33-32-105. Application -- exemptions. - Montana Statutes

     33-32-105. Application -- exemptions. (1) The provisions of this chapter apply to a person or entity performing utilization reviews who is, or is affiliated with, under contract with, or acting on behalf of:
     (a) a Montana business entity; or
     (b) a third party that provides or administers health care benefits to citizens of this state, including:
     (i) a health insurer, nonprofit health service plan, health service corporation, employees' health and welfare fund, or preferred provider organization authorized to offer health insurance policies or contracts;
     (ii) a health maintenance organization issued a certificate of authority in accordance with Title 33, chapter 31; or
     (iii) a state agency.
     (2) A general in-house utilization review for a health care provider, including an in-house utilization review that is conducted by or for a long-term care facility and that is required by medicare or medicaid regulations, is exempt from the provisions of this chapter as long as the review does not directly result in the approval or denial of payment for health care services for a particular case.
     (3) A peer review procedure conducted by a professional society or association of providers is exempt from the provisions of this chapter.

     History: En. Sec. 9, Ch. 665, L. 1991.