{"data":{"id":"us-mt/53-6-702","jurisdiction":"us-mt","citation":"53-6-702","heading":"Definitions.","body":"As used in this part, the following definitions apply:\n(1) \"Department\" means the department of public health and human services.\n(2) \"Health maintenance organization\" means a health maintenance organization as defined in 33-31-102.\n(3) (a) \"Managed health care entity\" or \"entity\" means a health maintenance organization or an insurer regulated under Title 33 that:\n(i) contracts for an estimated annual value of $1 million or more of state and federal medicaid funds; or\n(ii) operates statewide or covers 20% or more of the medicaid population.\n(b) The term does not include:\n(i) a provider of health care services under a contract with the department on a fee-for-service basis;\n(ii) a medicaid primary care case management service within the meaning of 42 CFR 438; or\n(iii) a PACE organization as defined in 42 CFR 460.6 or an accountable care organization as defined in 33-31-102 that has received a waiver under 33-31-201.\n(4) \"Program\" means an element of the integrated health care system created by this part.","path":["TITLE 53. SOCIAL SERVICES AND INSTITUTIONS","CHAPTER 6. HEALTH CARE SERVICES","Part 7. Medicaid Managed Care"],"source_url":"https://mca.legmt.gov/bills/mca/title_0530/chapter_0060/part_0070/section_0020/0530-0060-0070-0020.html","current_through":"Montana Code Annotated 2025","vintage":"","retrieved_at":"2026-09-14T04:57:16Z","sha256":"cdd9b796de2607d370e38bebc906e733691f3505934b827dfae7587d42505a40","source_id":"us-mt","stale":false,"prev":"us-mt/53-6-701","next":"us-mt/53-6-703"},"notice":"GroundRules: Original legal text. Not legal advice."}