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Rule Title: UTILIZATION REVIEW AND QUALITY ASSURANCE
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Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: HEALTHY MONTANA KIDS (HMK)
Subchapter: Services and Provider Requirements
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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37.79.607    UTILIZATION REVIEW AND QUALITY ASSURANCE

(1) The third party administrator shall have adequate staff and procedures to assure that health care provided to enrollees is medically necessary and appropriate.

(2) The third party administrator shall comply with and cooperate in any external quality review that may be implemented by the department or its designee. An external quality review may include participation in the design of the review, collection of data, and making data available to the department or its designee.

History: 53-4-1009, MCA; IMP, 53-4-1003, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08.


 

 
MAR Notices Effective From Effective To History Notes
37-415 1/18/2008 Current History: 53-4-1009, MCA; IMP, 53-4-1003, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08.
2/13/2004 1/18/2008 History: Sec. 53-4-1009, MCA; IMP, Sec. 53-4-1003, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04.
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