Healthcare (Medicare)

introduced · Montana · Legislature Feb 24, 2025

LC 2288: Revise health care laws relating to out-of-network services

This bill prohibits balance billing for out-of-network emergency ambulance services in Montana, requiring insurers to pay providers directly and preventing patients from being charged beyond their in-network cost-sharing amounts. It establishes that ambulance ground transportation must be reimbursed at established local rates or at least 400% of the Medicare rate if no local rate exists, while also limiting out-of-pocket maximums to $100 for these services. The Montana Insurance Department will create a public database of ambulance rates and enforce compliance through rulemaking and potential civil penalties. The law applies to most health insurance plans, including those for state employees and Medicare supplement policies, with self-funded plans able to opt-in by notifying the department.

Topics ✓ HealthcareSupports HealthcareBill protects patients from balance billing and limits out-of-pocket costs for emergency ambulance services, improving patient access and financial protection.95% confidence

Sub-Topics Medicare

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introduced · Montana · Legislature Jan 15, 2025

LC 1385: Provide for limitations on collection of medical debt

This bill limits how medical debt can be collected in Montana by banning wage garnishment, prohibiting liens on bank accounts, and requiring a waiting period before extraordinary collection actions like lawsuits or selling debt to third parties. It directly affects patients who owe money for health care services and health care providers who bill for those services. The law also requires patients to receive an advanced notice about potential Medicare coverage issues before receiving certain services and mandates that bills not be sent to collections until insurance appeals are resolved. These measures aim to reduce the financial burden of medical debt while allowing providers to pursue collection through standard means after the specified protections are met.

Topics ✓ HealthcareSupports HealthcareBill protects patient rights by limiting aggressive medical debt collection practices, improving access to healthcare services without fear of financial retaliation.90% confidence

Sub-Topics Medicare

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introduced · Montana · Legislature Feb 20, 2025

LC 1935: Generally revise laws relating to insurance coverage relating to obesity prevention

This bill requires health insurance plans in Montana to cover medically necessary injectable medicines prescribed for adults with prediabetes, gestational diabetes, or obesity, including both on-label and off-label uses. Coverage applies to policies issued, renewed, or modified in the state, though Medicare Advantage prescription drug plans are exempt. To maintain coverage, patients must participate in a lifestyle management plan if their health plan provides advance written notice. The legislation also amends existing state insurance laws regarding group plan membership for retirees, legislators, and judges, allowing them to remain in group plans until Medicare eligibility under certain conditions.

Topics ✓ HealthcareSupports HealthcareBill expands health insurance coverage for obesity-related medications and requires lifestyle management plans, improving patient access to preventive care.90% confidence

Sub-Topics Insurance Medicare Prescription Drugs

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introduced · Montana · Legislature Jan 25, 2025

LC 3816: Establish a nurse health corps

This bill creates the Montana Nurse Corps program to provide home health care visits to eligible individuals, including Medicare and Medicaid patients, those on state medical assistance, and uninsured people with family income at or below 400% of the federal poverty level. Licensed nurses in good standing can join the program by submitting information about their clinical services and locations, offering outpatient care at affordable rates of $10 per visit that can be billed to Medicare or Medicaid. The legislation limits nurse liability to cases of gross negligence or willful misconduct, requires patients to be notified of this protection, and allows the state board to purchase optional malpractice insurance funded by a fee on all licensed nurses.

Topics ✓ HealthcareSupports HealthcareBill establishes Nurse Corps program to expand home health care access for Medicare, Medicaid, and low-income uninsured patients at affordable rates.95% confidence

Sub-Topics Healthcare Workforce Medicare

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introduced · Montana · Legislature Feb 12, 2025

LC 1891: Allow for automatic CMS medicare fee schedule updates

This bill amends Montana's administrative rulemaking laws to allow the Department of Public Health and Human Services to automatically adopt Medicare fee schedules issued by the Centers for Medicare and Medicaid Services without requiring new legislation for each update. The key provision establishes a process where updated Medicare fee schedules are incorporated by rule, streamlining how healthcare payment rates are adjusted in the state. The bill also modifies existing notice requirements to ensure legislators and interested parties are informed about proposed rule changes, particularly when monetary amounts affecting fees or benefits are involved. These changes apply to the state's administrative agencies responsible for implementing federal Medicare regulations and affect healthcare providers and payers who rely on these fee schedules.

Topics ✓ HealthcareSupports HealthcareBill streamlines Medicare fee schedule updates, ensuring healthcare payment rates are adjusted efficiently without legislative delays, supporting healthcare funding stability.85% confidence

Sub-Topics Medicare Public Health

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introduced · Montana · Legislature Feb 24, 2025

LC 4251: Establish prompt cost report reimbursement act

This bill, known as the Prompt Cost Report Reimbursement Act, requires Montana's Department of Public Health and Human Services to process cost reports from critical access hospitals more quickly to ensure timely reimbursement. Currently, the department waits for Medicare audits before settling payments, which has caused multi-year delays for hospitals participating in Montana Medicaid. The law mandates that the department make an interim payment within 240 days of receiving a cost report, treating reported costs as accurate unless there are obvious errors. If an audit later reveals an overpayment, hospitals have 60 days to repay the amount, and if an underpayment is found, the department must reimburse within 90 days. The changes apply retroactively to cost reports submitted before the bill takes effect.

Topics ✓ HealthcareSupports HealthcareBill improves reimbursement timing for critical access hospitals, ensuring timely payments and protecting healthcare service access.90% confidence

Sub-Topics Medicare Public Health

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introduced · Montana · Legislature Feb 25, 2025

LC 3697: Generally revise health insurance laws relating to certain conditions

This bill requires health insurance plans issued in Montana to cover specific diabetes and obesity treatments, including glucagon-like peptide-1 receptor agonists, when deemed medically necessary. It applies to individual disability policies, certificates of insurance, and membership contracts but excludes disability income, hospital indemnity, Medicare supplement, specified disease, and long-term care policies. The legislation defines medically necessary coverage to include diagnoses of diabetes, class 3 obesity, or polycystic ovary syndrome, while allowing standard deductibles and coinsurance but prohibiting special limitations on these specific medications. Additionally, the bill amends existing state laws to permit legislators, judges, and their spouses to continue group health plan membership after leaving office under certain conditions.

Topics ✓ HealthcareSupports HealthcareBill mandates health insurance coverage for diabetes and obesity treatments, expanding access to necessary medical care.95% confidence

Sub-Topics Hospitals Long-Term Care Medicare

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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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