2021 State Legislative Agenda

The Montana Hospital Association (MHA) advocates for public policies that improve the health of Montanans and recognize the value of health care providers in sustaining their local communities.

2021 legislative priorities include:

  • Protect the State Medicaid Budget
  • Continued Funding of Medicaid Expansion
  • Expanding Telehealth
  • Protect Access to Behavioral Health Services
  • Medical Liability Reform

Protect Patient Access to Care

BUDGET AND MEDICAID

Ensure that essential healthcare services are available in all communities by protecting vital state funding for Medicaid. With the exception of Medicare, Medicaid is the largest healthcare insurer in the state, which makes it the largest state-funded program for providers.

  • Support the continuation of the Medicaid Expansion program
  • Support full funding of the current Medicaid program to avoid service or payment reductions
  • Support provider rate increases equivalent to the rate of inflation
  • Support the continuation of the Hospital Utilization Fee (HUF) for both inpatient (hospital “bed tax”) and outpatient services
  • Support full funding of senior and post-acute care services costs

The state’s budget problems almost certainly will dominate the 2021 session. As always, MHA will be closely following funding issues for health and human services and education.

  • Closely monitor State revenue/projections
  • Oppose unnecessary health and human services cuts
  • Oppose unnecessary university system funding cuts that impact health professions education
  • Support, as appropriate, alternate revenue opportunities for the state
  • Support EMS reimbursement equal to Medicare rates

RURAL HOSPITAL DESIGNATIONS

Adopt any new federal-level rural hospital designations designed to protect rural communities’ access to care.

  • Support legislation (if needed) to recognize a new Medicare designation that provides enhanced reimbursement for emergency and outpatient services without requiring inpatient care.

INSURANCE

MHA has long advocated that every Montanan should be protected from health insurance fraud and inappropriate coverage issues. MHA will monitor proposed insurance legislation that could negatively impact individuals and/or healthcare organizations across the state.

  • Oppose barriers to coverage
  • Support promotion of insurance exchange
  • Monitor limiting policy coverage
  • Oppose any effort to “price-fix” or impose a reference-based model

Advance Affordability in Healthcare

SURPRISE MEDICAL BILLS

Protect patients from surprise medical bills that result from unexpected gaps in their insurance coverage or medical emergencies, without reductions to in-network hospital services for in-network patients through rate setting or other mechanisms.

  • Support implementation of the “No Surprises Act,” a federal law to address surprise medical bills that passed in December 2020. The law goes into effect January 1, 2022.
  • Oppose additional state legislation that is duplicative or contradictory to the federal law.

TRANSPARENCY

Ensure patients have access to the information they need to make informed healthcare decisions, including their expected out-of-pocket costs.

  • Support hospitals’ implementation of new federal transparency requirements that went into effect January 1, 2021, and oppose any redundant state-level requirements
  • Oppose price-fixing and anti-competitive proposals such as reference-based pricing legislation
  • MHA will continue to post pricing information on its Montana Informed Patient Web portal
    mtha.org/mt-informed-patient

REDUCE ADMINISTRATIVE WASTE

Advance solutions to reduce administrative waste, such as by streamlining prior authorization requirements and processes.

REDUCE REGULATORY BURDEN

Reduce regulatory burdens that unnecessarily increase the cost of healthcare and divert resources and providers’ time from patient care. Federal-level regulatory burden alone costs roughly $1,200 every time a patient is admitted to the hospital. Reducing administrative activities related to regulatory compliance will allow clinicians to spend more time on patients rather than paperwork, and will support a level regulatory playing field.

MEDICAL LIABILITY REFORM

Reduce unnecessary costs in the system by passing comprehensive medical liability reform, including caps on non-economic damages and allowing courts to limit attorneys’ contingency fees.

Invest in Infrastructure

TELEHEALTH

Expand access to care through the use of telehealth and other technologies by providing Medicaid coverage and reimbursement for such services and including telehealth waivers in all new care models.

  • Sponsor legislation to make permanent the temporary waivers that expanded telehealth access, services and providers
  • Support legislation that expands digital infrastructure and rural broadband

ACCESS TO EMERGENCY MEDICAL SERVICES (EMS)

The average Montanan will have need of an ambulance service at least twice in his or her lifetime according to the state EMS and Trauma Systems Program. For those living or traveling in rural communities, access to EMS services is difficult and is jeopardy in many communities. Counties and hospitals providing EMS have struggled with dependence on an aging volunteer workforce and a lack of resources to fund paid personnel.

