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Montana bill to ease prior‑authorization delays wins broad provider support; insurers took neutral role
Summary
Representative Jonathan Karlen said HB 398 would require continuity of prior authorizations when patients change plans, expand authorization durations, and insist on peer‑to‑peer reviews for denials. Physicians, hospitals and patient advocates urged passage; insurers participated in negotiations and Blue Cross Blue Shield testified as a neutral collaborator.
Representative Jonathan Karlen presented House Bill 398 as a targeted effort to reduce interruptions in care caused by prior‑authorization processes. Key provisions described by the sponsor include honoring an existing prior authorization for a transition period when a patient changes insurance plans (initially 90 days), extending standard prior‑authorization validity to six months and to 12 months for defined chronic conditions, and requiring peer‑to‑peer clinical review by a reviewer with relevant specialty when a denial is issued.
Karlen and clinical proponents said the changes relieve administrative burdens that delay care for patients with complex or chronic conditions. Pediatric and specialty clinicians gave specific examples: Kim Longcake (pediatric gastroenterology advanced practitioner) and Jennifer Buszka (utilization review specialist at Shodair Children’s Hospital) described cases in which denials were overturned only after higher‑level review and where delays threatened continuity of treatment. Parent and patient testimony (Tiffany and Blaine Thornton) described life‑threatening delays when prior authorizations were rescinded or rescoped.
Health‑care associations (Montana Medical Association, Montana Hospital Association, Montana Academy of Pediatrics, Montana Pharmacy Association and others) testified in support. Drew Czik of Blue Cross Blue Shield of Montana appeared as an informational witness and said insurers participated in months of negotiation and supported the resulting compromise language, characterizing it as a broadly negotiated package.
Committee members asked about who pays and whether the changes would extend coverage; sponsors clarified the bill preserves insurers’ coverage decisions but directs what authorizations the new plan must honor for a specified transition period. Several senators complimented the multi‑stakeholder negotiations and proponents emphasized the bill’s consensus nature.
At the time the transcript ends on this hearing’s close, proponents urged passage and the sponsor thanked stakeholders for their collaboration.
