INSURANCE DEPARTMENT

6.6.8842 RESPONSIBILITY FOR CONTRACTED SERVICES A health carrier offering a managed care plan that uses a contractual arrangement to provide services to covered persons remains responsible for meeting the requirements of this chapter, including documentation requirements. Authori…

6.6.8850 CORRECTIVE ACTION (REPEALED) (REPEALED) Authorizing statute(s): 33-36-105, MCA Implementing statute(s): 33-36-105, MCA History: NEW, 1999 MAR p. 2052, Eff. 9/24/99; TRANS, from 37.108.250, 2023 MAR p. 1401, Eff. 10/21/23; REP, 2024 MAR p. 713, Eff. 4/13/24.

6.6.8851 APPEAL FROM DEPARTMENT DECISION (REPEALED) (REPEALED) Authorizing statute(s): 2-4-201, 33-36-105, MCA Implementing statute(s): 2-4-201, 33-36-105, MCA History: NEW, 1999 MAR p. 2637, Eff. 9/24/99; TRANS, from 37.108.251, 2023 MAR p. 1401, Eff. 10/21/23; REP, 2024 MAR p. …

6.6.8901 PURPOSE The purpose of these rules is to implement the quality assurance provisions of the Montana Managed Care Plan Network Adequacy and Quality Assurance Act specified in Title 33, chapter 36, part 3, MCA. These rules establish mechanisms for thecommissioner to evaluat…

6.6.8902 DEFINITIONS The following definitions, in addition to those contained in 33-36-103, MCA, apply to this subchapter: "HEDIS" means health plan employer data and information set, a standardized set of performance measures used by the national committee for quality assurance…

6.6.8905 QUALITY ASSURANCE STRUCTURE AND ACCREDITATION The health carrier shall appoint, prior to commencing operation, a medical physician licensed to practice in the state of Montana to advise, oversee, and actively participate in the implementation and operation of the quality…

6.6.8906 WRITTEN DESCRIPTION OF QUALITY ASSESSMENT PLAN The health carrier shall implement a written quality assessment plan that is evaluated annually and updated as necessary. The plan must be submitted to thecommissioner byJune 1 of each year. The plan must describe: the plan'…

6.6.8907 COMPONENTS OF QUALITY ASSESSMENT ACTIVITIES Annually, the health carrier shall evaluate its quality assessment activities by using the following 2024HEDIS measures: childhood immunization; breast cancer screening; cervical cancer screening; comprehensive diabetes care; a…

6.6.8910 QUALITY IMPROVEMENT At the commissioner's request, the health carrier shall provide documentation on its quality improvement activities and an evaluation of the effectiveness of the previous year's quality improvement activities. Such documentation must include the healt…

6.6.8911 CLINICAL FOCUSED STUDY The health carrier shall conduct a focused study relevant to the quality of its services for enrollee care. The health carrier must document the clinical focused study and submit it to the commissioner at the commissioner's request. The health carr…

6.6.8915 ENROLLEE COMPLAINT SYSTEM The health carrier shall have an internal complaint system for enrollees. Such a system shall comply with the requirements of 33-31-303, MCA. The health carrier shall conduct ongoing evaluations of all enrollee complaints, including complaints a…

6.6.8916 RECORDING CONSUMER SATISFACTION The health carrier shall record consumer components that identify enrollees' perceptions on the quality of the health carrier's services, including: enrollee satisfaction surveys; and enrollee complaints, including: the health carrier's re…

6.6.8920 CORRECTIVE ACTION (REPEALED) (REPEALED) Authorizing statute(s): 33-36-105, MCA Implementing statute(s): 33-36-105, 33-36-401, MCA History: NEW, 2001 MAR p. 1342, Eff. 7/20/01; TRANS, from 37.108.520, 2023 MAR p. 1403, Eff. 1/1/24; REP, 2024 MAR p. 714, Eff. 4/13/24.

