Bill > SB446

This bill revises laws related to healthcare utilization review, focusing on establishing stricter qualifications for physicians involved in adverse determinations and grievance reviews by health insurance providers. The bill requires that only licensed physicians with current, non-restricted medical licenses can make adverse determinations or review grievances for utilization review organizations. These physicians must have a specialty that focuses on the specific medical condition being reviewed and must work under the clinical direction of a medical director licensed in the state. The bill also adds new restrictions, such as prohibiting physicians from reviewing grievances in which they were directly involved or have a financial interest. Additionally, the bill modifies prior authorization requirements for prescription drugs, preventing health insurance issuers from requiring prior authorization for certain medications, including generic drugs after six months of continuous use, drugs for substance use disorder, and long-acting injectable antipsychotics. The bill includes a coordination instruction that if another bill (House Bill No. 398) is passed, the sections related to physician qualifications would become void, ensuring consistency in legislative changes.

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https://bills.legmt.gov/#/laws/bill/2/LC3198