24.29.2326    AREAS SERVED BY THE MANAGED CARE ORGANIZATION

(1) For the purposes of this rule, the term "claimant" means only those persons whose workers' compensation insurer has a service contract with the MCO in question.

(2) A claimant may be served by any MCO that offers primary medical services by an appropriate treating physician within 30 miles of the claimant's residence. If no MCO exists within 30 miles of the claimant's residence, then the claimant may be directed to any MCO that is within 100 miles of the place of residence. If no MCO exists within 100 miles of the place of residence of the claimant, then the claimant may be directed to the nearest MCO. If the claimant requires specialty medical services that are not available within the stated mileage restrictions, the managed care plan may refer the claimant to a provider outside of the stated mileage restrictions.

(3) The MCO must file with the department a map, of a scale not smaller than that used by the official Montana highway map, showing circles of a 30 mile radius and a 100 mile radius from each town where the primary medical services are offered by the managed care plan.

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