The proposed bill seeks to amend Montana's insurance law by prohibiting balance billing for out-of-network emergency services and establishing clear payment requirements for ambulance ground transportation. Insurers will be required to indemnify ambulance service providers directly and cannot charge enrollees for covered services if they have already paid the in-network cost-sharing amount. Additionally, the bill sets a maximum out-of-pocket expense of $100 for both in-network and out-of-network providers and mandates that ambulance services be reimbursed at local rates or at least 400% of the Medicare rate if no local rate is available. A public database of local rates will be created, and ambulance services must submit their rates to the department annually.

The bill also amends several sections of the Montana Code Annotated (MCA) to ensure compliance with these new regulations, including inserting language that requires the state employee group benefits plan and the Montana university system group benefits plan to follow the new billing requirements. It modifies existing provisions regarding balance billing information to protect patients' credit reports when insurers comply with the new regulations. Additionally, the bill clarifies the regulatory framework for health maintenance organizations (HMOs) and self-funded multiple employer welfare arrangements, ensuring that HMOs comply with specific regulations while streamlining the application of the insurance code to these arrangements. Certain outdated references are deleted to enhance clarity and efficiency in the regulatory framework.

Statutes affected:
LC Text: 2-18-704, 30-14-2602, 33-31-111, 33-35-306