Healthcare (Insurance)

introduced · Montana · Legislature Feb 20, 2025

LC 1935: Generally revise laws relating to insurance coverage relating to obesity prevention

This bill requires health insurance plans in Montana to cover medically necessary injectable medicines prescribed for adults with prediabetes, gestational diabetes, or obesity, including both on-label and off-label uses. Coverage applies to policies issued, renewed, or modified in the state, though Medicare Advantage prescription drug plans are exempt. To maintain coverage, patients must participate in a lifestyle management plan if their health plan provides advance written notice. The legislation also amends existing state insurance laws regarding group plan membership for retirees, legislators, and judges, allowing them to remain in group plans until Medicare eligibility under certain conditions.

Topics ✓ HealthcareSupports HealthcareBill expands health insurance coverage for obesity-related medications and requires lifestyle management plans, improving patient access to preventive care.90% confidence

Sub-Topics Insurance Medicare Prescription Drugs

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introduced · Montana · Legislature Feb 25, 2025

LC 3527: Create the building families act

This bill, known as the Building Families Act, requires health insurance plans in Montana to cover infertility diagnosis and treatment services, including in vitro fertilization, for covered individuals and their dependents. The law applies to small group, large group, and individual health insurance policies issued or renewed in the state and establishes a lifetime coverage limit of at least $25,000 for fertilization services. Insurance plans must treat infertility medications and services the same as other prescription medications and cannot impose different deductibles, waiting periods, or benefit restrictions on infertility care compared to other medical services. The bill defines infertility based on age-specific timeframes for attempting pregnancy and includes coverage for cases involving life-threatening genetic diseases.

Topics ✓ HealthcareSupports HealthcareBill mandates health insurance coverage for infertility diagnosis and treatment services, expanding access to reproductive healthcare services.95% confidence

Sub-Topics Insurance

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introduced · Montana · Legislature Feb 5, 2025

LC 1785: Generally revise insurance laws related to prior authorization of chronic conditions

This bill updates Montana's insurance laws to improve how health plans handle prior authorization for chronic conditions and ensure fair review processes. It requires health insurance companies to honor prior authorization decisions for at least three months when a patient switches plans, preventing unnecessary delays in care. The legislation also mandates that only physicians with relevant medical expertise can make adverse coverage decisions or review patient grievances, ensuring decisions are made by qualified medical professionals. Additionally, the bill clarifies key definitions used in insurance law, including what constitutes a chronic condition and adverse determination, to provide clearer standards for utilization review organizations.

Topics ✓ HealthcareSupports HealthcareBill improves patient access to care by preventing authorization delays and ensuring qualified physicians review coverage decisions for chronic conditions.95% confidence

Sub-Topics Insurance

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introduced · Montana · Legislature Feb 18, 2025

LC 1934: Generally revise laws relating to insurance coverage relating to cancer

This bill amends Montana's insurance laws to prohibit health insurers from requiring patients with advanced metastatic cancer to fail other drugs or prove a history of drug failure before covering FDA-approved prescription drugs for their condition. The provision applies only to drugs that align with best cancer treatment practices, are supported by evidence-based literature, and have FDA approval. Additionally, the bill expands group health insurance coverage requirements for state legislators, judges, and their spouses, allowing them to remain in group plans after retirement or leaving office under specific conditions. These changes directly affect health insurance companies, cancer patients, and public officials in Montana.

Topics ✓ HealthcareSupports HealthcareBill expands cancer drug coverage requirements, improves patient access to FDA-approved treatments, and protects patient rights by removing unnecessary drug failure mandates.95% confidence

Sub-Topics Insurance

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introduced · Montana · Legislature Feb 18, 2025

LC 2942: Generally revise laws related to electronic health care records

This bill requires health insurance carriers in Montana to establish and maintain specific application programming interfaces that allow patients and providers to access and exchange electronic health information. It mandates that insurers implement these digital connection points for patient records, provider directories, payer exchanges, and prior authorization processes by the dates set by federal regulations. Additionally, the law prohibits healthcare providers from blocking access to certain critical medical test results, such as cancer diagnoses, genetic markers, HIV status, and hepatitis indicators, requiring these results be shared with patients within 72 hours of finalization. The legislation also includes standard provisions for codification into state law, severability, and an effective date of January 1, 2026, with one section taking effect upon passage.

