{"data":{"id":"us-mt/53-6-1305","jurisdiction":"us-mt","citation":"53-6-1305","heading":"Montana HELP Act program -- delivery of health care services -- third-party administrator -- rulemaking.","body":"(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:\n(a) establishing networks of health care providers;\n(b) paying claims submitted by health care providers;\n(c) collecting the premiums provided for in 53-6-1307;\n(d) coordinating care;\n(e) helping to administer the program; and\n(f) helping to administer the medicaid program reforms as specified in 53-6-1311.\n(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.\n(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.\n(b) If the department contracts with a third-party administrator, the department shall:\n(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;\n(ii) provide coverage for exempted individuals through the medical assistance program established in Title 53, chapter 6, part 1; and\n(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.\n(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.","path":["TITLE 53. SOCIAL SERVICES AND INSTITUTIONS","CHAPTER 6. HEALTH CARE SERVICES","Part 13. Montana Health and Economic Livelihood Partnership (HELP) Act"],"source_url":"https://mca.legmt.gov/bills/mca/title_0530/chapter_0060/part_0130/section_0050/0530-0060-0130-0050.html","current_through":"Montana Code Annotated 2025","vintage":"","retrieved_at":"2026-09-14T04:57:17Z","sha256":"377e47c4d82636c7fc5ff6394b181f9f66219d9d0f26fb7313e8157c4bac1593","source_id":"us-mt","stale":false,"prev":"us-mt/53-6-1304","next":"us-mt/53-6-1306"},"notice":"GroundRules: Original legal text. Not legal advice."}