Bill Summary – FastDemocracy

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68th Legislature 2023                                                                                               HB 544.1
                                                 HOUSE BILL NO. 544
                                            INTRODUCED BY J. GILLETTE
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  A BILL FOR AN ACT ENTITLED: “AN ACT PROVIDING REQUIREMENTS FOR COVERAGE OF PHYSICIAN
  SERVICES FOR ABORTION UNDER THE MEDICAID AND CHILDREN'S HEALTH INSURANCE
  PROGRAMS; PROVIDING FOR PRIOR AUTHORIZATION; PROVIDING THAT ONLY ABORTION SERVICES
  PROVIDED BY A PHYSICIAN ARE COVERED SERVICES; AMENDING SECTION 53-4-1005, MCA; AND
  PROVIDING AN EFFECTIVE DATE.”
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  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
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          NEW SECTION. Section 1.         Abortion coverage. (1) Coverage under the Montana medicaid program
  for physician services for abortion is allowed only if the abortion is performed by a physician and only if:
          (a)      the life of the mother will be endangered if the fetus is carried to term;
          (b)      the pregnancy is the result of an act of rape or incest; or
          (c)      the abortion is medically necessary.
          (2)      To receive medicaid reimbursement for physician services for an abortion described in
  subsection (1)(a), a physician shall certify that the woman suffers from a physical disorder, physical injury, or
  physical illness, including a life-endangering physical condition caused by or arising from the pregnancy, that
  would place the woman in danger of death unless an abortion is performed.
          (3)      To receive medicaid reimbursement for physician services for an abortion described in
  subsection (1)(c), a physician shall certify that, although the woman is not in danger of death unless an abortion
  is performed, the woman suffers from:
          (a)      a physical condition that would be significantly aggravated by the pregnancy; or
          (b)      a severe mental illness or intellectual disability that would be significantly aggravated by the
  pregnancy.
          (4)      Prior authorization is required for physician services for abortion. If prior authorization is not
  obtained because of an emergency, a claim for payment must undergo post-service, prepayment review. Prior
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68th Legislature 2023                                                                                             HB 544.1
  authorization is not required for treatments for incomplete abortion, miscarriage, or septic abortion.
            (5)     The following supporting documentation must be submitted for an abortion described in
  subsection (1)(a) or (1)(c), either with the prior authorization request or with any claim for payment for which
  prior authorization was not received:
            (a)     the woman's medical history, including:
            (i)     age, current medications, medical conditions, and allergies;
            (ii)    number of pregnancies and number of live births;
            (iii)   last menstrual period and the status and results of any pregnancy test;
            (iv)    chronic illnesses and surgeries;
            (v)     behavioral health issues;
            (vi)    smoking and substance abuse; and
            (vii)   obstetric history;
            (b)     a brief review of systems to identify symptoms the woman may be experiencing;
            (c)     the results of a physical examination, including vital signs, heart, lungs, abdomen, extremities,
  and, if imaging is not available, estimate of gestational age;
            (d)     if available, results of laboratory tests, including rh factor, hemoglobin, and human chorionic
  gonadotropin;
            (e)     if available, imaging to estimate gestational age;
            (f)     documentation that:
            (i)     the diagnosis of the condition leading to a determination that an abortion is necessary was
  made by a medical professional qualified by education, training, and experience to make the diagnosis; and
            (ii)    the woman is receiving care for the condition;
            (g)     the reason for the abortion procedure;
            (h)     for medication or chemical abortions, documentation confirming review of contraindications,
  adequate patient education, and compliance with the requirements of the medicaid physician-related services
  manual;
            (i)     the treatment plan; and
            (j)     the woman's signed informed consent for the proposed abortion procedure.
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68th Legislature 2023                                                                                            HB 544.1
          (6)      As used in this section, the following terms apply:
          (a)      "Abortion" has the meaning provided in 50-20-104.
          (b)      "Physician" has the meaning provided in 37-3-102.
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          Section 2. Section 53-4-1005, MCA, is amended to read:
          "53-4-1005. (Temporary) Benefits provided. (1) Benefits provided to participants in the program
  may include but are not limited to:
          (a)      inpatient and outpatient hospital services;
          (b)      physician and advanced practice registered nurse services;
          (c)      laboratory and x-ray services;
          (d)      well-child and well-baby services;
          (e)      immunizations;
          (f)      clinic services;
          (g)      dental services;
          (h)      prescription drugs;
          (i)      mental health and substance abuse treatment services;
          (j)      habilitative services as defined in 53-4-1103;
          (k)      hearing and vision exams; and
          (l)      eyeglasses.
          (2)      The program must comply with the provisions of 33-22-153 and [section 1].
          (3)      The department shall adopt rules, pursuant to its authority under 53-4-1009, allowing it to cover
  significant dental needs beyond those covered in the basic plan. Expenditures under this subsection may not
  exceed $100,000 in state funds, plus any matched federal funds, each fiscal year.
          (4)      The department is specifically prohibited from providing payment for birth control
  contraceptives under this program.
          (5)      The department shall notify enrollees of any restrictions on access to health care providers, of
  any restrictions on the availability of services by out-of-state providers, and of the methodology for an out-of-
  state provider to be an eligible provider. (Terminates on occurrence of contingency--sec. 15, Ch. 571, L. 1999;
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68th Legislature 2023                                                                                                HB 544.1
  sec. 3, Ch. 169, L. 2007; sec. 10, Ch. 97, L. 2013; sec. 5, Ch. 399, L. 2017.)"
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          NEW SECTION. Section 3.          Codification instruction. [Section 1] is intended to be codified as an
  integral part of Title 53, chapter 6, part 1, and the provisions of Title 53, chapter 6, part 1, apply to [section 1].
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          NEW SECTION. Section 4.          Effective date. [This act] is effective July 1, 2023.
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Statutes affected: 
HB0544_1.pdf: 53-4-1005
HB0544_X.pdf: 53-4-1005
Enrolled: 53-4-1005
Introduced: 53-4-1005