(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 assure 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 department.

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

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

(c) An accredited health carrier whose quality assurance plan is approved by the department is not required to comply with ARM 37.108.505. If the accredited health carrier offers a closed or combination managed care plan, the health carrier must comply with ARM 37.108.510 and 37.108.515. All accredited health carriers, regardless of their offering of closed, combination, or open plans, must comply with ARM 37.108.507, 37.108.515, 37.108.516, and 37.108.520.

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