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Short hearing: bill would bar third-party payers from denying Medicaid claims solely for missing prior authorization
Summary
The Office of Inspector General told the committee Senate Bill 361 would bar a liable third‑party payer from denying payment for Medicaid services solely for lack of prior authorization, aligning state law with the federal Consolidated Appropriations Act of 2022.
Heather Smith, program compliance bureau chief with the Office of Inspector General, told the committee that Senate Bill 361 implements a federal change in the Consolidated Appropriations Act of 2022. The statute, she said, bars liable third‑party payers from refusing payment for Medicaid‑covered items solely because a prior authorization under the third‑party payer’s own rules was not received.
Smith said federal rules require Medicaid to be the payer of last resort and that the bill adds the new federal provision to Montana’s Medicaid third‑party liability rules so state recoveries will increase and federal rules will be followed. She said the change would not alter third‑party rules for non‑Medicaid members and that no opponents had signed up for the hearing. The committee discussed the change briefly; no vote or amendment was recorded in the transcript.
