6.6.8905    QUALITY ASSURANCE STRUCTURE AND ACCREDITATION

(1) 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 assurance program.

(2) The health carrier may delegate quality assurance activities. The health carrier shall retain responsibility for the performance of all delegated activities and shall develop and implement review and reporting requirements to ensure that the delegated entity performs all delegated quality assurance activities.

(3) A health carrier whose managed care quality assurance plan has been accredited by a nationally recognized accrediting organization shall initially provide a copy of the accreditation certificate or outcome report and the accrediting standards used by the accrediting organization to the commissioner.

(a) If the commissioner finds that the standards of the nationally recognized accrediting organization meet or exceed the commissioner's standards, the commissioner will approve the health carrier's quality assurance program.

(b) After approval by the commissioner, the accredited health carrier shall provide proof of its continued accreditation annually to the commissioner.

(c) All accredited health carriers, regardless of their offering of closed, combination, or open plans, must comply with ARM 6.6.8907, 6.6.8910, 6.6.8915, and 6.6.8916.

(d) The commissioner will maintain a list of its approved accrediting organizations whose standards have been determined by the commissioner to meet or exceed the commissioner's quality assurance standards.

 

History: 33-36-105, MCA; IMP, 33-36-105, 33-36-302, MCA; NEW, 2001 MAR p. 1342, Eff. 7/20/01; TRANS, from 37.108.505, 2023 MAR p. 1403, Eff. 1/1/24; AMD, 2024 MAR p. 714, Eff. 4/13/24.