The bill aims to revise health utilization review laws in Montana by introducing several key provisions. It prohibits retroactive denials of health insurance claims once prior approval for a covered service has been obtained, except in cases of fraud, misrepresentation, or other specified exceptions. Additionally, the bill allows for the prescription of biologic therapies for minors under 18, provided these therapies are FDA-approved for adults and deemed medically necessary based on peer-reviewed literature. The bill also amends existing law to ensure that health insurance contracts include these new provisions.

Furthermore, the bill includes a codification instruction to integrate the new sections into Title 33, chapter 32 of the Montana Code Annotated. It establishes a delayed effective date of January 1, 2026, and specifies that the new regulations will apply to health insurance policies issued or renewed on or after this date. Overall, the bill seeks to enhance protections for insured individuals, particularly minors, while ensuring that health insurance issuers adhere to updated standards for service approvals.

Statutes affected:
LC Text: 2-18-704
HB0544_1: 2-18-704