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6.6.4909    MEASURES RELATED TO COST AND MEDICAL USAGE—UTILIZATION MEASURES

(1) A recognized patient-centered medical home payor shall report to the commissioner on the following utilization measures:

(a) emergency room visits; and

(b) hospitalization rates.

(2) A patient-centered medical home payor shall report this information for its entire member population and separately for those members that are attributed to a patient-centered medical home. If the payor does not track member attribution to a patient-centered medical home, that payor may report only for its entire member population.

(3) The commissioner shall provide detailed instructions on the agency web site regarding the required data reporting on utilization measures by patient-centered medical home payors.

(4) The report is due annually on April 30.

 

History: 33-40-104, MCA; IMP, 33-40-104, 33-40-105, MCA; NEW, 2014 MAR p. 3045, Eff. 12/25/14; AMD, 2017 MAR p. 85, Eff. 1/7/17.

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