Healthcare

signed · Montana · Senate Apr 17, 2025

SB 361: Revise laws relating to health insurance claims submitted to the department of public health and human insurances

SB 361 revises Montana law regarding health insurance claims submitted by the Department of Public Health and Human Services (DPHHS). It prevents health insurance issuers and other entities responsible for claim payments from denying DPHHS claims solely based on the date of submission, claim format, lack of prior authorization, or failure to present proper documentation at the point of sale. This applies if DPHHS submits the claim within three years of the service date and takes enforcement action within six years of submission. The bill clarifies that it does not require payment for services not covered under a health plan or impose new financial liabilities beyond existing agreements.

Topics ✓ HealthcareSupports HealthcarePrevents insurers from denying DPHHS claims over technical issues like submission date or documentation, ensuring timely reimbursement and protecting patient access to covered services.95% confidence

Sub-Topics Public Health

died · Montana · Senate May 23, 2025

SB 438: Revise telehealth and telemedicine laws

SB 438 establishes a registration system for out-of-state health care providers offering telehealth services to Montana patients. It requires these providers to register with Montana’s Department of Labor and Industry if they hold an active license in another state, have no recent disciplinary actions, and meet scope-of-practice standards. The bill mandates providers to notify Montana authorities within 5 business days of any disciplinary action against their license in another state and allows Montana to impose disciplinary actions like registration suspension for noncompliance. It also defines key terms like "asynchronous" and "synchronous" telehealth and designates patient location as the venue for legal actions. The bill directly affects out-of-state telehealth providers, not patients, by creating new administrative and compliance requirements.

Topics ✓ HealthcareSupports HealthcareBill establishes registration for out-of-state telehealth providers, ensuring quality/safety standards and enabling expanded patient access to telehealth services.85% confidence

Sub-Topics Telehealth

Track

died · Montana · Senate May 23, 2025

SB 448: Generally revise laws related to payments made by health carriers

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.

Topics ✓ HealthcareSupports HealthcareRequires timely insurance payments to providers, reduces administrative delays, and protects provider rights through penalties for late payments, improving healthcare system efficiency.90% confidence

Sub-Topics Insurance

Track

signed · Montana · Senate May 16, 2025

SB 497: Provide laws related to healthcare provider burnout

SB 497 establishes laws for professional wellness programs aimed at addressing career fatigue in healthcare providers, including physicians, nurses, and dentists. The bill grants civil immunity to members and consultants of these wellness programs for actions performed within their duties. It revises reporting requirements, stating that participation in a wellness program alone does not obligate reporting a healthcare provider to their licensing board, unless there is a good faith determination of incompetence or danger. Additionally, the bill provides an evidentiary privilege, generally protecting the proceedings and records of these programs from discovery in civil actions or admission in licensing actions.

Topics ✓ HealthcareSupports HealthcareEstablishes wellness programs for healthcare providers to address burnout, supporting workforce retention and quality care through mental health-focused initiatives.95% confidence

Sub-Topics Medical Licensing

signed · Montana · Senate May 16, 2025

SB 447: Revise laws related to prior authorization

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.

Topics ✓ HealthcareSupports HealthcareExtends prior auth validity for chronic conditions and prohibits auth for certain prescriptions, improving patient access to care without restricting coverage.95% confidence

Sub-Topics Insurance

signed · Montana · Senate May 16, 2025

SB 446: Revise laws related to healthcare utilization review

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.

Topics ✓ HealthcareSupports HealthcareRestricts prior authorization for essential drugs (substance use, generics) and mandates physician oversight for coverage denials, improving patient access and protecting rights.85% confidence

Sub-Topics Substance Abuse

signed · Montana · House May 16, 2025

HB 953: Revise medicaid laws related to direct primary care

HB 953 revises Montana's Medicaid laws to allow for the coverage of direct primary care contracts under the state's Medicaid program. This bill directly affects Medicaid enrollees by providing them the option to use these services. It also prohibits the Department of Public Health and Human Services from requiring an enrollee to participate in primary care case management if they opt for a direct primary care contract. The bill provides a definition for "direct primary care contract" and includes an appropriation to support these changes.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid coverage for direct primary care, improving patient access and removing case management requirements per bill text.95% confidence

Sub-Topics Medicaid Primary Care Public Health

signed · Montana · Senate May 16, 2025

SB 535: Revise laws related to experimental treatments

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.

Topics ✓ HealthcareSupports HealthcareMandates 2% profit allocation for patient access to experimental treatments, directly expanding access and funding under healthcare services.95% confidence

Sub-Topics Insurance

signed · Montana · Senate Apr 4, 2025

SB 170: Eliminate termination date of community health aide program

This bill makes Montana's community health aide program permanent by removing its previously scheduled expiration date. It directs the Department of Public Health and Human Services to apply for Medicaid coverage for services provided by certified community health aides. The change directly affects community health aides and their patients, particularly in rural and tribal communities, ensuring continued access to essential healthcare services without future legislative renewal.

Topics ✓ HealthcareSupports HealthcareMakes community health aide program permanent, directs Medicaid coverage application, ensuring continued rural/tribal healthcare access without legislative renewal90% confidence ✓ Labor & EmploymentSupports Labor & EmploymentMakes community health aide program permanent, ensuring continued employment and Medicaid coverage for workers serving rural/tribal communities, aligning with worker protection.85% confidence

Sub-Topics Public Health