SB 446 revises laws related to health utilization review, affecting health insurance companies, utilization review organizations, and patients. It requires that only a physician licensed in the state, with a relevant specialty, can make adverse determinations (denials of coverage) or review grievances. The bill also restricts health insurance issuers from requiring prior authorization for certain prescription drugs, such as some generics, drugs for substance use disorder, and long-acting injectable antipsychotics. If an issuer or utilization review organization fails to comply with the requirements, the healthcare service under review will be automatically approved.
Senate Bill 335, known as the "Montana Dental Insurance Transparency and Accountability Act," establishes new regulations for dental insurance companies in Montana. It requires dental insurers to annually report their "dental loss ratio" (DLR), which measures the percentage of premium dollars spent on patient care, to the state's commissioner of securities and insurance. This reported DLR information, along with other plan details, will be made publicly available online for consumers to compare plans. The bill also mandates consumer rebates from dental insurers if their aggregated dental loss ratio falls below a certain threshold over a three-year period. This act applies to individual and group dental insurance plans, but excludes health plans with embedded dental benefits already subject to federal medical loss ratio requirements, as well as Medicaid and Healthy Montana Kids plans.
SB 524 revises laws concerning Category D assisted living facilities, which cater to residents who may pose a danger to themselves or others and require assistance with daily living activities. The bill allows these facilities to be independent or co-located with others, limiting them to 15 residents, and clarifies that while not required, prior authorization is needed for any use of seclusion or restraints. It mandates the Department of Public Health and Human Services to provide technical assistance and a specialized reimbursement model. Additionally, it establishes new processes for diverting individuals from the Montana State Hospital or committing them directly to Category D facilities.
SB 503 allows for the use of expired opioid antagonists, such as naloxone, to treat opioid-related drug overdoses. This bill grants partial immunity from liability to school employees, eligible recipients, medical practitioners, and pharmacists who administer or distribute these expired medications in good faith. It amends existing law to explicitly permit schools to stock and use expired opioid antagonists and extends immunity to school personnel, except in cases of gross negligence or intentional misconduct. The bill's purpose is to broaden access to life-saving opioid antagonist medication by permitting the use of expired doses.
HB 732, the "Prompt Cost Report Reimbursement Act," revises how the Montana Department of Public Health and Human Services reimburses critical access hospitals participating in the state's Medicaid program. The bill requires the department to perform a tentative settlement and make interim payments to these hospitals within 240 days of a cost report being submitted to the Medicare administrative contractor. A final settlement and adjustment will occur after the Medicare administrative contractor completes its full review or audit. This process aims to align Montana Medicaid's reimbursement with Medicare's, ensuring more timely payments to critical access hospitals for services rendered.
Senate Bill 95 allocates $300,000 to the Department of Public Health and Human Services for the biennium beginning July 1, 2025. This funding is dedicated to suicide prevention efforts specifically for service members, veterans, and their families. The bill outlines several key uses for the money, including implementing prevention strategies and establishing screening standards for suicide risk. It also aims to improve care transitions and increase lethal means safety through initiatives such as a statewide safe storage campaign and training events. The act is effective July 1, 2025, and terminates on June 30, 2027.
HB 576 revises the funding for Medicaid and health and support services for children and adults who are aged, blind, or disabled. The bill allows a portion of the state's annual tobacco settlement proceeds to be used as matching funds for federal programs, including the Children's Health Insurance Program (CHIP), home visiting services, and specific Medicaid waivers. It also expands the uses of an existing state special revenue account, enabling its funds to similarly provide matching funds for these same services. These changes are designed to help secure federal funding for a range of health and support programs.
HB 574 authorizes the Department of Public Health and Human Services to establish a program for Certified Community Behavioral Health Clinics (CCBHCs) by October 1, 2026. These clinics will provide comprehensive behavioral health services, including targeted case management, peer support, and outreach to emergency rooms and law enforcement. The bill also outlines specific requirements for CCBHCs, such as providing urgent care within one business day, offering a sliding fee scale, and not refusing services due to inability to pay. Additionally, it directs the department to establish reimbursement rates, monitor clinic performance, and develop an incentive program for clinics that achieve exceptional outcomes.
HB 806 generally revises the laws governing dietitians and nutritionists in Montana. The bill updates definitions related to the practice of nutrition and dietetics, and establishes new licensure requirements, including mandatory criminal background checks. It also outlines provisions for qualified supervisors, permits, and transitional licensure for these professionals. Additionally, the bill integrates licensed dietitians and nutritionists into the state's "quality educator" payment framework, affecting their recognition in public schools, special education cooperatives, and correctional facilities.
SB 449 generally revises health utilization review laws, affecting health insurance enrollees, health insurance issuers, and healthcare providers. It requires health insurers to honor existing prior authorizations for at least 90 days when an enrollee changes health plans and prevents requiring repeat step therapy protocols if already completed. The bill prohibits prior authorization for certain prescriptions written at discharge from inpatient care for at least three days. Additionally, it generally prevents health insurers from retroactively denying covered services that received prior authorization and mandates that insurers accept and respond electronically to prior authorization requests from healthcare providers.