MontanaHB 39869th Legislature, Regular Session (2025)HouseWALLET

Generally revise insurance laws related to prior authorization of chronic conditions

Sponsored By: Jonathan Karlen (Democrat)

Signed by Governor

Health Care ServicesInsuranceProfessions and Occupations GenerallyRevenue, State

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 3 benefits, 0 costs, 1 mixed.

Longer prior approvals, including chronic care

Beginning January 1, 2026, prior authorizations last at least 6 months from when your provider gets them. They can be shorter only if you lose coverage or if FDA or other safety guidance requires less time. For chronic conditions, approvals last 12 months, with the same FDA or safety and loss-of-coverage exceptions.

Care stays approved when you switch plans

Beginning January 1, 2026, if you change health plans, your new insurer must honor your prior authorization for at least the first 3 months once you or your provider send proof, and only if the service is covered under the new plan. If you switch to a different product from the same insurer, your prior authorization still stands for covered services. During that 3-month window, the plan can run its own review and issue a new decision, which can confirm or cut off approval. If plan rules change after you got an authorization, the change does not apply to you until the authorization ends or your plan year ends, whichever is sooner.

Stronger rules for who can deny care

Beginning January 1, 2026, only the right clinicians can deny care. If a physician requested the service, a physician must decide the denial. If another licensed provider requested it, a reviewer licensed in that same profession must decide, or a physician may decide. Any reviewer who denies care must have a current, nonrestricted license and experience treating the condition, or must send it to a physician with the right expertise. Only a physician with the proper specialty can review grievances. A licensed physician medical director must oversee all adverse determinations.

All changes start January 1, 2026

All these rules take effect January 1, 2026. Plans, reviewers, providers, and covered people follow them from that date.

Sponsors & Cosponsors

Sponsor

Jonathan Karlen
Democrat • House

Cosponsors

Willis Curdy
Democrat • Senate

Roll Call Votes

All Roll Calls

Yes: 273 • No: 21

Senate vote • 4/10/2025

Do Concur

Yes: 47 • No: 1

Senate vote • 4/9/2025

Do Concur

Yes: 45 • No: 3

House vote • 3/20/2025

Do Pass

Yes: 90 • No: 8

House vote • 3/19/2025

Do Pass

Yes: 91 • No: 9

Actions Timeline

Chapter Number Assigned
5/5/2025House
Signed by Governor
5/1/2025House
Transmitted to Governor
4/22/2025House
Signed by President
4/22/2025Senate
Signed by Speaker
4/18/2025House
Returned from Enrolling
4/11/2025House
Sent to Enrolling
4/10/2025House
3rd Reading
4/10/2025Senate
2nd Reading
4/9/2025Senate
Committee Report
3/28/2025Senate
Committee Executive Action
3/28/2025Senate
Hearing
3/24/2025Senate
Referred to Committee
3/21/2025Senate
Transmitted to Senate
3/20/2025House
3rd Reading
3/20/2025House
2nd Reading
3/19/2025House
Committee Report
2/27/2025House
Committee Executive Action
2/27/2025House
Hearing
2/20/2025House
Fiscal Note Printed
2/12/2025House
Fiscal Note Signed
2/11/2025House
Fiscal Note Received
2/11/2025House
Rereferred to Committee
2/10/2025House
Hearing Canceled
2/7/2025House
Hearing
2/6/2025House

Bill Text

Enrolled
4/15/2025
PDF
As Amended (Version 2)
2/27/2025
PDF
Introduced
2/5/2025
PDF

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