2009 Montana Code Annotated
TITLE 53. SOCIAL SERVICES AND INSTITUTIONS
CHAPTER 6. HEALTH CARE SERVICES
Part 7. Medicaid Managed Care
53-6-702. Definitions.

     53-6-702. Definitions. As used in this part, the following definitions apply:
     (1) "Department" means the department of public health and human services.
     (2) "Health maintenance organization" means a health maintenance organization as defined in 33-31-102.
     (3) (a) "Managed care community network" or "network" means an entity, other than a health maintenance organization, that provides or arranges for comprehensive physical or mental health care services under a contract with the department, that is reimbursed by a capitated rate or a fixed monetary amount for a specified time period with a risk of financial loss or a financial incentive to the entity, and that:
     (i) contracts for an estimated annual value of $1 million or more of state and federal medicaid funds; or
     (ii) operates statewide or covers 20% or more of the medicaid population.
     (b) The term does not include a provider of health care services under a contract with the department on a fee-for-service basis or a PACE organization, as defined in 42 CFR 460.6, that has received a waiver under 33-31-201.
     (4) "Managed health care entity" or "entity" means a health maintenance organization or a managed care community network.
     (5) "Program" means an element of the integrated health care system created by this part.

     History: En. Sec. 2, Ch. 502, L. 1995; amd. Sec. 5, Ch. 466, L. 2001; amd. Sec. 3, Ch. 401, L. 2003; amd. Sec. 4, Ch. 403, L. 2003; amd. Sec. 3, Ch. 195, L. 2009.