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Montana committee hears testimony for SB 446 to tighten prior-authorization reviews; insurers warn of costs
Summary
SB 446 would require appropriately specialized reviewers for prior-authorization denials and included a 'deeming' clause that would approve care automatically if insurers fail review timelines; health providers urged swift passage while major insurers cautioned the measure undoes months of negotiated compromise and could raise premiums. The committee adopted coordination language with House bills and removed the automatic 'deeming' section before concurring on the bill as amended.
Sen. Vince Ricci, sponsor of Senate Bill 446, told the House Business and Labor Committee he drafted the measure after hospital site visits and discussions with clinicians who told him prior-authorization processes were delaying care. “If an insurer does not comply with the requirements, either the timeline or appropriate reviewer, then the patient gets that service. It's considered approved,” Ricci said, explaining the bill’s original deeming provision.
Proponents, including pediatric nurse practitioner Kim Longcake of Logan Health Billings Clinic, described repeated examples of delayed or rejected requests that lacked specialty expertise on the reviewing side. “If they're going to say no we just need to make sure that it's an appropriate review on their end,” Longcake testified, citing a case in which a teen with Crohn’s disease waited weeks for approval despite an urgent request.
Supporters framed the bill as an extension of existing medication peer-review rules to procedures and imaging, and argued it would reduce harm from delays. Jean Branscum, CEO of the Montana Medical Association, cited survey data showing frequent denials and peer-to-peer reviews that often don’t reach a qualified specialist.
Insurers strongly opposed parts of SB 446. Drew Cziok, government-relations director for Blue Cross Blue Shield of Montana, said the measure revisits issues already negotiated in a prior package (House Bills 398, 399 and 544), would impose heavy specialty‑matching costs — an estimate of more than $1 million per year to administer was cited in committee testimony — and risk passing those costs to members. “This bill doesn't reflect that compromise,” Cziok said, urging the panel to leave previously negotiated bills in place.
Representatives of the American Health Insurance Plans and pharmacy benefit managers warned the bill’s deeming clause risked approving services without proper clinical review if technical issues, documentation gaps, or other exceptional circumstances caused a missed deadline. A representative of the Commissioner of Securities and Insurance noted many plans (for example, some self-funded or federal plans) are outside state regulation and would not be affected.
Committee staff later described coordination amendments that would prioritize existing negotiated House language where the bills overlap. In executive action the committee adopted a coordination instruction and then voted to remove the bill’s proposed new Section 3 — the automatic deeming provision — after a conceptual roll‑call vote. The committee then concurred on SB 446 as amended and moved it to the House floor. The conceptual roll-call deleting Section 3 was reported in committee as passing by recorded count (committee reported the conceptual vote with a majority in favor).
What happens next: SB 446 will go to the House floor with committee-concurred amendments that coordinate the bill with earlier negotiated House language and without the automatic deeming provision that drew insurer opposition.
