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24.29.2301    PURPOSE

(1) The purpose of these rules concerning managed care is to provide a process to certify managed care organizations (MCO) in a manner consistent with the purposes and provisions of the Workers' Compensation Act. MCOs are to serve the medical needs of injured workers in an efficient and cost-effective manner.

(2) A MCO may be formed by a single health care provider, a hospital, a consortium of medical service providers, or other groups or entities that provide the services required by these rules. In order to expand the areas served by a MCO, the use of satellite office locations providing medical services to injured workers is encouraged.

(3) Although these rules do not regulate preferred provider organizations (PPOs) , insurers are encouraged to use PPOs in addition to or in conjunction with the use of MCOs.

(4) The certification procedure contained in these rules consists of a two step process of a preliminary application and a final application. The department anticipates that preliminary applications may have to be revised or modified, and emphasizes that applicants are engaged in a process of certification. Certification of a MCO by the department, however, does not obligate insurers to contract with any MCO.

History: Sec. 39-71-203, 39-71-1103 and 39-71-1105 MCA; IMP, Sec. 39-71-1103 and 39-71-1105 MCA; NEW, 1994 MAR p. 420, Eff. 3/1/94.

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