HB 398 Montana House · 2025 Regular Session

Generally revise insurance laws related to prior authorization of chronic conditions

HB 398 revises health insurance laws regarding utilization review, impacting patients and health insurance companies. The bill requires health plans to honor previously approved health care services for at least three months when a patient changes plans, ensuring continuity of care. It mandates that only licensed physicians, specializing in the relevant condition, can make or review decisions to deny or reduce health care services (adverse determinations). Additionally, it clarifies the definition of "adverse determination" and other related terms within insurance law.

Issues: ✓ Healthcare

Bill status signed all 5 stages cleared

Introduction

Feb 2025

Committee Review

Mar 2025

House Passage

Apr 2025

Senate Passage

Apr 2025

Signed into Law

May 2025

Introduced Feb 5, 2025 Signed May 5, 2025

Maddy AI version diff · 4 comparisons

What changed between versions

HB0398_2(12).pdf → HB0398_X.pdf · 4 edits

MODERATE

This bill revises Montana's utilization review laws to clarify who can make adverse determinations and how continuity of care is handled when patients switch health plans. It mandates that adverse determinations be made by licensed physicians or qualified health care professionals with specific expertise, ensuring decisions are medically sound. The bill also updates the definition of 'adverse determination' to include more specific scenarios and clarifies that certifications granted by a previous insurer must be honored for at least three months when a patient changes plans.

Scope change

The bill applies to health insurance issuers and their utilization review organizations, tightening requirements on who can make denial decisions and how they must handle patient transitions between plans.

REQUIREMENT

Changed the requirements for individuals making adverse determinations to ensure they are made by licensed physicians or health care professionals with relevant specialized knowledge and experience.

Revised the continuity of care exemption to explicitly require health insurers to honor prior certifications for at least the first three months of a new plan.

DEFINITION

Updated the definition of 'adverse determination' to provide clearer language regarding denials, reductions, terminations, and failures to make payment.

Refined the definition of 'certification' to explicitly list requirements for medical necessity, appropriateness, health care setting, level of care, and level of effectiveness.

Floor votes · Senate Apr 10, 2025 · House Mar 20, 2025

How they voted

47–1

Passed · 2 other

Total votes 50

Apr 10, 2025

D Democratic18

18 Yea

100% Yea

R Republican32

29 Yea 1 Nay 2

90% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

May 1, 2025

Signed into law

(H) Signed by Governor

lower

Apr 22, 2025

Upper · Passed

(S) Signed by President

upper

Apr 18, 2025

Lower · Passed

(H) Signed by Speaker

lower

Apr 10, 2025

Senate · Passed

Senate Vote: pass (47-1-2)

senate

Mar 28, 2025

Upper · Passed

(S) Committee Report - (S) Business, Labor and Economic Affairs

upper

Mar 28, 2025

Upper · Passed

(S) Committee Executive Action - (S) Business, Labor and Economic Affairs

upper

Mar 21, 2025

Committee

(S) Referred to Committee - (S) Business, Labor and Economic Affairs

upper

Mar 20, 2025

House · Passed

House Vote: pass (90-8-2)

house

Feb 27, 2025

Lower · Passed

(H) Committee Report - (H) Business and Labor

lower

Feb 27, 2025

Lower · Passed

(H) Committee Executive Action - (H) Business and Labor

lower

Feb 10, 2025

Committee

(H) Rereferred to Committee - (H) Business and Labor

lower

Feb 6, 2025

Committee

(H) Referred to Committee - (H) Human Services

lower

Feb 5, 2025

Introduced

(H) Introduced

lower

1 primary · 0 co-sponsors