Topics ✓ HealthcareSupports HealthcareBill mandates electronic health records access and exchange, improving patient access to medical information and strengthening healthcare infrastructure.90% confidence ✓ TechnologySupports TechnologyBill mandates electronic health record access via APIs, promoting digital connectivity and patient data accessibility in healthcare.85% confidence

Sub-Topics Insurance

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introduced · Montana · Legislature Feb 23, 2025

LC 3197: Generally revise laws related to payments made by health carriers

This bill establishes new rules requiring health insurance companies in Montana to pay medical claims more quickly and fairly. It mandates that insurers must pay clean claims - those without errors or missing information - within 14 days for electronic submissions or 30 days for paper claims. The legislation also requires insurers to notify providers of any claim deficiencies within specific timeframes and prohibits unnecessary delays in processing claims due to mistakes. Health care providers, facilities, and suppliers are the primary beneficiaries, while health insurance carriers face potential penalties and enforcement actions from state regulators if they fail to comply with these payment timelines.

Topics ✓ HealthcareSupports HealthcareBill requires faster insurance claim payments and reduces processing delays, improving healthcare access and provider cash flow.90% confidence

Sub-Topics Insurance

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introduced · Montana · Legislature Feb 22, 2025

LC 3199: Revise laws related to prior authorization

This bill revises Montana laws governing prior authorization requirements for health insurance coverage. It primarily affects health insurance issuers, utilization review organizations, and patients by extending the validity of prior authorization certifications for chronic conditions to last as long as the condition itself. The legislation also prohibits prior authorization for certain prescriptions and updates definitions related to medical necessity, adverse determinations, and grievance processes. These changes aim to streamline administrative procedures and reduce barriers to accessing necessary healthcare services for individuals with ongoing medical needs.

Topics ✓ HealthcareSupports HealthcareBill extends prior authorization validity for chronic conditions, improving patient access and reducing administrative barriers to healthcare services.85% confidence

Sub-Topics Insurance

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introduced · Montana · Legislature Feb 15, 2025

LC 986: Generally revise laws related to dental insurance

This bill creates the Montana Dental Insurance Transparency and Accountability Act to increase transparency and fairness in dental insurance coverage for Montana residents. It requires dental insurers to report their medical loss ratio annually, showing what percentage of premium dollars are spent on patient care versus administrative costs, and mandates that insurers provide rebates to policyholders if they exceed certain spending thresholds. The law applies to all standalone dental insurance plans sold to Montana residents but excludes health plans with embedded dental benefits and Medicaid-covered services. Insurers must file detailed reports with the state commissioner by March 1 each year, and the commissioner must make this data publicly available online so consumers can compare plans.

Topics ✓ HealthcareSupports HealthcareBill increases transparency and fairness in dental insurance, requires reporting of medical loss ratios, and mandates rebates to policyholders, protecting patient rights and improving access.85% confidence

Sub-Topics Insurance Medicaid

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introduced · Montana · Legislature Feb 18, 2025

LC 2218: Provide for the hearing aid coverage act

This bill expands mandatory health insurance coverage in Montana to include hearing loss treatment for individuals of all ages, not just children. It amends existing state insurance laws to require group health plans to cover hearing loss treatments under the same provisions currently required for children with hearing loss. The legislation directly affects health insurance providers and policyholders by mandating that insurance contracts include these specific coverage provisions. The bill does not create new funding or change eligibility requirements, but rather updates existing statutory language to align coverage requirements with the age range of affected individuals.

Topics ✓ HealthcareSupports HealthcareBill expands mandatory health insurance coverage to include hearing loss treatment for all ages, strengthening access to healthcare services.95% confidence

Sub-Topics Insurance

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introduced · Montana · Legislature Feb 4, 2025

LC 3691: Prohibit health insurers from performing prior authorization on psychiatric drugs in shortage or discontinued

This bill prohibits health insurance companies in Montana from requiring prior authorization for psychiatric medications that are either in shortage or have been discontinued, as well as for long-acting injectable antipsychotics. It also removes prior authorization requirements for generic drugs that have been prescribed without interruption for six months and for dosage adjustments made by prescribers within FDA-approved ranges. Additionally, the bill mandates that any adverse prior authorization decisions for prescription drugs must be reviewed by a physician specializing in the relevant medical condition. These changes directly affect patients prescribed psychiatric medications and the insurance plans that cover them, aiming to reduce administrative barriers to accessing necessary mental health treatments.

Topics ✓ HealthcareSupports HealthcareBill removes prior authorization barriers for psychiatric medications, improving patient access to mental health care and protecting patient rights.90% confidence

Sub-Topics Insurance Mental Health

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