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6.6.4909    MEASURES RELATED TO COST AND MEDICAL USAGE—UTILIZATION MEASURES

(1) A recognized patient-centered medical home payor shall report to the commissioner on the following utilization measures:

(a) emergency room visits; and

(b) hospitalization rates.

(2) A patient-centered medical home payor shall report this information for its entire member population and separately for those members that are attributed to a patient-centered medical home. If the payor does not track member attribution to a patient-centered medical home, that payor may report only for its entire member population.

(3) The commissioner shall provide detailed instructions on the agency web site regarding the required data reporting on utilization measures by patient-centered medical home payors.

(4) The first report is due March 31, 2015, and annually thereafter.

History: 33-40-104, MCA; IMP, 33-40-104, 33-40-105, MCA; NEW, 2014 MAR p. 3051, Eff. 12/25/14.

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