Bill > HB398

This bill addresses several key provisions related to insurance prior authorization and utilization review, focusing on improving patient care and ensuring appropriate medical review processes. First, the bill establishes a continuity of care provision that requires health insurance issuers to honor certifications for health care services for at least the first 3 months when a covered person changes health plans, ensuring patients do not experience interruptions in their ongoing medical treatments. Second, the bill sets stringent qualifications for individuals making or reviewing adverse determinations, requiring that such reviews be conducted by licensed physicians or healthcare professionals with specific expertise in the medical condition being evaluated, and mandating that these professionals have current, non-restricted licenses and relevant experience treating the specific medical condition. The bill also extends the standard length of prior authorization from 3 to 6 months for most health care services, and specifically provides a 12-month authorization for chronic condition treatments, with exceptions for safety concerns or FDA guidance. Additionally, the bill introduces a new definition for "chronic condition" as a condition lasting one year or more that requires ongoing medical attention or limits daily living activities. These changes aim to provide more stability and consistency in health insurance prior authorization processes, ultimately supporting patients' continuous medical care and ensuring more specialized, informed medical reviews.

Business and Industry, Health and Social Services

https://bills.legmt.gov/#/laws/bill/2/LC1785