Generally revise laws related to electronic health care records
HB 590 revises Montana law governing electronic health records and health carrier data-sharing obligations. The bill requires health carriers to establish and maintain several application programming interfaces (APIs) for insureds and contracted providers, including patient access, provider directory, provider access, payer-to-payer exchange, and prior authorization APIs. These interfaces must be implemented by the earliest date required under applicable federal Centers for Medicare and Medicaid Services standards and must comply with CMS rules, including any enforcement delays or suspensions.
The bill also addresses disclosure of certain laboratory and diagnostic results in electronic health records. It prohibits information blocking by providers requesting lab tests and requires specified sensitive results to be released to patients within 72 hours after finalization, or sooner if the provider directs release. Covered results include pathology or radiology reports with a reasonable likelihood of indicating new or recurring malignancy, tests that could reveal genetic markers, positive HIV diagnostic tests, and hepatitis antigen results. The bill preserves a patient’s existing right to amend medical records under federal privacy rules.
HB 590 affects Title 33 insurance law and Title 50 public health law by adding new duties for health carriers and health care providers. It excludes dental-only and vision-only plans from the API requirements and authorizes the insurance commissioner to grant written deadline extensions when compliance would be unduly burdensome, impracticable, or economically harmful. Approved extensions must be published on the commissioner’s website, giving the state a role in overseeing implementation and exceptions.
The bill appears to have broad legislative support. It passed the House and Senate with large margins, including near-unanimous final votes after Senate amendments were concurred in by the House. The voting pattern suggests general agreement on improving interoperability, patient access to records, and compliance with federal health data standards.
The main point of contention is not reflected in committee testimony, but the structure of the bill suggests concerns about implementation burden, cost, and timing. Those issues are addressed directly by the extension process for carriers and by the delayed, CMS-linked effective-date framework. The sensitive-results disclosure provisions may also raise privacy and clinical judgment concerns, but the recorded votes indicate these concerns did not prevent strong bipartisan support.
HB 590 amends Montana insurance and health-records law by imposing new API and electronic health record disclosure requirements on health carriers and health care providers. It creates a state enforcement and exemption framework tied to federal CMS interoperability standards, while also adding a patient-access timeline for certain lab and diagnostic results. The bill primarily affects insurers, providers, patients, and the insurance commissioner, and it excludes dental-only and vision-only plans from the carrier API mandate.
The overall sentiment around HB 590 was strongly favorable. It advanced through both chambers with overwhelming majorities and only a handful of dissenting votes at each stage, indicating broad bipartisan support for modernizing electronic health record access and aligning Montana law with federal interoperability requirements. The final concurrence votes were unanimous or nearly unanimous, suggesting that any concerns were resolved through amendment or accommodation.
The most likely areas of contention were compliance burden, cost, and timing for health carriers, along with privacy and workflow concerns for providers handling sensitive test results. The bill directly addresses the first issue by allowing the insurance commissioner to extend deadlines when compliance would be unduly burdensome, impracticable, or economically harmful. The 72-hour release rule for malignancy-related reports, genetic markers, HIV, and hepatitis results may have raised concerns about patient anxiety, provider discretion, and record-management practices, but the recorded votes show little sustained opposition.