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Montana Title 33. Insurance and Insurance Companies § 33-19-309. Health carrier and patient access to health information--exemption--deadline extensions

Current as of January 01, 2024 | Updated by Findlaw Staff

<Section effective July 1, 2026.>

(1) A health carrier as defined in 33-2-2402 shall establish and maintain the following application programming interfaces for the benefit of the carrier's insureds and contracted providers:

(a) a patient access application programming interface, pursuant to 42 CFR 422.119(a) through 422.119(e);

(b) a provider directory application programming interface, pursuant to 42 CFR 422.120;

(c) a provider access application programming interface, pursuant to 42 CFR 422.121(a);

(d) a payer-to-payer exchange application programming interface, pursuant to 42 CFR 422.121(b);  and

(e) a prior authorization application programming interface, pursuant to section 42 CFR 422.122.

(2) A health carrier shall establish and maintain each application programming interface provided for in subsection (1) for the health carrier's insured and providers at the earliest date required by the centers for medicare and medicaid services for that type of application programming interface.

(3) An application programming interface must comply with standards published by the centers for medicare and medicaid services, including effective dates, enforcement delays, and suspensions.

(4) This section does not apply to a health carrier offering a dental only or vision only plan.

(5)(a) The commissioner may extend the deadlines described in this section.

(b) To obtain an extension, a health carrier shall submit a request in writing demonstrating that compliance:

(i) would be unduly burdensome, impracticable, or unfeasible;  and

(ii) would result in economic harm to the carrier or other stakeholders.

(c) An extension must be granted in writing, including the commissioner's reasoning for the decision to extend.

(d) An approved extension must be published on the commissioner's website.

(6) For the purposes of this section, “commissioner” means the insurance commissioner of the state of Montana.

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Cite this article: FindLaw.com - Montana Title 33. Insurance and Insurance Companies § 33-19-309. Health carrier and patient access to health information--exemption--deadline extensions - last updated January 01, 2024 | https://codes.findlaw.com/mt/title-33-insurance-and-insurance-companies/mt-code-ann-sect-33-19-309/

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