Healthcare (Medicare)

signed · Montana · Senate May 8, 2025

SB 191: Provide for the licensure of residential treatment centers

Senate Bill 191 establishes a new licensing system for residential treatment centers in Montana. It grants the Department of Public Health and Human Services the authority to create administrative rules for these centers, covering areas such as staff qualifications, treatment services, insurance, and background checks. The bill requires these centers to obtain accreditation from an entity approved by the U.S. Centers for Medicare and Medicaid Services, with provisional licenses available during the accreditation process. Finally, it extends eligibility for appropriate educational opportunities to children placed in these newly defined residential treatment centers.

Topics ✓ HealthcareSupports HealthcareEstablishes licensing standards requiring CMS-approved accreditation and insurance compliance for residential treatment centers, strengthening quality oversight in healthcare services.85% confidence

Sub-Topics Medical Licensing Medicare Public Health

signed · Montana · House May 13, 2025

HB 732: Establish prompt cost report reimbursement act

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.

Topics ✓ Budget & TaxesSupports Budget & TaxesBill mandates timely Medicaid reimbursements under appropriations process, promoting fiscal responsibility in state budget execution for healthcare funding.85% confidence ✓ HealthcareSupports HealthcareBill mandates timely Medicaid reimbursements to critical access hospitals, preventing financial strain and ensuring continued healthcare service provision.90% confidence

Sub-Topics Audits & Accountability Medicare Public Health

died · Montana · House May 22, 2025

HB 558: Establish a nurse health corps

HB 558 establishes the Montana Nurse Corps Act, enabling licensed nurses to provide home health care visits to specific patient groups at a fixed $10 fee per visit. It directly affects eligible patients (those enrolled in Medicare/Medicaid or with family income under 400% of the federal poverty level) and participating nurses who join the program. Key provisions include limiting nurse charges to $10 per visit for eligible patients, shielding nurses from liability for ordinary negligence (except gross negligence), and requiring patient notice of this liability protection. The bill also outlines nurse eligibility requirements and program oversight by the state nursing board.

Topics ✓ HealthcareSupports HealthcareEnables low-cost home health visits ($10/visit) for Medicare/Medicaid/low-income patients, expanding access to care through a new nurse corps program.90% confidence

Sub-Topics Healthcare Workforce Medicare

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signed · Montana · House May 5, 2025

HB 473: Allow for automatic CMS medicare fee schedule updates

HB 473 grants the Department of Public Health and Human Services (DPHHS) the authority to adopt Medicare fee schedules issued by the Centers for Medicare and Medicaid Services (CMS) through administrative rule. A key provision allows for the automatic incorporation of future updates to these federal fee schedules. This streamlines the process for DPHHS to align state reimbursement rates with federal Medicare standards. The bill affects the DPHHS's rulemaking procedures and indirectly impacts healthcare providers and beneficiaries whose services are reimbursed based on these schedules.

Topics ✓ HealthcareSupports HealthcareAutomates Medicare fee schedule updates to align state reimbursements with federal standards, improving provider payment stability and patient access to care.95% confidence

Sub-Topics Medicare Public Health

died · Montana · House May 22, 2025

HB 947: Revise insurance laws relating to continuous glucose monitors and supplies

HB 947 requires most individual health insurance policies in Montana to cover continuous glucose monitors (CGMs) and their supplies for people diagnosed with type I or type II diabetes when medically necessary, as prescribed by a healthcare provider. The bill prohibits insurers from denying coverage based on diabetes severity or insulin dependence, and bans special deductibles or limits specifically for CGMs - though standard deductibles may still apply. This affects diabetes patients covered by individual disability, health, or membership insurance plans (excluding Medicare supplements, hospital indemnity, or long-term care policies). The law aims to ensure consistent access to these critical blood sugar monitoring tools without discriminatory coverage barriers.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for CGMs, prohibits denial based on diabetes severity, and bans special deductibles - expanding access to essential diabetes care.95% confidence

Sub-Topics Hospitals Long-Term Care Medicare

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died · Montana · House May 22, 2025

HB 758: Revise health care laws relating to out-of-network services

HB 758 aims to protect health benefit plan enrollees from balance billing for out-of-network ground ambulance services. It prohibits ambulance services from billing enrollees more than their in-network cost-sharing for covered transportation. The bill requires insurers to pay ambulance providers directly, caps out-of-pocket costs for these services at $100, and ensures these costs count towards deductibles. It also mandates that insurers reimburse ambulance services at established local rates or at least 400% of the Medicare rate if no contracted rate exists, and requires the state to create a public database of local ambulance rates.

Topics ✓ HealthcareSupports HealthcarePrevents balance billing for ambulance services, caps out-of-pocket costs at $100, and ensures costs count toward deductibles, strengthening patient access and financial protection in healthcare.95% confidence

Sub-Topics Hospitals Medicare

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died · Montana · Senate May 23, 2025

SB 417: Generally revise laws relating to insurance coverage relating to obesity prevention

SB 417 would require most Montana health insurance plans to cover certain injectable medicines prescribed for glucose control or weight loss in adults diagnosed with prediabetes, gestational diabetes, or obesity. Coverage must be deemed medically necessary by a physician and requires participants to join a lifestyle management program to continue treatment. The bill applies to individual and group health insurance policies but excludes Medicare Advantage plans. It amends Montana insurance law to mandate this coverage as a standard benefit.

Topics ✓ HealthcareSupports HealthcareBill mandates insurance coverage for obesity/diabetes treatments, expanding access to prescribed medicines and requiring medically necessary care, aligning with healthcare access expansion indicators.95% confidence

Sub-Topics Medicare

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died · Montana · Senate May 23, 2025

SB 554: Generally revise laws related to hospitals operating as nonprofit care facilities

SB 554 (Montana) limits nonprofit hospitals (excluding critical access/rural emergency hospitals) to charging no more than 300% of the Medicare reimbursement rate for Medicare-eligible services. Hospitals exceeding this rate face an escalating excise tax (starting at 25% in 2027 and rising to 50% after 2030) and risk losing nonprofit status. The bill also requires hospitals to maintain written financial assistance and community benefit policies, submit annual reports including IRS Form 990, and comply with new reporting rules. This bill died in process in May 2025 and was never enacted.

Topics ✓ Budget & TaxesSupports Budget & TaxesImposes escalating excise tax (25-50%) on hospitals exceeding Medicare rate, generating state revenue through new tax mechanism.95% confidence ✓ HealthcareSupports HealthcareCaps hospital charges for Medicare services at 300% of Medicare rate, reducing patient costs and enforcing community benefit requirements to improve access.95% confidence

Sub-Topics Sales Tax Hospitals Medicare

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