SB 0117 Provides additional protection for health care consumers
LR Number:0091S.01I Fiscal Note:0091-01
Committee:Insurance and Housing
Last Action:02/20/01 - Hearing Conducted S Insurance & Housing Committee Journal page:
Effective Date:August 28, 2001
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Current Bill Summary

SB 117 - This act addresses four areas of the federal Patient's Bill of Rights which Missouri has not previously enacted. The following four areas are addressed:

DIRECT ACCESS TO AN OBSTETRICIAN/GYNECOLOGIST - Section 354.618 requires health carriers to allow a woman to designate her obstetrician/gynecologist as her primary care provider or, in the alternative, to have direct access to the services of her obstetrician/gynecologist without first obtaining a referral from her primary care provider. A similar provisions is contained in (TAT) CCS/SS/SCS/HS/HCS/HB 762 (2001).

PARTICIPATION IN CLINICAL TRIALS - Section 354.616 requires health carriers to permit enrollees with life-threatening or serious illnesses to participate in approved clinical trials, provided there is meaningful potential for significant clinical benefit.

PROHIBITING PHYSICIAN FINANCIAL INCENTIVES - Section 354.443 prohibits health maintenance organizations from entering into any compensation agreement with a provider that would induce the provider to limit medical care.

ENROLLEES MAY SUE HEALTH MAINTENANCE ORGANIZATIONS FOR IMPROPERLY DENYING CARE - This act creates a state cause of action for enrollees who are improperly denied care by their health maintenance organizations.

A health maintenance organization has the duty to exercise ordinary care when making health care treatment decisions and it will be liable to an enrollee when it fails to do so. However, a health maintenance organization will not be liable for improper care if it did not control, influence, or participate in the health care treatment decision and the health maintenance organization did not deny or delay payment for the enrollee's treatment. In addition, a health maintenance organization is not obligated to provide an enrollee treatment which is not covered under the health plan.

Under the Employee Retirement Income Security Act (ERISA), the states are preempted from regulating employer-provided health care coverage. This act makes it clear that the cause of action does not apply to employer-based plans.

This act is identical to SB 645 (2000).