This bill aims to revise health utilization review laws in Montana by introducing two significant provisions. First, it prohibits health insurance issuers from retroactively denying coverage for services that have already been approved and provided, except in cases of fraud, misrepresentation, nonpayment of premium, or if the service provided differs from what was approved. Second, it allows for the prescription of biologic therapies for minors under 18 years of age, provided these therapies are FDA-approved for adults, medically necessary, and supported by peer-reviewed medical literature demonstrating their safety and effectiveness for the relevant age groups.

Additionally, the bill amends Section 2-18-704 of the Montana Code Annotated to include these new provisions, ensuring that health insurance contracts must comply with the updated regulations regarding retroactive denials and biologic prescriptions for minors. The bill is set to take effect on January 1, 2026, and will apply to health insurance policies issued or renewed on or after that date.

Statutes affected:
LC Text: 2-18-704
HB0544_1(1): 2-18-704
HB0544_1(2): 2-18-704
HB0544_1(3): 2-18-704
HB0544_1(4): 2-18-704
HB0544_1: 2-18-704
HB0544_X(1): 2-18-704
HB0544_X(2): 2-18-704
HB0544_X(3): 2-18-704
HB0544_X(4): 2-18-704
HB0544_X(5): 2-18-704
HB0544_X: 2-18-704