{"data":{"id":"us-mt/33-32-103","jurisdiction":"us-mt","citation":"33-32-103","heading":"Utilization review plan.","body":"An entity covered under the provisions of this chapter may not conduct a utilization review of health care services provided or to be provided to a patient covered under a contract or plan for health care services issued in this state unless that entity, at all times, maintains and can provide at the commissioner's request a current utilization review plan that includes:\n(1) a description of review criteria, standards, and procedures to be used in evaluating proposed or delivered health care services that, to the extent possible, must:\n(a) be based on nationally recognized criteria, standards, and procedures;\n(b) reflect community standards of care, except that a utilization review plan for health care services under the medicaid program provided for in Title 53 need not reflect community standards of care;\n(c) ensure quality of care; and\n(d) ensure access to needed health care services;\n(2) policies and procedures to ensure that a representative of the entity conducting the utilization review is reasonably accessible to patients and health care providers at all times;\n(3) policies and procedures to ensure compliance with all applicable state and federal laws to protect the confidentiality of individual medical records;\n(4) a copy of the materials designed to inform applicable patients and health care providers of the requirements of the utilization review plan; and\n(5) any other information that may be required by the commissioner that is necessary to implement this chapter.","path":["TITLE 33. INSURANCE AND INSURANCE COMPANIES","CHAPTER 32. HEALTH UTILIZATION REVIEW","Part 1. General Provisions"],"source_url":"https://mca.legmt.gov/bills/mca/title_0330/chapter_0320/part_0010/section_0030/0330-0320-0010-0030.html","current_through":"Montana Code Annotated 2025","vintage":"","retrieved_at":"2026-09-14T04:52:55Z","sha256":"686edf6ce1ea5c3380b905732af4c5ce1d873362d1d5a4f63e02121c1ba1ae88","source_id":"us-mt","stale":false,"prev":"us-mt/33-32-102","next":"us-mt/33-32-104"},"notice":"GroundRules: Original legal text. Not legal advice."}