Section 53-6-1305 - [Terminates 6/30/2025] Montana HELP Act program - delivery of health care services - third-party administrator - rulemaking(1) The department may contract as provided in Title 18, chapter 4, with one or more third-party administrators to assist in administering the delivery of health care services to members eligible under 53-6-1304, including but not limited to: (a) establishing networks of health care providers;(b) paying claims submitted by health care providers;(c) collecting the premiums provided for in 53-6-1307;(e) helping to administer the program; and(f) helping to administer the medicaid program reforms as specified in 53-6-1311.(2) If the department decides to contract with a third-party administrator, the department shall determine the basic health care services to be provided through the arrangement with the third-party administrator.(3)(a) The department may exempt certain individuals who are eligible for medicaid-funded services pursuant to 53-6-1304 from receiving health care services through an arrangement with a third-party administrator if the individuals would be served more appropriately through the medical assistance program established in Title 53, chapter 6, part 1.(b) If the department contracts with a third-party administrator, the department shall: (i) adopt rules establishing criteria for determining whether a member is exempt from receiving health care services through an arrangement with the third-party administrator;(ii) provide coverage for exempted individuals through the medical assistance program established in Title 53, chapter 6, part 1; and(iii) for members participating in the arrangement with a third-party administrator, directly cover any service required under federal or state law that is not available through the arrangement with the third-party administrator.(4) The department may contract with a third-party administrator for the services allowed under subsections (1)(a) through (1)(f) only upon receipt of a federal waiver allowing a third-party administrator to provide services in accordance with this part. (Terminates June 30, 2025--secs. 38, 48, Ch. 415, L. 2019.)Amended by Laws 2019, Ch. 415,Sec. 33, eff. 7/1/2019.Added by Laws 2015, Ch. 368, Sec. 5, eff. 11/2/2015, upon approval by the U.S. department of health and human services of all waivers and approvals necessary to provide medicaid-funded services to individuals eligible pursuant to 53-6-1304 in the manner provided for in Laws 2015, Ch. 368; terminating 6/30/2019. Laws 2019, Ch. 415 extended the termination date to 6/30/2025.See Laws 2015, Ch. 368, Sec. 28.[Section 47 of Laws 2019, Ch. 415 provides: "Applicability. An individual enrolled in the expanded medicaid program provided for in Title 53, chapter 6, part 13, on the date the centers for medicare and medicaid services approves a waiver authorizing community engagement requirements shall comply with the community engagement requirements of [this act] within 180 days of the date the department of public health and human services has implemented the community engagement requirements."]