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SENATE BILL NO. 491
INTRODUCED BY D. GRIMES
A BILL FOR AN ACT ENTITLED: "AN ACT REVISING THE LAW GOVERNING HEALTH MAINTENANCE ORGANIZATIONS; ALLOWING THOSE LAWS TO APPLY TO HEALTH MAINTENANCE ORGANIZATIONS PROVIDING HEALTH CARE SERVICES FOR THE PURPOSES OF THE MONTANA MEDICAID PROGRAM THROUGH A CONTRACT WITH THE STATE OR A STATE AGENCY; AMENDING SECTIONS 33-1-102 AND 33-31-111, MCA; AND PROVIDING AN APPLICABILITY DATE."
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
Section 1. Section 33-1-102, MCA, is amended to read:
"33-1-102. Compliance required -- exceptions -- health service corporations -- health maintenance organizations -- governmental insurance programs. (1) A person may not transact a business of insurance in Montana or a business relative to a subject resident, located, or to be performed in Montana without complying with the applicable provisions of this code.
(2) The provisions of this code do not apply with respect to:
(a) domestic farm mutual insurers as identified in chapter 4, except as stated in chapter 4;
(b) domestic benevolent associations as identified in chapter 6, except as stated in chapter 6; and
(c) fraternal benefit societies, except as stated in chapter 7.
(3) This code applies to health service corporations as prescribed in 33-30-102. The existence of the corporations is governed by Title 35, chapter 2, and related sections of the Montana Code Annotated.
(4) This code does not apply to health maintenance organizations or to managed care community networks, as defined in 53-6-702, to the extent that the existence and operations of those organizations are governed by chapter 31 or to the extent that the existence and operations of those networks are governed by Title 53, chapter 6, part 7.
(5) This code does not apply to workers' compensation insurance programs provided for in Title 39, chapter 71, parts 21 and 23, and related sections.
(6) This code does not apply to the functions performed by a managed care contractor providing mental health services
under the Montana medicaid program as established in Title 53, chapter 6.
(6) THIS CODE APPLIES TO THE FUNCTIONS PERFORMED BY A MANAGED CARE CONTRACTOR PROVIDING MENTAL HEALTH SERVICES UNDER THE MONTANA MEDICAID PROGRAM AS ESTABLISHED IN TITLE 53, CHAPTER 6.
(7)(6)(7) This code does not apply to the state employee group insurance program established in Title 2, chapter 18, part
8. (8)(7)(8) This code does not apply to insurance funded through the state self-insurance reserve fund provided for in
2-9-202. (9)(8)(9) (a) This code does not apply to any arrangement, plan, or interlocal agreement between political subdivisions
of this state in which the political subdivisions undertake to separately or jointly indemnify one another by way of a
pooling, joint retention, deductible, or self-insurance plan.
(b) This code does not apply to any arrangement, plan, or interlocal agreement between political subdivisions of this state or any arrangement, plan, or program of a single political subdivision of this state in which the political subdivision provides to its officers, elected officials, or employees disability insurance or life insurance through a self-funded program."
Section 2. Section 33-31-111, MCA, is amended to read:
"33-31-111. Statutory construction and relationship to other laws. (1) Except as otherwise provided in this chapter, the insurance or health service corporation laws do not apply to any health maintenance organization authorized to transact business under this chapter. This provision does not apply to an insurer or health service corporation licensed and regulated pursuant to the insurance or health service corporation laws of this state except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.
(2) Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives is not a violation of any law relating to solicitation or advertising by health professionals.
(3) A health maintenance organization authorized under this chapter is not practicing medicine and is exempt from Title 37, chapter 3, relating to the practice of medicine.
(4) This chapter does not exempt a health maintenance organization from the applicable certificate of need requirements under Title 50, chapter 5, parts 1 and 3.
(5) This section does not exempt a health maintenance organization from the prohibition of pecuniary interest under 33-3-308 or the material transaction disclosure requirements under 33-3-701 through 33-3-704. A health maintenance organization must be considered an insurer for the purposes of 33-3-308 and 33-3-701 through 33-3-704.
(6) This section does not exempt a health maintenance organization from:
(a) prohibitions against interference with certain communications as provided under chapter 1, part 8;
(b) the provisions of Title 33, chapter 22, part 19;
(c) the requirements of 33-22-134 and 33-22-135; or
(d) network adequacy and quality assurance requirements provided under chapter 36.
(7) This chapter does not exempt a health maintenance organization from the application of this chapter solely because the organization provides services for the purposes of Title 53, chapter 6, through a contract with the state or a state agency.
(7)(8) Sections 33-22-141, 33-22-142, 33-22-246, 33-22-247, 33-22-514, 33-22-523, 33-22-524, and 33-22-526 apply
to health maintenance organizations."
NEW SECTION. Section 3. Applicability. [This act] applies to contracts with the state agreed to after October 1, 1999.
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Latest Version of SB 491 (SB0491.02)
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