Montana

SUMMARY

The Montana legislature was much more active in the most recent legislative term than it has been in previous sessions. Three healthcare bills relating to healthcare costs and markets passed the legislature, but were all vetoed by the Governor. These bills aimed to provide tax incentives for high-deductible health insurance plans, provide out of state insurer options, and revise current healthcare coverage laws.

Montana has been fairly active in healthcare reform in prior terms. Montana passed a bill in 2011 to study the viability of implementing a state APCD. In 2013, the legislature approved a bill to grant the commissioner of insurance rate-setting authority (a similar proposition failed in California). In addition, rural hospitals in Montana are increasingly consolidating, which has arguably been accelerated by the state’s election to reject Medicaid expansion.

 

LEGISLATION/REGULATION

Legislative Calendar

Montana’s legislative session has ended.

 

Recent Legislative Developments

Healthcare Transparency

2017 HB 326 REQUIRING REPORTING OF PRICING FACTORS FOR CERTAIN PRESCRIPTION DRUGS: Each manufacturer that is responsible for the national drug code pricing of a prescription drug that is made available in Montana and whose wholesale acquisition cost increases by more than two times the increase in the consumer price index for medical care commodities in the previous year shall provide the following information: all factors that have contributed to the increased price of the drug; the percentage of the increased cost attributable to each factor; and an explanation of the role of each factor in contributing to the cost of the drug. Inactive – Died in Committee. 
2016 HB498 AN ACT REVISING HEALTH CARE PROVIDER NETWORK DISCLOSURE LAWS: would require health care providers, outpatient centers for surgical care, clinics, and hospitals to provide patients with estimated charges for health care services or courses of treatment that exceed $500—upon patient request. The estimate would be required at the time the service is scheduled or within 10 business days of a patient’s request—whichever is sooner—and must include out-of-pocket charges. This would not be required for emergency medical services provided for the treatment of an emergency medical condition. Inactive — Died.
HB620

 

AN ACT ESTABLISHING A MONTANA ALL-PAYER CLAIMS DATABASE (APCD): would create an APCD that would require all health plans covering at least 5% of the lives covered by major medical health plans in Montana and all third-party administrators that administer claims for at least 5% of the lives covered under self-funded health plans to submit claims information to the Commissioner of Insurance. A health plan or third-party administrator that fails to comply could be subject to a fine of up to $5,000 per violation and may be prohibited from obtaining information maintained in the database. ACPD data would be available to payers, health plans, health care providers, consumers, and other interested parties.

 

Inactive — Died.

 

Healthcare Cost

2017 SB 345 PROVIDE FOR HIGH DEDUCTIBLE HEALTH INSURANCE THROUGH REIMBURSEMENTS AND TAX CREDITS: An Act relating to high-deductible health insurance plans and employer health reimbursement arrangements; providing various tax incentives; imposing duties on the Commissioner of Insurance; allowing an income tax credit for certain employer contributions to high-deductible health insurance premiums and health reimbursement arrangement-only plans. Inactive -Vetoed by Governor 5/4/17.
HB 195 REVISE LAWS RELATED TO PHARMACIES AND PRESCRIPTION DRUGS: Allows pharmacists who receive a prescription for a specific drug product by brand or proprietary name may select a less expensive drug product with the same name, strength, quantity, dose and dosage form as the prescribed drug that is, in the pharmacist’s professional opinion, therapeutically equivalent, bio-equivalent and bio-available. Inactive – Died in Committee.

 


Healthcare Markets

2017 SB 340 AUTHORIZES CHOICES FOR OUT-OF-STATE HEALTH CARE INSURANCE: Allowing for the provision of health or disability insurance by out-of-state insurers; providing a streamlined process for out-of-state health insurers to issue policies in Montana; requiring payment of premium taxes; requiring specific notice in applications and in policies; giving domestic insurers an option to match limited-mandate policies of foreign insurers sold in Montana. Inactive –Vetoed by Governor on 5/8/17.
HB 652 PROVIDE FOR HEALTH CARE AND INSURANCE COVERAGE LAWS: An Act generally revising healthcare and insurance coverage laws by providing health care and insurance coverage to high-risk people who cannot get comprehensive insurance coverage by using a reinsurance program or high-risk pool. Inactive -Vetoed by Governor on 5/8/17.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • HB 0573 (2011) directed the insurance commissioner to convene an advisory council to review the costs, benefits, and requirements necessary to maintain a statewide all-payer claims database (APCD) for healthcare. The council’s final report, published July 2011, is available here. The report recommends that the state study existing APCDs in other states to avoid the “pitfalls and challenges certain to emerge as the APCD is developed and expanded.”

