This bill aims to revise the laws surrounding utilization review in Montana, specifically focusing on the qualifications and requirements for individuals making or reviewing adverse determinations related to health care services. It establishes 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 mandates that only a physician can review grievances related to adverse determinations, ensuring that those making these critical decisions possess the necessary expertise and experience in the relevant medical conditions.

The bill also introduces provisions for continuity of care when a covered person changes health plans, requiring health insurance issuers to honor prior certifications for at least three months under certain conditions. It amends existing definitions and extends the validity of certifications for health care services from three to six months, with a specific provision for chronic conditions, which can be certified for up to twelve months. The effective date for these changes is set for 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