The 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, or other specified circumstances. This change is intended to provide greater security for covered individuals who have received prior approval for their medical services. Second, the bill allows for the prescription of biologic therapies for minors under 18 years of age, provided that these therapies are FDA-approved for adults and deemed medically necessary based on peer-reviewed literature.

Additionally, the bill amends Section 2-18-704 of the Montana Code Annotated to incorporate these new provisions, ensuring that health insurance contracts include the updated regulations regarding retroactive denials and biologic prescriptions for minors. The act 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