The bill aims to revise utilization review laws in Montana by establishing new requirements and qualifications for individuals involved in making or reviewing adverse determinations related to health care services. It mandates that adverse determinations must be made by qualified professionals, such as physicians or licensed health care professionals in the same field as the requesting provider. Additionally, it specifies that only a physician can review grievances related to adverse determinations, ensuring that these reviews are conducted by individuals with appropriate expertise. The bill also introduces a new definition for "chronic condition," emphasizing the need for ongoing medical attention or limitations on daily activities.

Furthermore, the bill includes provisions for continuity of care when a covered person changes health plans, requiring health insurance issuers to honor prior certifications for at least three months under certain conditions. It amends existing laws to extend the validity of certifications from three to six months, with specific provisions for chronic conditions, which can be certified for up to twelve months. The bill is set to take effect on January 1, 2026, and aims to enhance the quality and consistency of health care services provided to covered individuals in Montana.

Statutes affected:
LC Text: 33-32-102, 33-32-107
HB0398_1(1): 33-32-102, 33-32-107
HB0398_1(2): 33-32-102, 33-32-107
HB0398_1(3): 33-32-102, 33-32-107
HB0398_1(4): 33-32-102, 33-32-107
HB0398_1(5): 33-32-102, 33-32-107
HB0398_1: 33-32-102, 33-32-107
HB0398_2(1): 33-32-102, 33-32-107
HB0398_2(10): 33-32-102, 33-32-107
HB0398_2(11): 33-32-102, 33-32-107
HB0398_2(12): 33-32-102, 33-32-107
HB0398_2(2): 33-32-102, 33-32-107
HB0398_2(3): 33-32-102, 33-32-107
HB0398_2(4): 33-32-102, 33-32-107
HB0398_2(5): 33-32-102, 33-32-107
HB0398_2(6): 33-32-102, 33-32-107
HB0398_2(7): 33-32-102, 33-32-107
HB0398_2(8): 33-32-102, 33-32-107
HB0398_2(9): 33-32-102, 33-32-107
HB0398_2: 33-32-102, 33-32-107
HB0398_X(1): 33-32-102, 33-32-107
HB0398_X(2): 33-32-102, 33-32-107
HB0398_X(3): 33-32-102, 33-32-107
HB0398_X(4): 33-32-102, 33-32-107
HB0398_X(5): 33-32-102, 33-32-107
HB0398_X: 33-32-102, 33-32-107