Healthcare (Medicare)

HB 473 grants the Department of Public Health and Human Services (DPHHS) the authority to adopt Medicare fee schedules issued by the Centers for Medicare and Medicaid Services (CMS) through administrative rule. A key provision allows for the automatic incorporation of future updates to these federal fee schedules. This streamlines the process for DPHHS to align state reimbursement rates with federal Medicare standards. The bill affects the DPHHS's rulemaking procedures and indirectly impacts healthcare providers and beneficiaries whose services are reimbursed based on these schedules.

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.

SB 417 would require most Montana health insurance plans to cover certain injectable medicines prescribed for glucose control or weight loss in adults diagnosed with prediabetes, gestational diabetes, or obesity. Coverage must be deemed medically necessary by a physician and requires participants to join a lifestyle management program to continue treatment. The bill applies to individual and group health insurance policies but excludes Medicare Advantage plans. It amends Montana insurance law to mandate this coverage as a standard benefit.

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.