On May 4, 2022, Commissioner Downing issued an informational bulletin to announce an extension of transitional relief for certain non-grandfathered individual and small group policies known as “grandmothered” policies. The bulletin follows the recent CMS extension of the federal nonenforcement policy concerning specific ACA compliance requirements for these plans.

On November 14, 2013, CMS announced a transitional policy with respect to the healthcare reform mandates for coverage in the individual and small group markets. This nonenforcement policy provided relief from certain market reforms, including prohibitions of coverage exclusions based on pre-existing conditions and requirements to cover essential health benefits and limit annual out-of-pocket spending.

Under the policy, state authorities could permit health insurance issuers to continue coverage that would otherwise have been cancelled for failure to comply with the ACA requirements. The commissioner has historically allowed insurers the option to continue such coverage. The recently announced extension applies to renewals for plan or policy years beginning on or after October 1, 2022 and remains in effect until CMS announces that all such coverage must come into compliance with the specified requirements.

Small employers currently covered by such grandmothered policies issued in the state should be aware of the bulletin. These employers should work with their advisors and insurers regarding renewal of the coverage.

Extended Transitional Policy Bulletin »

On March 11, 2022, Commissioner Downing issued an Advisory Memo regarding coverage of preventive colonoscopies without cost-sharing. The memo follows recent federal guidance based on a recommendation by the United States Preventive Services Task Force (USPSTF).

The ACA requires group health plans and health insurers to cover certain preventive services without cost-sharing, including evidence-based items and services with an “A” or “B” recommendation by the USPSTF. The USPSTF recommends an “A” rating screening for colorectal cancer for adults aged 50 to 75 years and recently extended its recommendation with a “B” rating to adults aged 45 to 49 years. In May 2021, the USPSTF updated its recommendation for colorectal cancer screening to indicate that a follow-up colonoscopy is required after abnormal direct visualization or stool screening tests.

Based upon the USPSTF recommendation, the DOL, HHS and IRS issued guidance in January 2022 that requires group health plans and insurers to cover follow-up colonoscopies. Specifically, coverage must be provided without cost-sharing for a colonoscopy conducted after a positive non-invasive stool-based screening test or direct visualization screening test for colorectal cancer for individuals described in the USPSTF recommendation.

Employers should be aware of this coverage requirement, which is effective for plan years beginning on or after May 31, 2022. Additionally, they should review the memo and the referenced federal guidance for further details.

2022-03-11 Advisory Memorandum Regarding Coverage of Preventative Colonoscopies without Cost Sharing »

On April 19, 2021, Gov. Gianforte signed House Bill 43 into law. This legislation is designed to expand access to telehealth services in the state on a permanent basis. The law is effective on January 1, 2022.

During the COVID-19 pandemic, the state suspended certain telehealth limitations to enable more residents to use these services. For example, the requirement for a prior established provider-patient relationship was temporarily removed. Geographical patient restrictions were also lifted.

The new law makes these pandemic-initiated changes permanent. It also allows additional types of technology to be used to provide telehealth services. Accordingly, audio and audio-only communications will be permitted, so residents in rural neighborhoods without access to broadband internet can still receive medical care. Furthermore, the law extends telehealth coverage requirements to public employee benefit plans and self-insured student health plans.

Affected employers may want to be aware of these developments.

News Release »
HB 43 »

On February 23, 2021, Commissioner Downing issued an Informational Bulletin to announce a one-year extension of transitional relief for certain non-grandfathered individual and small group policies known as “grandmothered” policies. The bulletin follows the CMS extension of the federal non-enforcement policy concerning specific ACA compliance requirements for these plans.

 On January 19, 2021, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Montana and allows the issuer to renew these non-ACA compliant plans.

The Commissioner’s adoption of the extension under the bulletin applies to policy years beginning on or before October 1, 2022, and coverage extending through December 31, 2022.

Accordingly, small employers who are currently covered by such “grandmothered” policies issued in the state should be aware of the bulletin. These employers should work with their advisors and insurers regarding possible renewal of the coverage.

Informational Bulletin »

On April 21, 2020, Gov. Bullock issued a directive regarding telehealth services and reimbursement as a result of the coronavirus (COVID-19) pandemic. The message is directed at health insurers, health plan sponsors, health care providers and state residents.

The directive follows the state’s emergency declaration and recent federal guidance regarding telehealth services. It modifies prior state regulations to ensure residents have broader access and coverage for telehealth services. The communication also provides direction for health insurers with respect to telehealth use, delivery and reimbursement.

For the duration of the emergency, limitations on the types of technology and locations that can be used to deliver telehealth services are removed. The requirement of a pre-existing provider/patient relationship is also eliminated.

The directive reinforces that under telehealth parity, insurers must generally provide coverage and reimbursements for medically necessary telehealth services to the same extent as in-person services. Insurers are reminded that federal law mandates coverage for COVID-19 testing and diagnosis without cost sharing. Additionally, insurers and self-insured plans are encouraged to lower or eliminate cost sharing for other types of telehealth visits to incentivize patients to continue necessary care during the emergency. (Recent federal guidance permits mid-year amendments that expand telehealth services and/or eliminate related cost sharing.)

