6.6.8801    DEFINITIONS

The following definitions, in addition to those contained in 33-36-103, MCA, apply to this chapter:

(1) "Access plan" means a document filed by a health carrier with the commissioner that complies with the standards set forth in ARM 6.6.8805 through 6.6.8807 and 33-36-201, MCA.

(2) "Advanced practice registered nurse" means a nurse midwife, a nurse anesthetist, a nurse practitioner, or a clinical nurse specialist.

(3) "Geographic service area" means a geographic area of Montana in which a health carrier has a network that has been deemed adequate by the commissioner.

(4) "Mid-level provider" means a physician assistant-certified or an advanced practice registered nurse.

(5) "Non-urgent care with symptoms" means care required for an illness, injury, or condition with symptoms that do not require care within 24 hours to prevent a serious risk of harm but do require care that is neither routine nor preventive in nature.

(6) "Primary care provider (PCP)" means a physician, mid-level provider, federally qualified health center or rural health clinic as defined in ARM 37.86.4401, migrant health center, or other community-based provider that is designated by a health carrier to supervise, coordinate, or provide initial or continuing care to an enrollee, and if required by the health carrier, initiate a referral for specialty care services rendered to the enrollee.

(7) "Specialty provider" or "specialist" means a physician or other provider whose area of specialization is an area other than general medicine, family medicine, general internal medicine, or general pediatrics. A provider whose area of specialization is obstetrics and/or gynecology may be either a PCP or a specialist within the meaning of this rule.

(8) "Urgent care" means those health care services that are not emergency services but that are necessary to treat a condition or illness that could reasonably be expected to present a serious risk of harm if not treated within 24 hours.

 

History: 33-36-105, MCA; IMP, 33-36-103, 33-36-105, MCA; NEW, 1999 MAR p. 2052, Eff. 9/24/99; TRANS, from 37.108.201, 2023 MAR p. 1401, Eff. 10/21/23; AMD, 2024 MAR p. 713, Eff. 4/13/24.