SB 446: Revise laws related to healthcare utilization review - Montana

SB0446_X(2).pdf → SB0446_X(3).pdf · 4 edits

MODERATE

The bill was simplified by removing language about automatic approval for non-compliance and restructured to clearly separate qualifications for physicians making adverse determinations from those reviewing grievances. The most significant policy change is the addition of a new exemption preventing prior authorization denials for long-acting injectable antipsychotics, alongside updates to ensure grievance reviewers have specific specialty and experience matching the patient's condition.

Scope change

The bill's scope of prohibited prior authorization requirements was expanded to include long-acting injectable antipsychotics, while the enforcement mechanism for non-compliance was removed.

REQUIREMENT

Added a prohibition on prior authorization denials for long-acting injectable antipsychotic drugs.

ELIGIBILITY

Reorganized and clarified the specific specialty and experience requirements for physicians reviewing grievances.

ENFORCEMENT

Removed the provision mandating automatic approval of services if a review organization fails to comply with requirements.

TECHNICAL

Simplified the bill title and removed redundant language regarding automatic approval.

SB0446_4(3).pdf → SB0446_X.pdf · 4 edits

MODERATE

This bill updates the qualifications for physicians reviewing adverse determinations and grievances in health care utilization reviews. It clarifies that only licensed physicians with relevant specialties can make these decisions and adds new restrictions on when insurance companies can deny prior authorization for certain prescription drugs, including long-acting injectable antipsychotics. The bill also establishes automatic approval for services if the review organization fails to comply with legal requirements.

Scope change

The bill expands the scope of protected prescription drugs by adding long-acting injectable antipsychotics to the list of medications that cannot be denied prior authorization solely based on dosage adjustments or therapeutic duplication.

ELIGIBILITY

Updated requirements for physicians making adverse determinations to include specific specialty focus on the condition being reviewed and clinical direction by a medical director.

Added new qualifications for physicians reviewing grievances, requiring them to have the same specialty as the treating provider, experience treating the specific condition, and prohibiting conflicts of interest.

REQUIREMENT

Added a new category of protected drugs (long-acting injectable antipsychotics) to the list of medications that cannot be denied prior authorization.

Clarified that prior authorization for prescription drugs does not require a physician's involvement if the decision does not result in an adverse determination.

SB0446_3(7).pdf → SB0446_4.pdf · 4 edits

MODERATE

The bill was renumbered from SB 446.3 to SB 446.4 and significantly restructured its content. The original text, which focused on physician qualifications for reviewing grievances, was largely replaced with new provisions detailing specific circumstances where prior authorization for prescription drugs cannot be denied (such as therapeutic duplication or dosage adjustments). Additionally, the bill now includes a coordination clause stating that if another related bill passes, specific sections of this act become void.

Scope change

The bill's scope shifted from general grievance review procedures to specific restrictions on denying prior authorization for prescription drugs, while also adding a mechanism to avoid conflicts with other legislation.

TECHNICAL

The bill number was updated from SB0446.3 to SB0446.4, indicating a revision in the legislative process.

A coordination section was added to automatically void parts of this bill if a conflicting House Bill No. 398 is also passed.

REQUIREMENT

The detailed requirements for physicians reviewing grievances were removed and replaced with specific rules on when health insurers cannot deny prior authorization for prescription drugs.

New provisions were added to prevent denial of coverage for drugs due to therapeutic duplication, dosage adjustments, or treatment of substance use disorders.

SB0446_2(15).pdf → SB0446_3.pdf · 2 edits

MINOR

The bill number was updated from SB 446.2 to SB 446.3 to reflect its progression in the legislative process. The text was cleaned up to remove redundant formatting and ensure consistent spacing. A new coordination section was added to clarify that if both this bill and House Bill 398 pass, specific sections of this bill will be voided, preventing conflicting laws.

Scope change

The bill's substantive scope regarding health care review and physician requirements remains unchanged; the new section only addresses potential conflicts with another concurrent bill.

TECHNICAL

Added a new coordination section stating that if House Bill 398 is also passed, Sections 1 and 2 of this act will be voided.

Updated the bill number from SB 446.2 to SB 446.3 and corrected minor formatting inconsistencies in the title and section headers.

SB0446.002.003_combo_final-not condensed.pdf → SB0446_2(12).pdf · 4 edits

MODERATE

The bill was renumbered from SB 446.002.003 to SB 446.2, and the internal section numbering was adjusted to align with a new structure. The substantive policy regarding physician qualifications for adverse determinations and grievance reviews remains unchanged. A previous coordination clause that would have voided sections if a conflicting House Bill passed was removed, and page numbering was updated to reflect the new version.

Scope change

The bill's scope and applicability remain unchanged; only the bill number and internal section numbering were modified.

TECHNICAL

The bill number was changed from SB 446.002.003 to SB 446.2.

Section numbers were renumbered: the original Section 3 (Codification instruction) became Section 4, and the original Section 4 (Coordination instruction) was deleted entirely.

The coordination clause that would void the act if House Bill No. 398 was passed was removed.

Page headers and footers were updated to reflect the new bill number and page count.

SB0446_2(11).pdf → SB0446.002.003_combo_final-not condensed.pdf · 3 edits

MINOR

The bill adds a drafter's name and version number to the header, removes a redundant page break, and inserts a new coordination clause. This new clause ensures that if another related bill (HB 398) is passed, the sections of this bill regarding adverse determinations and grievances are automatically voided to prevent conflicting laws.

Scope change

The bill's scope remains focused on health utilization review, but it now includes a conditional mechanism that can nullify parts of the bill if a separate, related bill is enacted.

TECHNICAL

Added drafter name (Jameson Walker) and version number (SB0446.002.003) to the document header.

Removed a redundant page break and footer text from the middle of the document.

REQUIREMENT

Added a new coordination section stating that if HB 398 is passed, the sections of this bill concerning adverse determinations and grievance reviews will be voided.

SB0446_1(5).pdf → SB0446_2.pdf · 1 edit

MINOR

The document appears to be a technical revision of the bill's header and page numbering rather than a substantive policy change. The text removed the original page number marker and updated the bill identifier from 'SB 446.1' to 'SB0446.2', likely reflecting a new version number or a correction in the legislative printing process.

TECHNICAL

Updated the bill version identifier in the header from 'SB 446.1' to 'SB0446.2' and adjusted the page numbering format.

LC3198.pdf → SB0446_1.pdf · 2 edits

MINOR

The bill was renumbered from LC 3198 to SB 446 and updated with specific sponsor names. The substantive policy content regarding physician qualifications for adverse determinations and grievance reviews remains identical to the previous version, with no changes to legal requirements, funding, or enforcement mechanisms.

TECHNICAL

Bill number changed from LC 3198 to SB 446.1 and sponsor names were added.

Page headers and footers were updated to reflect the new bill number and authorized print version status.

Revise laws related to healthcare utilization review

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