SCS/HCS/HB 1695 - This act requires certain governmental food establishments to give preference to foods containing higher levels of calcium if at the same or lower price than similar products. Such preference is not required, however, if it interferes with patient care. These requirements are in addition to national school lunch requirements and do not apply to contracts entered into before July 1, 2002 (Section 34.375). This provision is similar to SB 671.

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 (Sections 354.085 and 354.405).

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). This provision is also contained in SS/SCS/HB 1446.

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) . This provision is also contained in SS/SCS/HB 1446.

This act requires health insurance companies to provide coverage for routine patient care costs incurred as the result of phase III or IV of clinical trials undertaken to treat cancer. Entities providing clinical trial treatment must have sufficient expertise and training to treat a sufficient number of patients. There must be identical or superior non-investigational treatment alternatives available before providing clinical trial treatment. Clinical trial coverage shall include coverage for drugs and devices approved by the FDA, whether or not the FDA has approved the drug or device for the patient's particular condition. The clinical trials will only be covered if they are approved or funded by certain entities. Providers participating in clinical trials shall obtain the patient's informed consent for participating in the clinical trial (Section 376.429). This provision is substantially similar to SB 827. This provision is also contained in SS/SCS/HB 1446.

Currently, Section 376.1219, RSMo, mandates health insurance coverage for formula used in the treatment of phenylketonuria. This act also requires coverage for low protein modified food products intended for the treatment of inherited metabolic diseases. This provision is also contained in SS/SCS/HB 1446.

This act allows a physician to refer a patient who has been newly diagnosed with cancer to a specialist for a second opinion regarding the patient's treatment. Insurance companies must provide coverage for the second opinion rendered by the specialist. A referral must be given to an out of network specialist if a specialist is not available within the provider's network. This provision does not apply to certain insurance policies (Section 376.1253). This provision is substantially similar to SB 1026. This provision is also contained in SS/SCS/HB 1446.
STEPHEN WITTE