Montana § 53-6-1305 Montana Help Act Program -- Delivery Of Health Care Services -- Third-Party Administrator -- Rulemaking

Montana Statutes

§ 53-6-1305 — Montana Help Act Program -- Delivery Of Health Care Services -- Third-Party Administrator -- Rulemaking

Montana § 53-6-1305

Title 53SOCIAL SERVICES AND INSTITUTIONS

Ch. 6HEALTH CARE SERVICES

Part 13Montana Health and Economic Livelihood Partnership (HELP) Act

This text of Montana § 53-6-1305 (Montana Help Act Program -- Delivery Of Health Care Services -- Third-Party Administrator -- Rulemaking) is published on Counsel Stack Legal Research, covering Montana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Mont. Code Ann. § 53-6-1305 (2026).

Text

53-6-1305 . Montana HELP Act program -- delivery of health care services -- third-party administrator -- rulemaking.

(1)The department may contract as provided in Title 18, chapter 4, with one or more third-party administrators to assist in administering the delivery of health care services to members eligible under 53-6-1304 , including but not limited to:

(a)establishing networks of health care providers;

(b)paying claims submitted by health care providers;

(c)collecting the premiums provided for in 53-6-1307 ;

(d)coordinating care;

(e)helping to administer the program; and

(f)helping to administer the medicaid program reforms as specified in 53-6-1311 .

(2)If the department decides to contract with a third-party administrator, the department shall determine the basic health care

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53-6-1305 . Montana HELP Act program -- delivery of health care services -- third-party administrator -- rulemaking. (1) The department may contract as provided in Title 18, chapter 4, with one or more third-party administrators to assist in administering the delivery of health care services to members eligible under 53-6-1304 , including but not limited to:
(a) establishing networks of health care providers;
(b) paying claims submitted by health care providers;
(c) collecting the premiums provided for in 53-6-1307 ;
(d) coordinating care;
(e) helping to administer the program; and
(f) helping to administer the medicaid program reforms as specified in 53-6-1311 .
(2) If the department decides to contract with a third-party administrator, the department shall determine the basic health care services to be provided through the arrangement with the third-party administrator.
(3) (a) The department may exempt certain individuals who are eligible for medicaid-funded services pursuant to 53-6-1304 from receiving health care services through an arrangement with a third-party administrator if the individuals would be served more appropriately through the medical assistance program established in Title 53, chapter 6, part 1.
(b) If the department contracts with a third-party administrator, the department shall:
(i) adopt rules establishing criteria for determining whether a member is exempt from receiving health care services through an arrangement with the third-party administrator;
(ii) provide coverage for exempted individuals through the medical assistance program established in Title 53, chapter 6, part 1; and
(iii) for members participating in the arrangement with a third-party administrator, directly cover any service required under federal or state law that is not available through the arrangement with the third-party administrator.
(4) The department may contract with a third-party administrator for the services allowed under subsections (1)(a) through (1)(f) only upon receipt of a federal waiver allowing a third-party administrator to provide services in accordance with this part.