SB 554 (Montana) limits nonprofit hospitals (excluding critical access/rural emergency hospitals) to charging no more than 300% of the Medicare reimbursement rate for Medicare-eligible services. Hospitals exceeding this rate face an escalating excise tax (starting at 25% in 2027 and rising to 50% after 2030) and risk losing nonprofit status. The bill also requires hospitals to maintain written financial assistance and community benefit policies, submit annual reports including IRS Form 990, and comply with new reporting rules. This bill died in process in May 2025 and was never enacted.
SB 479 proposes to revise Montana laws around chemical abortion by requiring health care providers to physically examine patients, be present during administration, schedule a follow-up within 7 days, and provide disposal kits (catch kits and medical waste bags) for patients to return used materials. It holds manufacturers of abortion drugs responsible for environmental cleanup if drug byproducts contaminate wastewater systems, with fines up to $20,000 per violation. The bill exempts life-threatening medical emergencies and prohibits prosecuting patients for violations. This legislation directly affects health care providers prescribing abortion drugs and pharmaceutical manufacturers, with penalties including felony charges for providers violating the requirements. The bill died in process in May 2025 and was never enacted.
SB 100 establishes new rules for Medicaid payments in Montana's assisted living facilities. It requires the state agency to adjust room and board costs annually based on recipients' income (minus a $100 personal needs allowance) and directs the shift of Medicaid-covered assisted living services from the current "Big Sky Waiver" program to the federal "Community First Choice" program by 2026. The bill mandates quarterly reporting on service usage, waitlists, and costs for both programs. It affects Medicaid-eligible seniors receiving assisted living care, ensuring payments align with income and streamlining service delivery under federal Medicaid options.
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.
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.
HB 364 proposes to update laws concerning student immunizations and exemptions in K-12 schools. It would require school governing authorities to submit written reports on student immunization and exemption data to state and local health departments. These reports must only contain deidentified or aggregate information, ensuring student privacy. The Department of Public Health and Human Services would determine the specific form and schedule for these reports.
HB 377 revises Montana law to ensure parents generally have access to their minor child's health care records. It requires health providers to give parents access to a child's health information within 3 days of a request (or provide contact details for the records' location), with exceptions for court-limited parental rights, child abuse investigations, or government guardianship. The bill also clarifies that minors who can consent to certain care (like mental health services) have exclusive control over information related to that specific care, removing a minor's ability to enforce privacy violations by non-HIPAA-covered providers. This primarily affects parents, minors seeking care without parental consent, and health care providers managing minors' records.
HB 947 requires most individual health insurance policies in Montana to cover continuous glucose monitors (CGMs) and their supplies for people diagnosed with type I or type II diabetes when medically necessary, as prescribed by a healthcare provider. The bill prohibits insurers from denying coverage based on diabetes severity or insulin dependence, and bans special deductibles or limits specifically for CGMs - though standard deductibles may still apply. This affects diabetes patients covered by individual disability, health, or membership insurance plans (excluding Medicare supplements, hospital indemnity, or long-term care policies). The law aims to ensure consistent access to these critical blood sugar monitoring tools without discriminatory coverage barriers.
HB 758 aims to protect health benefit plan enrollees from balance billing for out-of-network ground ambulance services. It prohibits ambulance services from billing enrollees more than their in-network cost-sharing for covered transportation. The bill requires insurers to pay ambulance providers directly, caps out-of-pocket costs for these services at $100, and ensures these costs count towards deductibles. It also mandates that insurers reimburse ambulance services at established local rates or at least 400% of the Medicare rate if no contracted rate exists, and requires the state to create a public database of local ambulance rates.
HB 943 establishes the Montana Rare Disease Advisory Council within the Department of Public Health and Human Services. This 17-member council, composed of patients, caregivers, medical professionals, researchers, and other stakeholders, will provide guidance, education, and recommendations on the needs of individuals with rare diseases in Montana. Its duties include surveying patient needs, developing policy recommendations for improved access to care and treatment, publishing resources, and identifying research opportunities. The council is required to meet regularly and submit annual reports to the Governor and Legislature, and the bill includes an appropriation to cover initial costs.
