Overview
Montana promotes the use of telemedicine by providing coverage and cost-sharing parity between telemedicine and in-person services. Coverage for telemedicine services must be equivalent to the coverage for in-person services. To make telemedicine services more affordable to patients, cost-sharing requirements that are not generally applicable to in-person services may not be imposed on telemedicine services.
Montana continues to actively pursue legislation to promote price transparency, with multiple efforts focused on implementing surprise billing protections. In recent sessions, legislators introduced legislation that would have required certain health care facilities to provide cost information on services expected to exceed $500, as well as establish procedures for informing consumers about out-of-network health care costs. A similar bill would have established limits on a consumer’s out-of-network costs under certain circumstances and implemented procedures about informing consumers about the ability to opt out of services. In 2016, the state unsuccessfully attempted to create an All-Payer Claims Database (APCD), which would require health plans to submit claims information or be subject to a penalty. In another effort to improve transparency and drive down prices, the legislature proposed to study the effects of reference-based pricing on health care prices and transparency in health care pricing.
In the healthcare market, Montana exercises regulatory oversight over provider mergers by requiring pre-transaction notice to and approval from the attorney general or court for transactions involving certain public benefit or religious corporations. The legislature repealed the state’s certificate of public advantage law in 2019. Additionally, in 2013, the legislature approved a bill to grant the commissioner of insurance rate-setting authority.
To stabilize the individual insurance market, Montana enacted the Montana Reinsurance Association Act establishing the Montana Reinsurance Association and Program. The bill also authorized the state to apply for a State Innovation Waiver and federal pass-through funding to partially finance the reinsurance program under section 1332 of the Patient Protection and Affordable Care Act (PAACA). The state received an approved State Innovation Waiver from the federal government for the period January 1, 2020 through December 31, 2024. The reinsurance program will pay insurers up to 60% of claims paid between $40,000 and an estimated $101,750 cap.
See below for an overview of existing Montana state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/2/2023 - 5/11/2023 (2023 term). *Legislature convenes in odd number years only.
HB 152 – Montana
Introduced: 2019 Status: Inactive / Dead
Revise laws related to surprise medical bills: An act revising health care provider network disclosure laws to avoid surprise medical bills; providing additional information and control to health care consumers; providing procedures for informing consumers …
HB 195 – Montana
Introduced: 2017 Status: Inactive / Dead
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, …
HB 222 – Montana
Introduced: 2021 Status: Inactive / Dead
Establish limits on cost-sharing for insulin. Each individual policy of disability insurance or certificate issued that contains coverage for prescription drugs must limit the insured’s required copayment or other cost-sharing requirement to $35 for each …
HB 231 – Montana
Introduced: 2021 Status: Enacted
Revise laws relating to certificate of need. AN ACT REVISING CERTIFICATES OF NEED TO INCLUDE ONLY LONG-TERM CARE FACILITIES AND SERVICES; AND AMENDING SECTIONS 50-5-101, 50-5-301, 50-5-302, 50-5-304, 50-5-307, 50-5-308, 50-5-309, AND 53-6-110, MCA.
HB 231 – Montana
Introduced: 2019 Status: Enacted
An act generally revising the scope of practice for pharmacist allowed to administer vaccines: expanding rule making authority.
Mont. Code Ann. § 33-22-112. Disability insurance coverage of services of state institutions — provision void — rate of payment: Disability Insurance General Provisions – Montana
Introduced: Status: Enacted
It is unlawful for any insurance company issuing disability insurance policies in Montana to exclude from coverage in a disability insurance policy services rendered the insured while a resident in a Montana state institution if …
Download
Mont. Code Ann. § 33-22-114. Coverage required for services provided by physician assistants, advanced practice registered nurses, and registered nurse first assistants: Disability Insurance General Provisions – Montana
Introduced: Status: Enacted
An insurer, a health service corporation, or any employee health and welfare fund that provides accident or health insurance benefits to residents of this state shall provide, in group and individual insurance contracts, coverage as …
Download
Mont. Code Ann. § 33-22-125. Independent chiropractic physical examination or review of records: Disability Insurance General Provisions – Montana
Introduced: Status: Enacted
If a patient’s attending health care professional is a licensed chiropractor, the following provisions govern the conduct of a utilization review of the health care services rendered to the patient by the chiropractor.
Download
Mont. Code Ann. § 33-22-129. Coverage for outpatient self-management training and education for treatment of diabetes — limited benefit for medically necessary equipment and supplies: Disability Insurance General Provisions – Montana
Introduced: Status: Enacted
Each group disability policy, certificate of insurance, and membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for outpatient self-management training and education for the treatment …
Download
Mont. Code Ann. § 33-22-137. Cost-sharing requirements — applicability: Disability Insurance General Provisions – Montana
Introduced: Status: Enacted
The insured shall pay only the required copayment or other cost-sharing requirement for a covered prescription drug at the time of purchase if the prescription drug dispenser, third-party administrator, or health insurance issuer can determine …
Download
Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Montana enacts budgets on a two-year cycle. The governor submits a proposed budget in November and the legislature adopts a budget in April. The biennium begins July 1.
REGULATION & ENFORCEMENT
- Montana was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.
KEY RESOURCES
- Montana State Legislature
- Montana Department of the Attorney General
- Montana Commissioner of Securities & Insurance
- Montana Governor’s Office of Budget & Program Planning