SS/SCS/HB 1446 - This act modifies health provisions relating to clinical trials, cancer second opinions and other various health issues.

PHARMACY BENEFIT STUDY - This act requires the Department of Social Services Division of Medical Services to study the development of a preferred drug list, the use of a pharmacy benefit manager, drug manufacturer rebates, prior authorization of new drugs, pharmacy dispensing fees and drug ingredient cost reimbursement with the Medicaid Program. The department shall issue a report to the Governor, the Senate Appropriations Committee, the Senate Public Health Committee and the House Budget Committee. The study shall consider the impact on patients, direct and indirect costs, and anticipated savings of each proposal. This study must be completed prior to January 15, 2003 (Section 1).

BONE MARROW TRANSPLANTS - This act allows minors to make anatomical donations with consent. This act also requires health carriers and benefit plans to cover human leukocyte antigen testing for use in bone marrow transplantation. Testing must be performed in an appropriate facility. A form indicating informed consent must be completed which will authorize use of the results in the National Marrow Donor Program. Health plans may limit enrollees to one testing per lifetime, but may not charge extra fees for the test. These provisions are similar to ones contained in SB 871 (2002) (Sections 194.220, 194.230 and 376.1275).

PACE PROJECTS - This act allows specified health maintenance organizations acting as programs for all-inclusive care for the elderly (PACE) projects to be exempt from the certificate of authority requirement. This exemption applies only to the approved PACE contract. This provision is identical to HB 2049 (2002)(Section 354.407).

STATE CAFETERIA PLAN - This act revises the operation of the Cafeteria Plan for State employees. The act requires the Commissioner of Administration to include in the Cafeteria Plan, products from venders if: 1)the product is eligible under the United States Code; 2) the vendor is approved by the Office of Administration; and 3) the vendor is receiving at least $500,000 annually from State employees through voluntary payroll deductions (Section 33.103).

PROHIBITION AGAINST PUBLIC FUNDS FOR ABORTIONS AND CLONING (Section 33.900) - This act prevents any public funds from being expended, paid or granted to or on behalf of an existing or proposed health and social services program to directly or indirectly subsidize abortion services or human cloning projects. The act also requires an independent audit every three years of any entity that receives public funds. This provision is similar to one contained in SCS/HS/HCS/HB 1906 (2002)(section 33.900).

DEEMED APPROVAL - This act holds that whenever a health service corporation submits a policy form to the Director of Insurance, and the Director does not disapprove the form within 45 days (up from 30 days), the form is deemed approved and is not subject to disapproval for 12 months. If during the 12-month period the Director determines that any provision of the policy is contrary to statute, the Director shall notify the health service corporation of the specific provision that is contrary to statute and may request that it file an amendment within 30 days to modify the provision so that it conforms with the statute. Upon approval of the amendment by the Director, the health services corporation shall issue a copy of the amendment to each individual or entity in which the deemed policy form was previously issued. The health services corporation may issue the conforming amendment to the group contract holder so that it can distribute the amendment to its members or by including a copy of the amendment in the health services corporation's next scheduled mailing to its members. Such amendment have the force and effect as if the amendment was in the original filing or policy (Section 354.085). A similar procedure shall also be followed when an HMO files certain documents (pertaining to its certificate of authority with the Department of Insurance) (Section 354.405).

NETWORK ADEQUACY - This act deems a managed care plan's network as adequate if the managed care plan is:

(1) A Medicare + Choice coordinated care plan offered by the health carrier pursuant to a contract with the federal centers for medicare and medicaid services; (2) A managed care plan that has been accredited by National Committee for Quality Assurance (NCQA), and such accreditation is in effect at the time the access plan is filed; (3) The managed care plan's network has been accredited by the Joint Commission on the Accreditation of Health Organizations at a level of accreditation without type I recommendations or better. If the accreditation applies only to a portion of the managed care plan's network, only the accredited portion will be deemed adequate; or (4) The managed care plan network is accredited by any other accrediting organization that is approved by the department of insurance. This provision is similar to one contained in SB 1061 and 1062 (2002) (section 354.603).

CLINICAL TRIALS - This act requires health insurance plans to provide coverage for routine patient care costs incurred as a result of participating in clinical trials (phases III and IV) for the prevention and treatment of cancer. The clinical trial must be approved or funded by one of the entities which are specified in the act. Entities seeking coverage of a clinical trial approved by an academic institutional review board in Missouri are required to maintain and electronically list clinical trials which meet the requirements of the substitute. Providers participating in clinical trials are required to obtain a patient's informed consent which is consistent with current legal and ethical standards. Information required by this provision will be available to the health insurer upon request. A policy, plan, or contract paid under Title 18 or Title 19 of the federal Social Security Act is exempt from the requirements of this act. This provision is similar to one contained in SCS/SB 1063 & 827 and HB 1695 (2002) (Section 376.429).

