SCS HB 1302 -- ESSENTIAL COMMUNITY PROVIDERS

Individual physicians can be called "essential community
providers" when they practice in areas designated by the U.S.
Department of Health and Human Services as medically
underserved.  The essential community provider is required to
spend a minimum of 20 hours per week in the health professional
shortage area and be available to patients during evenings and
weekends.  Essential community providers must have hospital
staff privileges or be affiliated with doctors who have such
privileges and cannot be direct employees of a health care
insurer.

Health care insurers that market a group policy or contract for
health care coverage are not required to offer it to all
essential community providers in the service areas of the plan.
The terms of the contract offered to essential community
providers must be as favorable as the terms offered to other
physician providers for the scope of services rendered.  Names
of individual essential community providers will be published
and distributed to consumers and enrollees of the plan when the
essential community provider is a primary care physician.  When
the essential community provider is a specialist, his or her
name will appear on the list of specialists distributed to the
primary care physicians in the plan.  Health care insurers may
terminate the contract of a physician for cause.  The name
"essential community provider" cannot be transferred to another
physician or site.  Physicians may apply to the director of the
Department of Health to be named an essential community provider.

Current law requires health maintenance organizations to obtain
permission of the enrollee and the enrollee's physician before
changing a maintenance drug, except when the drug is classified
as a narrow therapeutic index drug.  This bill repeals this
exception.  In addition, the bill specifies that generic drugs
may be dispensed for prescribed brand name maintenance drugs
according to Section 338.056, RSMo.

Health insurers and similar entities are required to cover the
administration of general anesthesia and hospital charges for
dental care to children under 5, the severely disabled, or a
person with a medical or behavioral condition that requires
hospitalization, or general anesthesia when dental care is
provided whether in a participating hospital or surgical center.
Prior authorization may be required by the health carrier.  This
does not apply to limited benefit health insurance policies like
short-term major medical policies of 6 months or less, accident--
only or dental-only or specified-disease-only policies.

Consistent with the Employee Retirement Income Security Act of
1974 (ERISA), health insurers, HMOs, and nonprofit health
service plans paid interest will pay the proportionate amount of
the interest to the enrollee or the insured for the time period
that the enrollee paid for the service or while reimbursement
was due to the insured or enrollee.  Advance practice nurses
will be reimbursed on claims for services by health insurers if
the service was within the scope of practice.

Health insurers and similar entities are required to pay
interest at a 1% monthly interest rate on the amount of the
claim remaining unpaid 45 days after the claim is filed.

HB 1302 -- ESSENTIAL COMMUNITY PROVIDERS (Bland)

Individual physicians can be called "Essential Community
Providers" when they practice in medically underserved areas
according to the Department of Health and Human Services.  The
Essential Community Provider is required to spend a minimum of
20 hours per week in the health professional shortage area and
be available to patients during evenings and weekends.
Essential Community Providers must have hospital staff
privileges or be affiliated with doctors who have such
privileges.  Essential Community Providers cannot be direct
employees of a health care insurer.

Health care insurers that market a group policy or contract for
health care coverage are not required to offer it to all
Essential Community Providers in the service areas of the plan.
The terms of the contract offered to Essential Community
Providers must be as favorable as the terms offered to other
physician providers for the scope of services rendered.  Names
of individual Essential Community Providers will be published
and distributed to consumers and enrollees of the plan when the
Essential Community Provider is a primary care physician.  When
the Essential Community Provider is a specialist, his or her
name will appear on the list of specialists distributed to the
primary care physicians in the plan.  Health care insurers may
terminate the contract of a physician for cause.  The name
"Essential Community Provider" cannot be transferred to another
physician or site.  Physicians may apply to the director of the
Department of Health to be named an Essential Community Provider.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
$75,000 in FY 1999, $85,000 in FY 2000, and $90,000 in FY 2001.

HB 1302 -- ESSENTIAL COMMUNITY PROVIDERS

CO-SPONSORS:  Bland, Crump, McBride

COMMITTEE ACTION:  Voted "do pass" by the Committee on Public
Health and Safety by a vote of 11 to 5.

Individual physicians can be called "Essential Community
Providers" when they practice in medically underserved areas
according to the Department of Health and Human Services.  The
Essential Community Provider is required to spend a minimum of
20 hours per week in the health professional shortage area and
be available to patients during evenings and weekends.
Essential Community Providers must have hospital staff
privileges or be affiliated with doctors who have such
privileges.  Essential Community Providers can not be direct
employees of a health care insurer.

Health care insurers that market a group policy or contract for
health care coverage are not required to offer it to all
Essential Community Providers in the service areas of the plan.
The terms of the contract offered to Essential Community
Providers must be as favorable as the terms offered to other
physician providers for the scope of services rendered.  Names
of individual Essential Community Providers will be published
and distributed to consumers and enrollees of the plan when the
Essential Community Provider is a primary care physician.  When
the Essential Community Provider is a specialist, his or her
name will appear on the list of specialists distributed to the
primary care physicians in the plan.  Health care insurers may
terminate the contract of a physician for cause.  The name
"Essential Community Provider" cannot be transferred to another
physician or site.  Physicians may apply to the director of the
Department of Health to be named an Essential Community Provider.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
$75,000 in FY 1999, $85,000 in FY 2000, and $90,000 in FY 2001.

PROPONENTS:  Supporters say that this bill has been around for
about 3 years passing with 127 house votes the first year it was
heard.  This bill recommends that HMO's take on Essential
Community Providers who have served the poor and are currently
locked out by the HMO's.  Essential Community Providers would
serve in underserved areas.  This legislation does not apply to
staff model HMO's such as Kaiser.

Testifying for the bill were Representative Bland; and
Department of Health.

OPPONENTS:  There was no opposition voiced to the committee.

Harolyn Light, Legislative Analyst

HB 1302 -- Essential Community Providers

Co-Sponsors:  Bland, Crump

Individual physicians can be called "Essential Community
Providers" when they practice in medically underserved areas
according to the Department of Health and Human Services.  The
Essential Community Provider is required to spend a minimum of
20 hours per week in the health professional shortage area and
be available to patients during evenings and weekends.
Essential Community Providers must have hospital staff
privileges or be affiliated with doctors who have such
privileges.  Essential Community Providers can not be direct
employees of a health care insurer.

Health care insurers that market a group policy or contract for
health care coverage are required to offer it to all Essential
Community Providers in the service areas of the plan.  The terms
of the contract offered to Essential Community Providers must be
as favorable as the terms offered to other physician providers
for the scope of services rendered.  Names of individual
Essential Community Providers will be published and distributed
to consumers and enrollees of the plan when the Essential
Community Provider is a primary care physician.  When the
Essential Community Provider is a specialist, his or her name
will appear on the list of specialists distributed to the
primary care physicians in the plan.  Health care insurers may
terminate the contract of a physician for cause.  The name
"Essential Community Provider" cannot be transferred to another
physician or site.  Physicians may apply to the director of the
Department of Health to be named an Essential Community Provider.