33-40-103. (Temporary) Definitions. As used in this part, the following definitions apply:
     (1) "Covered medical services" means the health care services that are included as benefits under a health plan.
     (2) "Department" means the department of public health and human services provided for in 2-15-2201.
     (3) (a) "Health plan" means any public or private program that pays for medical care, including but not limited to a health benefit plan issued by or administered by an insurer, a health service corporation, a health maintenance organization, a multiple employer welfare arrangement, or a third-party administrator or a plan described under 33-1-102(7), (9), or (12).
     (b) The term does not include the provision of services through the medicaid program or the healthy Montana kids program as authorized in Title 53.
     (4) "Patient-centered medical home" means a model of health care that is:
     (a) directed by a primary care provider offering family-centered, culturally effective care that is coordinated, comprehensive, continuous, and, whenever possible, located in the patient's community and integrated across systems;
     (b) characterized by enhanced access, with an emphasis on prevention, improved health outcomes, and satisfaction;
     (c) qualified by the commissioner under 33-40-104 as meeting the standards of a patient-centered medical home; and
     (d) reimbursed under a payment system that recognizes the value of services that meet the standards of the patient-centered medical home program.
     (5) "Prevention services" means health care services that include primary prevention services and clinical prevention services.
     (6) "Primary care practice" means a solo health care provider or a health care practice that is organized by or includes licensees under Title 37 who provide primary medical care, including but not limited to pediatricians, internal medicine physicians, family medicine physicians, nurse practitioners, and physician assistants.
     (7) "Qualified individual" means a policyholder, certificate holder, member, subscriber, enrollee, or other individual who is participating in a health plan and who is enrolled in a patient-centered medical home program. (Terminates December 31, 2017--sec. 14, Ch. 363, L. 2013.)

     History: En. Sec. 3, Ch. 363, L. 2013.