UNIFORM PRESCRIPTION DRUG CARD - This act requires health benefit plans to issue uniform prescription drug information cards that conform to the National Council for Prescription Drug Programs standards. This provision will become effective January 1, 2003 and shall also apply to health benefit plans renewed after this date (Section 376.430).

MASTECTOMY BRASSIERES COVERAGE - This act requires health insurance entities to provide coverage for at least four mastectomy brassieres per year. This is similar to HB 1970 (2002) (Section 376.1209).

CANCER SECOND OPINIONS - This act requires health care entities to provide coverage for a second medical opinion by an appropriate specialist for patients with a newly diagnosed cancer. Effective January 1, 2003, this coverage must be provided even if the appropriate specialist is not in the provider's network. The coverage required by the substitute does not apply to certain health insurance policies. This provision is similar to one contained in SB 1026 and HB 1695 (2002) (Section 376.1253).

HEALTH BENEFIT PLAN - This act clarifies the definition of "health benefit plan" as that term is used in the laws governing insurance, stating that the term does not include workers' compensation or liability insurance policies (Section 376.1350).

INTERNET FORMS - This act allows any managed care entity to provide documents and materials to an enrollee via the entity's Internet site, instead of in printed form, upon securing a waiver from the enrollee. The enrollee may revoke the waiver at any time. This portion of the act is similar to SB 1004 (2002) (Section 376.1450).

SA 1 - REMOVES PROVISIONS REGARDING MANDATED BENEFIT ADVISORY COMMISSION.

SA 2 - MODIFIES LANGUAGE ON SECOND CANCER OPINION PROVISION.

SA 3 - THIS ACT REQUIRES A HEALTH CARRIER TO ALLOW ANY HEALTH CARE PROVIDER TO PARTICIPATE IN ITS NETWORK IF THAT PERSON SATISFIES ALL OF THE SELECTION STANDARDS. THIS PROVISION SHALL ONLY APPLY TO JASPER AND NEWTON COUNTIES. CURRENTLY, SECTION 354.606, RSMo, DEALS WITH CONTRACTS BETWEEN HEALTH CARRIERS (currently defined as HMOs) AND HEALTH CARE PROFESSIONALS (currently defined as physicians or other health care practitioners who provide specific health services). NEW LANGUAGE CLARIFIES THE DEFINITION OF "HEALTH CARRIER" TO MEAN AS DEFINED IN SECTION 376.1350, RSMo, WHICH INCLUDES ANY ENTITY SUBJECT TO INSURANCE LAWS IN THIS STATE, INCLUDING ACCIDENT AND SICKNESS INSURANCE, HMOs, NONPROFIT HOSPITALS, AND HEALTH SERVICE CORPORATIONS, AMONG OTHERS. HEALTH CARRIERS MAY NOT DEVELOP SELECTION CRITERIA IN SUCH A WAY THAT IT WILL DENY A HEALTH CARE PROFESSIONAL THE OPPORTUNITY TO BECOME A PARTICIPATING PROVIDER IF THAT PROFESSIONAL MEETS ALL OF THE SELECTION CRITERIA AND IS WILLING TO ABIDE BY ALL OTHER TERMS AND CONDITIONS. CURRENT LANGUAGE ALSO CONTAINS A PROVISION THAT HEALTH CARRIER DO NOT, HOWEVER, NEED TO HIRE MORE PROVIDERS THAN NECESSARY TO MAINTAIN AN ADEQUATE NETWORK (Section 354.606).

SA 5 - IMPLEMENTS AN EFFECTIVE DATE REGARDING ANATOMICAL DONATIONS.

SA 6 - ALLOWS MORE ENTITIES TO CONDUCT TESTING FOR HUMAN LEUKOCYTE ANTIGEN TESTING.

SA 7 - ESTABLISHES A SUNSET REGARDING WHEN DEPARTMENT OF INSURANCE MUST PROMULGATE RULES ON MANAGED CARE ORGANIZATIONS AND WORKER'S COMPENSATION.

SA 8 - THIS ACT REQUIRES HEALTH INSURANCE ENTITIES TO PROVIDE COVERAGE FOR CHILDREN'S HEARING AIDS. HEALTH INSURANCE ENTITIES MAY LIMIT THE COVERAGE TO $1,250 IN BENEFITS COVERAGE FOR EACH EAR WITH A HEARING LOSS. DEDUCTIBLES OR CO-PAYMENTS CANNOT EXCEED 20% OF THE ACTUAL COVERED SERVICE COSTS. THIS PROVISION IS SIMILAR TO ONE CONTAINED IN HB 1396 (2002) (Section 376.1221).

