The bill aims to revise utilization review laws in Montana by establishing new requirements and qualifications for individuals involved in making or reviewing adverse determinations related to health care services. It mandates that adverse determinations must be made by qualified professionals, such as physicians or licensed health care professionals in the same field as the requesting provider. Additionally, it specifies that only a physician can review grievances related to adverse determinations, ensuring that these reviews are conducted by individuals with appropriate expertise. The bill also clarifies the definition of "adverse determination" and introduces new definitions related to health care services and conditions.

Furthermore, the bill includes provisions for continuity of care when a covered person changes health plans, requiring health insurance issuers to honor prior certifications for a minimum of three months. It amends the duration of prior authorizations, extending the validity of certifications from three to six months, and establishes a twelve-month validity for certifications related to chronic conditions, unless shorter durations are warranted for safety concerns. The bill is set to take effect on January 1, 2026.

Statutes affected:
LC Text: 33-32-102, 33-32-107
HB0398_1(1): 33-32-102, 33-32-107
HB0398_1(2): 33-32-102, 33-32-107
HB0398_1(3): 33-32-102, 33-32-107
HB0398_1(4): 33-32-102, 33-32-107
HB0398_1(5): 33-32-102, 33-32-107
HB0398_1: 33-32-102, 33-32-107
HB0398_2(1): 33-32-102, 33-32-107
HB0398_2(10): 33-32-102, 33-32-107
HB0398_2(11): 33-32-102, 33-32-107
HB0398_2(12): 33-32-102, 33-32-107
HB0398_2(2): 33-32-102, 33-32-107
HB0398_2(3): 33-32-102, 33-32-107
HB0398_2(4): 33-32-102, 33-32-107
HB0398_2(5): 33-32-102, 33-32-107
HB0398_2(6): 33-32-102, 33-32-107
HB0398_2(7): 33-32-102, 33-32-107
HB0398_2(8): 33-32-102, 33-32-107
HB0398_2(9): 33-32-102, 33-32-107
HB0398_2: 33-32-102, 33-32-107
HB0398_X(1): 33-32-102, 33-32-107
HB0398_X(2): 33-32-102, 33-32-107
HB0398_X(3): 33-32-102, 33-32-107
HB0398_X(4): 33-32-102, 33-32-107
HB0398_X(5): 33-32-102, 33-32-107
HB0398_X: 33-32-102, 33-32-107