Healthcare (Insurance)

SB 448, a health insurance payment reform bill, requires Montana health carriers (insurance companies) to pay "clean claims" from healthcare providers within 14 days for electronic submissions or 30 days for paper submissions. It defines a "clean claim" as one with all required documentation and no errors, and mandates that carriers notify providers of missing information within 10 days if a claim is incomplete. The bill also establishes penalties for late payments due to carrier errors and allows providers to pursue legal action if payments are delayed unlawfully. This directly affects healthcare providers (hospitals, doctors, labs), health carriers, and enrollees by streamlining payment processes and reducing billing delays.

SB 447 revises state laws related to prior authorization for health care services, affecting individuals with health insurance and health insurance issuers. The bill extends the length of a prior authorization certification. For treatment of chronic conditions, a prior authorization would be valid for the duration of that condition. Additionally, this bill prohibits prior authorization for certain prescriptions.

SB 535 revises laws related to experimental treatments, primarily by requiring experimental treatment centers to obtain a license from the state department. These centers must adhere to operational standards and pay licensing fees. The bill also mandates that licensed centers allocate 2% of their net annual profits to support access to experimental treatments for qualifying Montana residents. This allocation can be fulfilled by providing free treatment or contributing to a new Insurance Premium Support Account. This account is established to help fund health insurance premiums for eligible Montana residents who purchase insurance on the federal marketplace and meet specific income criteria.