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- 2025
69th Legislature 2025 SB 446
- 1 - Authorized Print Version – SB 446
ENROLLED BILL
AN ACT REVISING LAWS RELATED TO HEALTH UTILIZATION REVIEW; REQUIRING A PHYSICIAN
LICENSED IN THE STATE TO MAKE OR REVIEW AN ADVERSE DETERMINATION OR REVIEW A
GRIEVANCE; AND AMENDING SECTION 33-32-221, MCA.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
Section 1. Qualifications of individuals who make or review adverse determinations. (1) Only a
physician may make an adverse determination pursuant to 33-32-211 or 33-32-212 for a utilization review
organization.
(2) A physician who makes an adverse determination:
(a) must possess a current, valid nonrestricted license to practice medicine;
(b) must have a specialty that focuses on the diagnosis and treatment of the condition being
reviewed; and
(c) shall make the adverse determination under the clinical direction of one of the utilization review
organization’s medical directors who is responsible for the oversight of the utilization review activities. A
medical director used for this purpose must be a physician licensed in the state.
Section 2. Qualifications of individuals who review grievance. (1) Only a physician may review a
grievance as provided under 33-32-308 or 33-32-309 for a utilization review organization.
(2) A physician who reviews a grievance:
(a) must possess a current, valid nonrestricted license to practice medicine;
(b) must have the same specialty as a health care provider who typically manages the medical
condition or disease or provides the health care service that is the subject of the grievance;
(c) must have experience treating patients with the medical condition or disease that is the subject
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69th Legislature 2025 SB 446
- 2 - Authorized Print Version – SB 446
ENROLLED BILL
of the grievance; and
(d) shall review the grievance under the clinical direction of one of the utilization review
organization’s medical directors who is responsible for the oversight of the utilization review activities. A
medical director used for this purpose must be a physician licensed in the state.
(3) A physician who reviews a grievance may not:
(a) have been directly involved in making the adverse determination that is the subject of the
grievance; and
(b) have a financial interest in the outcome of the grievance.
Section 3. Section 33-32-221, MCA, is amended to read:
"33-32-221. Prior authorization requirements. (1) A health insurance issuer may not perform prior
authorization on benefits for:
(a) any generic prescription drug that is not listed within any of the schedules of controlled
substances found at 21 CFR 1308.11 through 21 CFR 1308.15 or the schedules of controlled substances found
in Title 50, chapter 32, after a covered person has been prescribed the covered drug at the same quantity
without interruption for 6 months;
(b) any prescription drug or drugs, generic or brand name, on the grounds of therapeutic
duplication for the same drug if the covered person has already been subject to prior authorization on the
grounds of therapeutic duplication for the same dosage of the prescription drug or drugs and coverage of the
prescription drug or drugs was approved;
(c) any prescription drug, generic or brand name, solely because the dosage of the medication for
the covered person has been adjusted by the prescriber of the prescription drug, as long as the dosage is
within the dosage approved by the food and drug administration or is consistent with clinical dosing for the
medication; or
(d) any prescription drug, generic or brand name, prescribed for treatment of a substance use
disorder, provided that the drug is approved by the U.S. food and drug administration for treatment of
substance use disorder and the prescription does not exceed the U.S. food and drug administration labeled
dosages; or
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69th Legislature 2025 SB 446
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ENROLLED BILL
(d)(e) any prescription drug, generic or brand name, that is a long-acting injectable antipsychotic.
(2) Any adverse determination for a prescription drug made during prior authorization by a health
insurance issuer must be made by a physician whose specialty focuses on the diagnosis and treatment of the
condition for which the prescription drug was prescribed to treat, provided that prior authorization that does not
result in an adverse determination does not require the involvement of a physician on the part of a health
insurance issuer."
Section 4. Codification instruction. (1) [Section 1] is intended to be codified as an integral part of
Title 33, chapter 32, part 2, and the provisions of Title 33, chapter 32, part 2, apply to [section 1].
(2) [Section 2] is intended to be codified as an integral part of Title 33, chapter 32, part 3, and the
provisions of Title 33, chapter 32, part 3, apply to [section 2].
Section 5. Coordination instruction. If both House Bill No. 398 and [this act] are passed and
approved, then [sections 1 and 2 of this act] are void.
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I hereby certify that the within bill,
SB 446, originated in the Senate.
___________________________________________
Secretary of the Senate
___________________________________________
President of the Senate
Signed this _______________________________day
of____________________________________, 2025.
___________________________________________
Speaker of the House
Signed this _______________________________day
of____________________________________, 2025.
SENATE BILL NO. 446
INTRODUCED BY V. RICCI, C. SCHOMER, E. BUTTREY, C. HINKLE, J. ETCHART, L. DEMING, J. KARLEN,
B. MITCHELL
AN ACT REVISING LAWS RELATED TO HEALTH UTILIZATION REVIEW; REQUIRING A PHYSICIAN
LICENSED IN THE STATE TO MAKE OR REVIEW AN ADVERSE DETERMINATION OR REVIEW A
GRIEVANCE; AND AMENDING SECTION 33-32-221, MCA.