BEFORE THE COMMISSIONER OF SECURITIES AND INSURANCE

OFFICE OF THE MONTANA STATE AUDITOR

 

In the matter of the amendment of ARM 6.6.8901, 6.6.8905, 6.6.8906, 6.6.8907, 6.6.8910, 6.6.8911, 6.6.8915, and 6.6.8916, the repeal of ARM 6.6.8920 and 6.6.8921, and the adoption of NEW RULE I pertaining to Quality Assurance for Managed Care Plans

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NOTICE OF AMENDMENT AND REPEAL

 

TO: All Concerned Persons

 

1. On February 9, 2024, the Commissioner of Securities and Insurance, Office of the Montana State Auditor (CSI) published MAR Notice No. 6-286 pertaining to the proposed amendment, repeal, and adoption of the above-stated rules at page 162 of the 2024 Montana Administrative Register, Issue Number 3.  

 

2. A public hearing was not contemplated or requested. One written comment was received on March 8, 2024, by hand delivery to CSI offices. CSI's response to the comment is set forth in paragraph 6 below.

 

           3. CSI has amended ARM 6.6.8901, 6.6.8905, 6.6.8906, 6.6.8907, 6.6.8910, 6.6.8911, 6.6.8915, and 6.6.8916 as proposed.

 

4. CSI has repealed ARM 6.6.8920 and 6.6.8921 as proposed.

 

5. CSI does not adopt NEW RULE I. 

 

6. CSI has thoroughly considered the comment provided, which relates to NEW RULE I that was proposed in MAR Notice No. 6-286. The comment expressed concerns that NEW RULE I makes no allowance for a formal meeting, discussion, or negotiation by and between the CSI and an insurer in an attempt to reach a mutually agreeable corrective action plan. The comment stated that NEW RULE I provides no guarantee that future CSI administrations would agree to engage in any pre-recommendation discussions and encouraged CSI to incorporate a provision expressly providing for the ability of the parties to engage in pre-recommendation discussions in an attempt to reach a mutually agreeable corrective action plan. 

 

CSI's response to the comment is that CSI is not adopting NEW RULE I. CSI has done so because the determination of compliance and, consequently, a particular recommended corrective action under 33-36-401, MCA, may vary widely depending on the circumstances, and therefore CSI has decided to handle communication and notices related to these issues on a case-by-case basis.  In addition, 33-36-401(1), MCA, does not require a formal meeting, discussion, or negotiation with a health carrier before determining compliance or making a corrective action recommendation.  In making the rules in this manner, CSI has not eliminated the possibility of discussions between CSI and the health carrier during the process of determining compliance and making recommendations set forth in 33-36-401, MCA, but simply declines to require it, which is consistent with other subject matters regulated by CSI. If the corrective action proceeds to an enforcement action pursuant to 33-36-401(2), MCA, the action is governed by the Montana Administrative Procedure Act, which involves notice of a proposed action and the opportunity for the carrier to request a hearing, or, alternatively, an informal disposition. See 2-4-601, et seq., MCA.

 

 

/s/ Ole Olson                                                /s/ Mary Belcher

Ole Olson                                                      Mary Belcher

Rule Reviewer                                              Deputy Auditor

Commissioner of Securities and Insurance,

Office of the Montana State Auditor

 

 

Certified to the Secretary of State April 2, 2024.