  • Support changes to the licensure and certification of EMS professionals permitting them to be used more effectively in hospitals and available for hospital-based EMS programs
  • Support changes to licensing and certification of EMS professionals to permit the articulation of military medical training towards Emergency Care Provider (ECP) licensure
  • Support realignment of EMS licensure from Department of Labor and Industry to DPHHS

TAX REFORMS

The vast majority of hospital and clinic services are provided by not-for-profit organizations.  Each of these providers is licensed by the state and recognized as a charitable organization by section 501(c)(3) by the Internal Revenue Service (IRS). In return for the state and federal exemption, hospitals agree to provide a community benefit that includes a host of services for which there is little or no compensation. Without the tax exemption, most not-for-profit healthcare organizations would cease to exist, leaving large areas of the state and population without needed healthcare. MHA will protect the tax status of its not-for-profit members and appropriately address any policy proposals that threaten tax exemptions.

  • Oppose changes that would further restrict or unnecessarily burden the tax-exempt status of not-for-profit healthcare organizations
  • Oppose increased property tax singled out for healthcare organizations
  • Support tax credits for construction of healthcare workforce housing
  • Support extending the qualified endowment tax credit

SENIOR SERVICES/POST-ACUTE CARE

MHA serves a number of post-acute care and senior services providers, including hospital-based programs. In addition to Medicaid funding and workforce concerns there will be other ‘specific’ legislative proposals during the session. MHA support bills that enhance these service areas, and will oppose bills that add regulatory and administrative burden.

  • Support decrease in state regulatory burden
  • Pursue/support tax credit for building affordable senior housing
  • Support elimination of state tax on social security
  • Support/pursue changes to the Medicaid program to provide needed resources for Montanans that suffer from Alzheimer’s or related dementias
  • Support reforms to Medicaid allowing a nursing facility to be an originating telehealth site
  • Support adoption of Uniform Guardianship Law

Improve the Health Status of Montana Residents

BEHAVIORAL HEALTH

A major focus for MHA toward its vision to improve the health status of Montanans is improving and expanding programs, services and resources dedicated to behavioral health. MHA supports policies to better integrate and coordinate behavioral health services with physical health services.

  • Support legislation that will improve access to mental health/crisis services
  • Support legislation that will expand and enable development of suicide prevention programs
  • Support legislation that will meaningfully address the regulation of opioid use and those struggling with a substance use disorder
  • Support the Governor’s new investments in behavioral health funding
  • Support expanded use of telehealth for behavioral health

POPULATION HEALTH

MHA’s vision is to advance Montana to a Top 10 healthy state. There are a number of legislative actions that could enhance the progress being made in the state to become ‘healthier’; there will also be legislation introduced that will curtail any progress. MHA supports legislation that will improve the health and safety of the state’s population.

  • Support legislation to increase child/adolescent immunization
  • Support legislation for a primary offense seat belt law
  • Support legislation to preserve healthcare coverage
  • Support legislation to expand food programs
  • Support legislation to restrict or decrease access to youth tobacco
  • Support legislation that strengthens hospitals’ ability to manage chronic conditions

Strengthen the Healthcare Workforce

WORKFORCE

The healthcare workforce in Montana is one of the fastest aging groups in the country. As the ‘baby boom’ generation begins its migration towards retirement, there do not appear to be enough younger workers in the state to replace those leaving healthcare. With that reality MHA continues to advocate for initiatives that would strengthen the state’s healthcare workforce both in number and education opportunities.

  • Support legislation to further develop the healthcare workforce in rural communities
  • Support university system funding for health professions education
  • Support legislation enabling licensed health professionals to utilize their full scope of practice
  • Support legislation to expand information gathered for licensed health professionals during license renewal process
  • Support Residency programs and preserve funding for Graduate Medical Education (GME)
  • Preserve 30 WWAMI slots
  • Preserve MRPIP program
  • Preserve Enhanced Nurse Licensure Compact (NLC) and support legislation for entering into additional healthcare professional licensing compacts
  • Monitor legislation to decrease workplace violence
  • Support pathways for secondary/high school students to engage in work readiness programs and develop stackable credits that can be used to build skills