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Rule Title: DEFINITIONS
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Department: PUBLIC HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Chapter: MANAGED CARE QUALITY ASSURANCE
Subchapter: Network Adequacy for Managed Care
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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37.108.201    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 department that complies with the standards set forth in ARM 37.108.205 through 37.108.207 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 department.

(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 46.12.1708, 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: Sec. 33-36-105, MCA; IMP, Sec. 33-36-103 and 33-36-105, MCA; NEW, 1999 MAR p. 2052, Eff. 9/24/99.


 

 
MAR Notices Effective From Effective To History Notes
9/24/1999 Current History: Sec. 33-36-105, MCA; IMP, Sec. 33-36-103 and 33-36-105, MCA; NEW, 1999 MAR p. 2052, Eff. 9/24/99.
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