 

  • Code Ann. § 33-22-107 mandates that a health insurer must give advanced notice prior to an increase in premium rates (60 days for a group policyholder and 45 days for an individual policy holder) in writing and by mail.

 

  • Code Ann. § 33-16-203 requires that rates and supporting documents substantiating the filing must be submitted to the commissioner of insurance before use within the state.

 

Network Adequacy

  • Code Ann. § 33-36-201 through 213 prescribes standards for network adequacy under a managed care plan, stating that a health care must maintain a network sufficient and number and types of providers to ensure that all services to covered persons are accessible without unreasonable delay. Adequacy is defined within the section as, among other things, geographic accessibility, hours of operation, and the ratio of covered persons to primary care and specialty care providers. The commissioner of insurance has the authority to take corrective actions against insurance carriers for failure to comply with this chapter.

 

Healthcare Contracting

  • Stat Ann. § 33-37-104 states that “[a] health care provider, a health carrier, or other managed care entity may not terminate a contract with a participating provider prior to the expiration of its term except for just cause. For purposes of this subsection, “just cause” means reasonable grounds for termination based on a failure to satisfactorily perform contract obligations or other legitimate business reason.”

 

Healthcare Markets

  • Code Ann. § 50-4-601 through 4-603 authorizes the state regulatory authority to grant certificates of public advantage and state action immunity regarding agreements, mergers, or consolidations between health care facilities and physicians that may otherwise be considered violations of state or federal antitrust law. The department will only issue a certificate if they find that the agreement is likely to result in lower health care costs or is likely to result in improved access to health care or higher quality health care without undue increase in health care costs.

 

  • Code Ann. § 33-22-1704 authorizes health insurers to contract with a preferred provider to set the amount an insured may be charged for services rendered, but requires that an insurer must provide all known providers of the same health care service in that area with an equal opportunity to submit a competitive bid or offer to become a preferred provider. The insurer shall select the lowest cost bid or offer, or reject the offer consistent with the terms of the request for proposal.

 

  • Code Ann. § 33-18-102 prohibits trade practices determined to be an unfair method of competitive or an unfair or deceptive act or practice in the business of insurance.

 

  • Code Ann. §§ 50-5-301 through 5-310 prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Public Health and Human Services through the state’s Certificate of Need process. A Certificate of Need regime aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.

 

  • Mont. Code Ann. § 33-40-101 through 105 authorizes the “patient-centered medical home” model of health care and grants such organizations immunity from competition law under the state action doctrine. A patient-centered medical home is a facility that is directed by a primary care provider to offer comprehensive care with an emphasis towards preventative services, utilizing alternative payment systems to recognize the value of services according to quality and outcome measures. “All health care providers and payors who participate in a patient-centered medical home shall, as a condition of participation, collectively commission one independent study on savings generated by the patient-centered medical home program and report to the children, families, health, and human services interim committee no later than September 30, 2016.”

2018-2019 BUDGET

The biennium budget begins on July 1 of an odd-numbered year and ends on June 30 of the next odd-numbered year. To view Montana’s Department of Public Health and Human Services 2018-2019 Budget, click here.

 

LITIGATION/ENFORCEMENT

  • The Attorney General is conducting a review of the proposed sale of Community Medical Center (Missoula) to a joint venture consisting of Billings Clinic and Regional Care Hospital Partners (RCHP/Billings). Comments may be submitted here.

 

KEY RESOURCES

Montana State Legislature

Montana Department of the Attorney General

Montana Commissioner of Securities & Insurance