HB 398 revises health insurance laws regarding utilization review, impacting patients and health insurance companies. The bill requires health plans to honor previously approved health care services for at least three months when a patient changes plans, ensuring continuity of care. It mandates that only licensed physicians, specializing in the relevant condition, can make or review decisions to deny or reduce health care services (adverse determinations). Additionally, it clarifies the definition of "adverse determination" and other related terms within insurance law.
HB 544 revises health insurance laws, affecting health insurance issuers, covered individuals, and state employees/retirees. It prohibits health insurance issuers from retroactively denying coverage for services that received prior approval, with exceptions for fraud or misrepresentation. The bill also allows biologic therapies to be prescribed to minors under 18, even if FDA-approved only for adults, provided the treatment is medically necessary and supported by peer-reviewed medical literature. Furthermore, it amends provisions for state insurance contracts, detailing conditions under which certain state employees, retirees, and their families, as well as legislators and judges, can continue membership in state group health plans.
HB 607, known as the "Hearing Aid Coverage Act," proposes to expand health insurance coverage for hearing loss. The bill revises current law that mandates coverage only for children, extending this requirement to include individuals of all ages. It achieves this by amending sections 2-18-704 and 33-22-128 of the Montana Code Annotated, which govern mandatory provisions in insurance contracts. This change would require state insurance plans to cover treatment for hearing loss for both children and adults.
Senate Bill 495 eliminates the Tobacco Prevention Advisory Board. The bill repeals the specific section of law that established this board. It also amends existing statute to remove the board from the list of entities funded by state special revenue accounts, which are primarily used for tobacco disease prevention programs and the Children's Health Insurance Program. The direct effect is the dissolution of the advisory board, which previously provided guidance for these programs.
HB 218 revises the practice of optometry by expanding the scope of services licensed optometrists can provide. It permits optometrists to perform certain in-office surgical procedures and laser surgical procedures, specifically limited to the anterior segment of the eye and adnexa. However, the bill explicitly excludes penetrating intraocular surgery, intravitreal injection, and refractive surgery. To perform laser surgical procedures, optometrists must be certified by the board after completing required didactic and clinical training. This act takes effect on July 1, 2025.
HB 399 revises prior authorization laws for health insurance issuers, aiming to simplify access to certain prescription drugs for covered individuals. The bill prohibits prior authorization for oral and inhaled generic prescription drugs, inhaled medications for asthma or chronic lung diseases, and insulin for diabetes patients. It also restricts prior authorization for generic drugs used consistently for six months and for dosage adjustments within approved limits. If an insurer makes an adverse determination for a prescription drug, the decision must be made by a specialist physician, and the insurer must provide a list of covered therapeutic alternatives.
SB 211 revises the emergency use of epinephrine in school settings. The bill expands the definition of "medication" that students with asthma, severe allergies, or anaphylaxis can possess and self-administer to include epinephrine nasal spray. It also allows public and nonpublic schools to maintain a stock supply of epinephrine nasal spray, in addition to autoinjectable epinephrine, for emergency administration by school nurses or other authorized personnel. These changes provide schools with additional options for responding to severe allergic reactions.
SB 82 establishes a new program within Montana's Department of Public Health and Human Services to support individuals under age 55 with severe visual impairments in achieving independent living goals. The bill defines "severe visual impairment" as a disability that significantly hinders daily tasks even with correction, and outlines specific services including mobility training, Braille instruction, assistive technology, and peer counseling. Eligibility is determined by the department based on established criteria, with services provided based on available funds and consumer needs, while also guaranteeing a fair hearing for those disagreeing with decisions. The program takes effect July 1, 2025, and applies to Montana residents meeting the defined criteria.
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.
