State Law

Admin. Rules of Montana-Dept. #37-Subchapter 2-Network Adequacy for Managed Care

08/09/2023 Montana Section 37.108.214

Mandatory Coverage

Network Adequacy

(1) The following must be reimbursed without regard to either prior authorization or the contractual relationship between the health carrier and the provider:

(a) emergency services as defined in 33-36-103, MCA;

(b) covered services that do not meet the criteria for emergency services, but which were medically necessary and immediately required because an unforeseen illness, injury or condition occurred when the enrollee was outside the health carrier’s geographic service area and could not reasonably access services through the health carrier’s network of providers; and

(c) renal dialysis, if covered, that is provided while the enrollee is outside the health carrier’s service area for no more than 30 calendar days per year.