# Mont. Code Ann. § 33-32-103: 33-32-103 Utilization review plan

> Montana · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-103

## Section

- **Citation:** Mont. Code Ann. § 33-32-103
- **Heading:** 33-32-103 Utilization review plan
- **Jurisdiction:** Montana
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** MT Code / Title 33 / Chapter 32 / Part 1 / Section 33-32-103

## Text

33-32-103 . Utilization review plan. An entity covered under the provisions of this chapter may not conduct a utilization review of health care services provided or to be provided to a patient covered under a contract or plan for health care services issued in this state unless that entity, at all times, maintains and can provide at the commissioner's request a current utilization review plan that includes:

(1) a description of review criteria, standards, and procedures to be used in evaluating proposed or delivered health care services that, to the extent possible, must:

(a) be based on nationally recognized criteria, standards, and procedures;

(b) reflect community standards of care, except that a utilization review plan for health care services under the medicaid program provided for in Title 53 need not reflect community standards of care;

(c) ensure quality of care; and

(d) ensure access to needed health care services;

(2) policies and procedures to ensure that a representative of the entity conducting the utilization review is reasonably accessible to patients and health care providers at all times;

(3) policies and procedures to ensure compliance with all applicable state and federal laws to protect the confidentiality of individual medical records;

(4) a copy of the materials designed to inform applicable patients and health care providers of the requirements of the utilization review plan; and

(5) any other information that may be required by the commissioner that is necessary to implement this chapter.

## Nearby sections

- [Mont. Code Ann. § 33-32-101 33-32-101 Purpose](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-101.md)
- [Mont. Code Ann. § 33-32-102 33-32-102 Definitions](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-102.md)
- [Mont. Code Ann. § 33-32-103 33-32-103 Utilization review plan](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-103.md)
- [Mont. Code Ann. § 33-32-104 33-32-104 Preemption by federal law](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-104.md)
- [Mont. Code Ann. § 33-32-105 33-32-105 Application -- exemptions](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-105.md)
- [Mont. Code Ann. § 33-32-106 33-32-106 Disclosure of utilization review requirements -- drug benefit information](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-106.md)
- [Mont. Code Ann. § 33-32-107 33-32-107 Length of prior authorization](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-107.md)
- [Mont. Code Ann. § 33-32-108 33-32-108 Retroactive denials prohibited](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-108.md)
- [Mont. Code Ann. § 33-32-109 33-32-109 Biologic prescriptions for minors](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-109.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P1_S33-32-103. Check the current official text before relying on it. Not legal advice.