With respect to licensing requirements, the directive clarifies the types of state-licensed health care providers that may deliver telemedicine. Insurers are required to take measures to ensure their telehealth network is adequate, including making out-of-state providers available, if necessary. Insurers and providers are urged to try to avoid out-of-network and surprise billing for telehealth services and reminded of the federal prohibition against “balance billing” for COVID-19 treatment services.

Employers should be aware of the directive and modifications to prior telehealth laws in the state. They may wish to contact their carriers for further information regarding the available telehealth services. The measures are effective immediately.

Directive Implementing Executive Orders 2-2020 and 3-2020 »

On June 2, 2017, Gov. Bullock signed HB 142 into law, which amends sections 2-18-704, 33-22-701, 33-22-702, 33-22-703, 33-22-705, 33-31-111 and 33-35-306 of the Montana Code while repealing sections 33-22-704 and 33-22-706. This law requires insurers to cover mental health services at the same level as they do for physical health services. This means copays, deductibles and out-of-pocket costs for mental health must be equal to those provided for physical health services.

This law is effective for all health insurance issuers that issue, modify or renew group health plans in Montana on or after Jan. 1, 2018.

HB 142 »

On April 15, 2017, Gov. Bullock signed SB 44 into law, creating Chapter 231, which amends Sections 20-25-1403, 33-30-102, 33-31-111 and 33-35-306 of the Montana Code. This law requires health insurance issuers and health benefit plans to pay air ambulance service changes if the services are necessary due to an emergency medical condition. This would include amounts that exceed allowable copayments, coinsurance and deductibles and would also include services provided by out-of-network providers. In addition, the law establishes dispute resolution processes for air ambulance providers and insurers.

Emergency medical conditions means medical conditions characterized by symptoms of sufficient severity for a person knowledgeable in health and medicine to reasonably expect jeopardy to a person’s health (including the health of an unborn child), serious impairment to bodily functions or serious dysfunction of any bodily organ or part absent immediate medical attention.

Payment by issuers and plans would not be required if plan participants have an air ambulance membership subscription that pays for the services provided.

This amendment was effective upon passage.

Chapter 231 »

On April 18, 2017, Gov. Bullock signed HB 469 into law, creating chapter 206, which amends section 33-22-111 of the Montana Code. Under existing Montana law, all policies or certificates of disability insurance (which includes health plans) must allow the insured the full freedom of choice of practitioner. The list of practitioners included the following: any licensed physician, physician assistant, dentist, osteopath, chiropractor, optometrist, podiatrist, psychologist, licensed social worker, licensed professional counselor, acupuncturist, naturopathic physician, physical therapist, speech-language pathologist, audiologist, licensed addiction counselor and advanced practice registered nurse. This new amendment broadens the practitioners for which a choice must be granted to include licensed and family therapists.

This amendment to the statute is effective Jan. 1, 2019.

Chapter 206 »

On Mar. 23, 2017, Gov. Bullock signed S.B. 129 into law, creating enrolled Chapter 94. The legislation amends the state’s telemedicine statute by requiring insurance coverage for dental services offered through telemedicine. Under existing Montana law, insured group health plans must provide coverage for health-care services provided through telemedicine if such services are otherwise covered by plans. Such coverage must be equivalent to coverage for services provided in person by health-care providers or at health-care facilities. This new amendment broadens the definition of licensed health-care providers to include dentists and dental hygienists.

This amendment to the statute is effective Jan. 1, 2018.

Chapter 94 »

On April 21, 2020, Gov. Bullock issued a directive regarding telehealth services and reimbursement as a result of the coronavirus (COVID-19) pandemic. The message is directed at health insurers, health plan sponsors, health care providers and state residents.

The directive follows the state’s emergency declaration and recent federal guidance regarding telehealth services. It modifies prior state regulations to ensure residents have broader access and coverage for telehealth services. The communication also provides direction for health insurers with respect to telehealth use, delivery and reimbursement.

For the duration of the emergency, limitations on the types of technology and locations that can be used to deliver telehealth services are removed. The requirement of a pre-existing provider/patient relationship is also eliminated.

The directive reinforces that under telehealth parity, insurers must generally provide coverage and reimbursements for medically necessary telehealth services to the same extent as in-person services. Insurers are reminded that federal law mandates coverage for COVID-19 testing and diagnosis without cost sharing. Additionally, insurers and self-insured plans are encouraged to lower or eliminate cost sharing for other types of telehealth visits to incentivize patients to continue necessary care during the emergency. (Recent federal guidance permits mid-year amendments that expand telehealth services and/or eliminate related cost sharing.)

With respect to licensing requirements, the directive clarifies the types of state-licensed health care providers that may deliver telemedicine. Insurers are required to take measures to ensure their telehealth network is adequate, including making out-of-state providers available, if necessary. Insurers and providers are urged to try to avoid out-of-network and surprise billing for telehealth services and reminded of the federal prohibition against “balance billing” for COVID-19 treatment services.

Employers should be aware of the directive and modifications to prior telehealth laws in the state. They may wish to contact their carriers for further information regarding the available telehealth services. The measures are effective immediately.

Directive Implementing Executive Orders 2-2020 and 3-2020 »