5 things to know about health care changes in Montana

The 2021 Montana legislative session will be remembered as one of the state's most consequential as a Republican-led legislature and governor's office passed new laws restricting abortions, lowering taxes and regulating marijuana.

But the debate over those and other highly publicized issues may have caused other meaningful legislation related to health care to slip off the public's radar. Here are five substantial health-related policies that emerged from the recently ended session. They include bills that Gov. Greg Gianforte has signed or is expected to sign into law.

1. The permanent expansion of telehealth

One byproduct of the covid-19 pandemic has been the widespread use of computers, tablets and smartphones for medical and behavioral health appointments instead of in-person office visits. Telehealth has particularly benefited Montana's large rural population during the pandemic.

"A lot of Montanans are in very rural areas and often need to take extended time off work, drive long distances, find child care just so they can attend a routine health care appointment," said state Sen. Jen Gross (D-Billings).

Gross sponsored one of two Montana bills that make permanent the expanded telehealth regulations set by emergency order at the start of the pandemic last year. The new laws redefine telehealth to include nonclinical health services, require private insurers and Medicaid to cover telehealth services and authorize state licensing boards to set rules regulating the practice.

The new laws also allow audio-only telehealth appointments, which supporters say are needed for rural areas without broadband internet coverage. An exception is that a doctor can't certify a patient for the state's medical marijuana program by phone without a previously established doctor-patient relationship. Telehealth by text messaging and fax alone is also still illegal.

The boom in virtual health care is being met with concern by local providers who worry that large out-of-state providers might poach patients and by regulators who see the potential for telehealth scams and fraud.

2. The weakened authority of local public health officials

Lawmakers fettered local public health officials with legislation after local health departments implemented and enforced state and federal recommendations to stop the spread of the coronavirus, such as mask mandates, limits on gathering and bans on indoor dining.

Many public health officials have faced threats and harassment over their work to enforce those covid restrictions, leading to high rates of turnover in health departments across the nation.

One measure passed by Republican-majority lawmakers ensures that any Montana public health order can be changed or repealed by elected officials, such as a county commission, and it bans officials from placing any restrictions on attending church services.

Another measure bars public health officials from issuing orders that restrict the ability of a private business to operate. There are some exceptions, such as restaurant health inspections. A third allows citizens to amend or reject public health orders by referendum, while a fourth overturned a law that penalized law enforcement officials who refused to enforce public health orders.

State lawmakers also added a provision in a bill on how to distribute the federal aid in the American Rescue Plan Act that would withhold 20% of any infrastructure grant made to a city, town or county if that local government enforces covid restrictions such as mask mandates and restaurant limits. Gianforte lifted those statewide restrictions after taking office, and the provision takes aim at local governments, like Gallatin County, that decided to keep their own restrictions.

"It's time for us to make sure the state is open," said Rep. Frank Garner (R-Kalispell), who backed the provision.

3. Making it more difficult to stay enrolled in Medicaid expansion

Lawmakers cut funding for the state Medicaid expansion program's 12-month continuous eligibility provision, which has allowed people enrolled in the program to receive benefits for a full year, regardless of changes to their income.

Continuous eligibility is meant to reduce the churning of Medicaid expansion rolls as people are added and removed if their income fluctuates, such as with seasonal work.

Instead, those enrollees will be required to certify their eligibility more than once a year. Department of Public Health and Human Services spokesperson Jon Ebelt said in an email that the department has reached out to the federal Centers for Medicare & Medicaid Services for guidance on how to make the change after the pandemic emergency ends.

Nearly 98,000 Montana adults were enrolled in the Medicaid expansion program in March, according to the most recent data.

4. Anti-vaccinators make their mark

Riding a wave of opposition toward the covid vaccines, the Montana Legislature passed a bill that makes it more difficult to require workers to be vaccinated as a condition of employment. That measure received much publicity and several last-minute amendments in the session's final days as hospitals and long-term care facilities warned it would force them to require face masks for employees and permanently ban visitors. The bill that passed "poses a significant threat to public safety," Montana Hospital Association CEO Rich Rasmussen said.

Another consequential vaccination bill that received less attention will make it easier for parents to obtain medical exemptions for their children for vaccines required by schools. State law requires kids to be vaccinated against illnesses such as measles and pertussis to go to school, but students can be exempted for religious or medical reasons.

Previously, a physician needed to sign off on a medical exemption. The new law allows a wide range of health professionals to do so, including nurses, pharmacists, massage therapists, chiropractors and nutritionists. It also makes it more difficult for schools to share exemption data with health officials.

Some parents who testified in support of the bill during legislative hearings said they wanted a medical exemption option because their children might need that medical documentation in the future to attend college or get a job that might not accept a religious exemption.

The state health department and the American Academy of Pediatrics opposed the legislation. "This bill has the effect of making medical exemptions extremely easy to obtain in cases where they might not be warranted," said Dr. Lauren Wilson, a pediatrician and vice president of the Montana chapter of the American Academy of Pediatrics.

5. Hearing aids for kids

Lawmakers passed a bipartisan measure that will require private insurers and the state employee health plan to cover hearing amplification devices and services for children 18 and under.

The new law won't affect a large number of people in the state, but supporters said it will make a difference in the lives of families who spend $6,000 every three to five years on hearing aids for their children.

Kiera Kirschner of Bozeman testified before lawmakers during the session that her 2½-year-old son was born with hearing loss and has had hearing aids since he was 2 months old.

"My son did not choose to have hearing loss," Kirschner said. "He needs hearing aids so he can grow and develop. They're medically necessary."

Montana is the 26th state to require such insurance coverage, and insurers said they did not oppose the measure because the total cost would not be significant.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.