for
				review and approval, the commissioner will either approve, disapprove, or
				request additional information on the proposed plan within 60 calendar days.
				The commissioner has a total of 60 calendar days to review and issue a decision
				concerning any proposed access plan, not including any 30-calendar day response
				period that may be granted a health carrier proposing the plan. The
				commissioner may grant up to two 30-day response periods during the review of
				each access plan.
(2) During the
				commissioner's review of its proposed access plan, a health carrier must
				respond to the commissioner's request for information within 30 calendar days
				after the date of the request. If the response remains incomplete, the
				commissioner may grant the health carrier a second 30-calendar day period
				within which to submit a complete response. If, after two requests by the
				commissioner for information, the health carrier fails to provide information
				that the commissioner deems sufficient to satisfy its requests, the access plan
				will be disapproved and the health carrier will be required to submit a new
				proposed access plan prior to enrolling initial or additional
				enrollees.
(3) The total number of
				days allowed for the review of a given proposed access plan may not exceed 120
				calendar days, including both time spent by the commissioner in review of the
				proposed plan and any time granted to a health carrier to respond to the
				commissioner's requests for additional information.
AUTH:
					 33-36-105, MCA; IMP:
					 33-36-105,
					 33-36-201,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.88 - Network Adequacy for Managed Care Plans › Rule 6.6.8806 - ACCESS PLAN UPDATES

Current through Register Vol. 13, July 5, 2024
(1) Health carriers
				shall be responsible for monitoring the status of their networks and must
				submit an updated access plan to the commissioner within 30 calendar days after
				a material change in the status of their network. For the purposes of this
				rule, a material change is a change in the composition of a health carrier's
				provider network or a change in the size or demographic characteristics of the
				population enrolled with the health carrier that renders the health carrier's
				network non-compliant with one or more of the network adequacy standards set
				forth in ARM
				6.6.8815,
				6.6.8819, and
				6.6.8827. If the revised access
				plan is not submitted within 30 calendar days after the material change in
				network status occurs, the health carrier must cease enrolling new recipients
				in the affected geographic service area until the revised access plan is
				approved by the commissioner. Review of the revised access plan is subject to
				the procedures and consequences outlined in ARM
				6.6.8805.
(2) In addition to the requirement in (1):
(a) the health carrier must submit an updated
				access plan to the commissioner pursuant to
				33-36-201(4),
				MCA; and
(b) health carriers must
				file an updated access plan with the commissioner if the number of providers in
				the overall provider network or in any specialty provider network decreases by
				more than 5% during the year in any single geographic service area or in the
				overall network. The carrier must file the plan within 30 days of the date the
				carrier learns of the decrease.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.88 - Network Adequacy for Managed Care Plans › Rule 6.6.8808 - ACCESS CRITERIA

Current through Register Vol. 13, July 5, 2024
(1) The
				commissioner will utilize the criteria set forth in this chapter and Title 33,
				chapter 36, MCA, to determine whether the network maintained by a health
				carrier offering a managed care plan in Montana is sufficient in numbers and
				type of providers.
AUTH:
					 33-36-105, MCA; IMP:
					 33-36-105,
					 33-36-201,
					 MCA