CCS/SS/SCS/HS/HCS/HB 762 - This act requires additional insurance and Medicaid coverage for women's health services.

A technical correction is made to whistleblower protections for certain health care employees. Whistleblower employees must be informed of their right to notify the Department of Health of any additional information concerning alleged violations of law or rules concerning patient care and safety or facility safety. (Section 197.285).

A new subdivision 27 is added to Section 208.151, RSMo, to provide that persons who have been diagnosed with breast or cervical cancer will be eligible for Medicaid coverage if other eligibility requirements are met. To be eligible, the person must:

- be under 65; - have been screened for breast or cervical cancer under the federal Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program; - need treatment for breast or cervical cancer; and - be uninsured;

During the eligibility determination, the person may be eligible during a period of presumptive eligibility. If all eligibility requirements are met, then the person will receive Medicaid coverage. This provision is similar to SB 448. (Section 208.151).

A new Section 376.1199 is created to require HMOs to:

1) Provide direct access to OB/GYN services. A health carrier may not impose additional charges on enrollees who utilize such coverage, unless also imposed for similar coverage. This section does not include coverage for abortion, other than for spontaneous abortion or to prevent the mother's death. This provision is similar to SB 424 (2001), SCS/SBs 391 & 395 (2001) and TAT CCS/HS/HCS/SCS/SB 266 (2001);

2) Notify enrollees annually of cancer screenings;

3) Provide coverage for osteoporosis. Enrollee charges must be applied in a manner similar to other forms of coverage; and

4) If the HMO provides pharmaceutical coverage, then it must provide contraceptives at no charge or at the same charge as other pharmaceuticals on its formulary. The term "contraceptive" does not include drugs or devices used to induce abortion. This requirement includes contraceptives prescribed for purposes other than contraceptive or abortion use.

Health carriers may issue plans or riders that exclude contraceptive coverage for moral, ethical, or religious reasons. Such health carriers, however, must also provide a rider for enrollees to receive contraceptive coverage. Costs associated with such exclusion will be paid by the policyholder. Any health carrier owned, operated, or controlled in substantial part by an entity operating pursuant to moral, ethical, or religious tenets is exempt from the contraceptive requirement. Written information must be provided to enrollees regarding contraceptive coverage. Health carriers may not disclose the names of enrollees who exclude or purchase coverage for contraceptives and such enrollees may not be discriminated against. This portion is substantially similar to portions of HB 285. (Section 376.1199).

Currently, insurance companies must cover mastectomies and prosthetic devices or reconstructive surgery after a mastectomy. This act adds that no time limit shall be imposed on an individual for the receipt of a prosthetic or reconstructive surgery. It also provides that if an individual changes his or her insurance, then the new policy subject to the federal Women's Health and Cancer Rights Act must provide coverage consistent with that act. This provision is similar to SB 349. (Section 376.1209).

A new section requires the Department of Insurance to obtain approval from the attorney general's office before entering into certain contracts. (Section 1).
ERIN MOTLEY