Healthcare (Insurance)

died · Montana · Senate May 23, 2025

SB 527: Create the building families act

SB 527, the "Building Families Act," would require most health insurance plans in Montana to cover infertility diagnosis and treatment, including in vitro fertilization (IVF), up to a $25,000 lifetime limit. It directly affects insured Montanans seeking infertility care by mandating coverage for these services without extra deductibles, copays, or restrictions that differ from standard medical coverage. The bill defines infertility based on medical guidelines and prohibits insurers from imposing unique limitations on fertility treatments compared to other prescription drugs or services. It applies to all small group, large group, and individual health plans sold in Montana that cover medical expenses.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for infertility treatments including IVF, expanding access without extra costs per medical guidelines.95% confidence

Sub-Topics Insurance

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signed · Montana · House Apr 17, 2025

HB 399: Revise prior authorization laws

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.

Topics ✓ HealthcareSupports HealthcareBill prohibits prior authorization for essential medications (insulin, asthma drugs, generics), directly improving patient access to prescribed treatments without unnecessary barriers.95% confidence

Sub-Topics Insurance Prescription Drugs

died · Montana · House May 20, 2025

HB 565: Require health insurance companies doing business in Montana to cover IVF treatment

House Bill 565, also known as the "Building Families Act," would have required certain health insurance policies in Montana to cover the diagnosis and treatment of infertility, including in vitro fertilization (IVF). This mandate would have applied to small group, large group, and individual health insurance policies issued or renewed in the state. The bill defined infertility based on factors like age and time trying to conceive, or a physician's findings. It set a lifetime coverage minimum of at least $40,000 for fertilization services and aimed to ensure fertility coverage was not subject to different limitations than other medical benefits.

Topics ✓ HealthcareSupports HealthcareHB 565 mandates insurance coverage for IVF treatment, expanding access to fertility care under Montana health insurance policies, directly advancing healthcare coverage for reproductive services.95% confidence

Sub-Topics Insurance

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vetoed · Montana · Senate Jul 14, 2025

SB 422: Generally revise laws relating to insurance coverage relating to cancer

SB 422 requires Montana health insurers to cover FDA-approved drugs for advanced or metastatic cancer without forcing patients to first fail other treatments. It prohibits insurers from demanding that patients prove they've tried and failed alternative drugs before approving coverage for new treatments that align with national cancer guidelines. This directly affects patients diagnosed with advanced or metastatic cancer in Montana, ensuring faster access to potentially life-saving medications without unnecessary bureaucratic hurdles. The law applies only to drugs approved by the FDA and consistent with evidence-based cancer treatment protocols.

Topics ✓ HealthcareSupports HealthcareMandates insurers cover FDA-approved cancer drugs without prior treatment failure requirements, improving patient access to life-saving treatments per national guidelines.95% confidence

Sub-Topics Insurance

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signed · Montana · House May 5, 2025

HB 398: Generally revise insurance laws related to prior authorization of chronic conditions

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.

Topics ✓ HealthcareSupports HealthcareRequires continuity of care for chronic conditions and mandates specialist review for denials, protecting patient access to approved treatments and reducing arbitrary insurance denials.85% confidence

Sub-Topics Insurance

died · Montana · Senate May 23, 2025

SB 483: Generally revise health care laws

SB 483 would revise Montana's health care laws by adding specific definitions to clarify insurance coverage processes, particularly around "step therapy" protocols. It directly affects health insurance issuers, providers, and patients by standardizing terms like "adverse determination" (denials of coverage), "clinical peer" reviews, and "step therapy" requirements. Key provisions define how insurers must review coverage requests, including requiring medical necessity justifications and establishing clearer pathways for appeals. The bill focuses on improving transparency in insurance decision-making without creating new benefits or funding. (Note: This bill died in process on May 23, 2025, and did not become law.)

Topics ✓ HealthcareSupports HealthcareStandardizes insurance definitions and mandates medical necessity justifications for coverage, protecting patients from arbitrary denials and improving access to care.95% confidence

Sub-Topics Insurance

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signed · Montana · House May 5, 2025

HB 544: Generally revise health insurance laws relating to health utilization review

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.

Topics ✓ HealthcareSupports HealthcareProhibits retroactive coverage denials and expands access to biologic therapies for minors, protecting patient rights and improving access to care.95% confidence

Sub-Topics Insurance

died · Montana · Senate May 23, 2025

SB 448: Generally revise laws related to payments made by health carriers

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.

Topics ✓ HealthcareSupports HealthcareRequires timely insurance payments to providers, reduces administrative delays, and protects provider rights through penalties for late payments, improving healthcare system efficiency.90% confidence

Sub-Topics Insurance

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signed · Montana · Senate May 16, 2025

SB 447: Revise laws related to prior authorization

SB 447 revises state laws related to prior authorization for health care services, affecting individuals with health insurance and health insurance issuers. The bill extends the length of a prior authorization certification. For treatment of chronic conditions, a prior authorization would be valid for the duration of that condition. Additionally, this bill prohibits prior authorization for certain prescriptions.

Topics ✓ HealthcareSupports HealthcareExtends prior auth validity for chronic conditions and prohibits auth for certain prescriptions, improving patient access to care without restricting coverage.95% confidence

Sub-Topics Insurance

signed · Montana · Senate May 16, 2025

SB 535: Revise laws related to experimental treatments

SB 535 revises laws related to experimental treatments, primarily by requiring experimental treatment centers to obtain a license from the state department. These centers must adhere to operational standards and pay licensing fees. The bill also mandates that licensed centers allocate 2% of their net annual profits to support access to experimental treatments for qualifying Montana residents. This allocation can be fulfilled by providing free treatment or contributing to a new Insurance Premium Support Account. This account is established to help fund health insurance premiums for eligible Montana residents who purchase insurance on the federal marketplace and meet specific income criteria.

Topics ✓ HealthcareSupports HealthcareMandates 2% profit allocation for patient access to experimental treatments, directly expanding access and funding under healthcare services.95% confidence

Sub-Topics Insurance