HB 740 revises laws affecting pharmacies, pharmacy benefit managers (PBMs), and other entities involved in prescription drug dispensing and reimbursement. The bill establishes new restrictions on how PBMs can audit pharmacies and recoup funds, such as prohibiting recoupment for clerical errors without actual financial harm and banning the use of extrapolation in calculations. It also updates regulations for Maximum Allowable Cost (MAC) lists and reference pricing, requiring PBMs to ensure drugs on MAC lists are available and to frequently update and disclose pricing information to pharmacies.
HB 601 establishes an online portal by May 1, 2026, to assist Medicaid applicants and enrollees. This portal allows designated "community assisters" to help individuals apply for Medicaid coverage and submit required documents. Key functions include enabling assisters to review application status, view department notices, report eligibility changes, and update contact information for their clients. The portal also allows, but does not require, assisters to submit initial applications or redeterminations and upload verification documents. This aims to streamline the application process for individuals seeking Medicaid assistance through community organizations.
HB 687 revises the age range for expanded Medicaid participants who are required to engage in community engagement activities. Previously, participants aged 19 to 55 were subject to this requirement. This bill extends that upper age limit, now requiring individuals from 19 to 62 years old to participate. Affected participants must complete 80 hours per month in activities such as employment, education, work training, or community service, unless they qualify for an exemption. This change directly impacts expanded Medicaid recipients between the ages of 56 and 62.
HB 56 establishes an assessment fee program for ground ambulance providers licensed in the state. These providers will pay a uniform fee of 5.75% of their net operating revenues annually to the Department of Revenue. The revenues generated from this assessment are specifically designated to supplement Medicaid payments for ambulance services. The bill also outlines procedures for reporting, collection, auditing, and penalties for non-compliance.
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 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.
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.