SA 10 - THIS ACT REQUIRES HEALTH CARRIERS TO PROVIDE A STATEMENT OF THE ANNUAL CLAIMS HISTORY OF A HEALTH CARRIER WHEN REQUESTED BY THE EMPLOYER. THE INFORMATION MUST BE PROVIDED WITHIN 30 DAYS OF THE REQUEST. THE INFORMATION MAY BE USED BY THE EMPLOYER FOR THE SOLE PURPOSE OF EVALUATING AND MARKETING THE GROUP INSURANCE PROGRAM (Section 376.1600).

SA 11 - REMOVES A SECTION FROM THE BILL WHICH WOULD HAVE ALLOWED FORMER MEMBERS OF THE GENERAL ASSEMBLY AND OTHER ELECTED OFFICIALS TO RECEIVE STATE INSURANCE AT THE SAME RATES AS CURRENT MEMBERS.

SA 12 - REQUIRES HEALTH INSURERS TO PAY FOR LOW PROTEIN MODIFIED FOOD PRODUCTS THAT ARE RECOMMENDED BY A PHYSICIAN FOR TREATMENT OF PATIENTS WITH CERTAIN INHERITED DISEASES. THIS PROVISION IS SIMILAR TO ONE CONTAINED IN HCS/HB 1695 (2002)(Section 376.1219).

SA 13 - REQUIRES THE DIRECTOR OF THE DEPARTMENT OF MENTAL HEALTH, IN COLLABORATION WITH OTHER STATE AGENCIES, TO IMPLEMENT A STATE SUICIDE PREVENTION PLAN (Section 630.900).

SA 14 - PROVIDES THAT THE FACT THAT AN INSURER ENTERS INTO A VOLUNTARY AGREEMENT WITH ONE OR MORE MANAGED CARE ORGANIZATIONS SHALL NOT EXEMPT THE INSURER FROM COMPLYING WITH REGULATIONS REGARDING OTHER MANAGED CARE ORGANIZATIONS IN WHICH THE INSURER HAS NO VOLUNTARY AGREEMENT WITH, BUT WHICH THE EMPLOYER HAS CONTRACTED WITH. THE INSURER SHALL ALSO COMPLY WITH THE REQUIREMENTS CONCERNING THE REIMBURSEMENT OF MANAGED CARE ORGANIZATIONS IN WHICH THE INSURER HAS NO DIRECT CONTRACT (Sections 287.135 and 287.140).

SA 15 - REQUIRES INSURANCE COMPANIES TO PROVIDE MANDATORY COVERAGE FOR TWENTY-FOUR HOURS OF INPATIENT CARE FOLLOWING SURGERY. THE INPATIENT CARE MAY BE FOR LESS THAN TWENTY-FOUR HOURS IF THE PATIENT AGREES TO A SHORTER PERIOD OF INPATIENT CARE AND THE INSURANCE POLICY PROVIDES COVERAGE OF POST-DISCHARGE CARE. ALL INSURANCE POLICIES SHALL PROVIDE NOTICE OF THIS REQUIRED COVERAGE. THIS REQUIRED COVERAGE SHALL NOT BE SUBJECT TO GREATER DEDUCTIBLES OR COPAYMENTS THAN OTHER SIMILAR HEALTH CARE COVERAGES PROVIDED IN THE POLICY. THIS PROVISION IS SIMILAR TO SB 1044 (2002) (Section 376.1212).

SA 18 - CREATES THE MISSOURI COMMISSION ON PREVENTION AND MANAGEMENT OF OBESITY WITHIN THE DEPARTMENT OF HEALTH AND SENIOR SERVICES. THE COUNCIL WILL EXIST UNTIL AUGUST 28, 2004, AND ITS DUTIES WILL INCLUDE: - COLLECTING DATA REGARDING OBESITY IN MISSOURI; - LISTING PROGRAMS AND SERVICES AVAILABLE TO OVERWEIGHT CHILDREN AND ADULTS; - LISTING FUNDS AVAILABLE FOR SUCH SERVICES; - COLLECTING DATA TO DEMONSTRATE ECONOMIC IMPACT OF NOT TREATING OBESITY; - IDENTIFYING BARRIERS TO PREVENTION AND MANAGEMENT OF OBESITY; - IDENTIFYING RECOMMENDATIONS TO INCREASE PREVENTION AND MANAGEMENT. THE COMMISSION WILL CONSIST OF TWENTY-ONE MEMBERS AND MUST MEET BY OCTOBER 1, 2002, AND AT LEAST QUARTERLY THEREAFTER. THE COMMISSION MUST HAVE AN APPROPRIATE ETHNIC AND GEOGRAPHIC COMPOSITION. THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND SENIOR SERVICES WILL BE THE CHAIR. BY JANUARY 1, 2003, THE DEPARTMENT MUST ESTABLISH A RESOURCE DATABANK CONTAINING INFORMATION ABOUT OBESITY AND RELATED SUBJECTS. THIS PROVISION IS SIMILAR TO SB 680 (2002)(Section 192.975).

SA 19 - EXCLUDES CERTAIN POLICIES FROM THE CLINICAL TRIAL MANDATE.