6.6.8921 INFORMAL RECONSIDERATION OF DEPARTMENT DECISION (REPEALED) (REPEALED) Authorizing statute(s): 33-36-105, MCA Implementing statute(s): 33-36-401, MCA History: NEW, 2001 MAR p. 1342, Eff. 7/20/01; TRANS, from 37.108.521, 2023 MAR p. 1403, Eff. 1/1/24; REP, 2024 MAR p. 714,…

6.6.9001 APPLICATION REQUIREMENTS An application for a waiver under33-2-2501, MCA,must include the following information: the identity of the insurer applying for the waiver; the identity of the directors and executive officers of the insurer, any persons who are beneficial owner…

6.6.9002 WAIVER MONITORING At the time of granting a waiver, the commissioner shall provide an insurer granted a waiver under33-2-2501, MCA,with a list of reporting requirements and dates for reporting as warranted by the facts and circumstances of the particular waiver. Authoriz…

6.6.9003 WAIVER REVOCATION The commissioner may revoke a waiver if the insurer who obtains the waiver fails to comply with any terms, conditions, or limitations established by the commissioner, the requirements of 33-2-2501, MCA, or if the waiver is causing harm to a consumer or …

6.6.9004 WAIVER EXTENSION An extension request under 33-2-2501(3)(b), MCA,must be submitted to the commissioner within 45 days of the expiration of the waiver period. This request must include the length of the extension period requested and the specific reasons why the extension…

6.6.9005 EXPEDITED WAIVER APPLICATIONS Where a product or service has been granted a waiver by the Commissioner, any applicant wishing to offer a substantially similar product or service may file an expedited application meeting the following requirements: An application must be …

6.6.901 PURPOSE The purpose of this rule is to set forth standards to protect active duty service members of the United States Armed Forces from dishonest and predatory insurance sales practices by declaring certain identified practices to be false, misleading, deceptive, or unfa…

6.6.902 SCOPE This rule shall apply only to the solicitation or sale of any life insurance or annuity product by an insurer or insurance producer to an active duty service member of the United States Armed Forces. Authorizing statute(s): 33-1-313, 33-18-103, MCA Implementing stat…

6.6.903 AUTHORITY This rule is issued under the authority of 2007 Montana Laws, chapter 333 (to be codified as 33-18-103 , MCA, 2007). Authorizing statute(s): 33-1-313, 33-18-103, MCA Implementing statute(s): 33-18-103, MCA History: NEW, 2007 MAR p. 1180, Eff. 1/1/08.

6.6.904 EXEMPTIONS This rule shall not apply to solicitations or sales involving: credit insurance; group life insurance or group annuities where there is no in-person, face-to-face solicitation of individuals by an insurance producer or where the contract or certificate does not…

6.6.905 DEFINITIONS For the purposes of ARM 6.6.901 through 6.6.909: "Active duty" means full-time duty in the active military service of the United States and includes members of the reserve component (National Guard and Reserve) while serving under published orders for active d…

6.6.906 PRACTICES DECLARED FALSE, MISLEADING, DECEPTIVE, OR UNFAIR ON A MILITARY INSTALLATION The following acts or practices when committed on a military installation by an insurer or insurance producer with respect to the in-person, face-to-face solicitation of life insurance a…

6.6.907 PRACTICES DECLARED FALSE, MISLEADING, DECEPTIVE, OR UNFAIR REGARDLESS OF LOCATION The following acts or practices by an insurer or insurance producer constitute corrupt practices, improper influences, or inducements and are declared to be false, misleading, deceptive, or …

6.6.908 SEVERABILITY If any provision of these rules or the application thereof to any person or circumstance is held invalid for any reason, the invalidity shall not affect the other provisions or any other application of these rules which can be given effect without the invalid…

6.6.909 EFFECTIVE DATE ARM 6.6.901 through 6.6.909 shall become effective January 1, 2008, and shall apply to acts or practices committed on or after the effective date. Authorizing statute(s): 33-1-313, 33-18-103, MCA Implementing statute(s): 33-18-103, MCA History: NEW, 2007 MA…