SB 1063 Requires coverage for clinical trials and modifies various provisions regarding health insurance
Sponsor:Rohrbach Co-Sponsor(s)
LR Number:3935S.06C Fiscal Note:3935-06
Committee:Insurance and Housing
Last Action:05/17/02 - S Inf Calendar S Bills for Perfection Journal page:
Title:SCS SBs 1063 & 827
Effective Date:August 28, 2002
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Current Bill Summary

SCS/SBs 1063 & 827 - This act creates provisions relating to insurance mandates, health data, provision of charity care and clinical trials.

EXPANDED ACCESS TO DATA - This act repeals the portion of the law which prohibits the Department of Health from disclosing the data submitted by hospitals and ambulatory surgical centers to the public. Under the current law, this raw data is not accessible to the public. The public can only receive reports or studies based upon this data. This data will now be public information in a format known as a public use data file subject to individual privacy laws.

PROSPECTIVE PRICING INFORMATION - This act also requires hospitals and ambulatory surgical centers to provide prospective pricing information regarding their most health care services to the Department of Health. The pricing data must be submitted in a format that is understandable to lay persons so that health care consumers can compare prices of future health care services.

MANDATED BENEFIT REVIEW COMMISSION - This act establishes the Mandated Benefit Review Commission within the Department of Insurance. The Commission will be comprised of the Director of the Department of Insurance, the Director of the Department of Health, 4 members of the General Assembly (2 Senate/2 House - nonvoting advisory capacity), and 6 individuals appointed by the governor with the advice and consent of the Senate (2 health insurance purchasers, 2 employers (small and large), and 2 employees who pay a percentage of their employer sponsored health insurance. The Commission must be established by October 1, 2002 (Sections 376.1575 -376.1596).

Once the Commission has been established, it must review all existing state mandated benefits and issue a report to the General Assembly by the tenth legislative day in January 2004. The report shall discuss the projected costs of all state and federal mandates and the Commission shall recommend to the General Assembly which mandated benefits should be repealed from state law.

The Commission shall also review all mandated benefits proposed by member of the General Assembly. Whenever a bill containing a mandated benefit is proposed, the Committee having jurisdiction over the proposal shall determine whether the Committee favors the proposed mandate or not. If the Committee is in favor of the mandate, the Committee may refer the matter to the Commission for its review. The Committee must review the proposed mandate and issue a report to the committee. The report must contain the social impact of mandating the benefit (see section 376.1590 for factors), the financial impact of mandating the benefit, the medical efficacy of mandating the benefit, and the effects of balancing the social, economic and medical efficacy considerations. Once a review and evaluation of the mandated benefit has been made by the commission, the committee shall review the commission's findings. No proposed mandate may be enacted into law unless the commission has reviewed the mandate.

CHARITABLE CARE BY NONPROFIT HOSPITALS - This act requires nonprofit hospitals to adopt a community benefits plan which will evaluate how nonprofit hospitals provide community benefits and charitable care. This must be conducted by January 1, 2004. Beginning April 1, 2004, the nonprofit hospitals must submit community benefit reports to the Department of Health outlining how their institution provides community benefits. The Department of Health is authorized to assess a $200 per day civil penalty against nonprofit hospitals who fail to submit a report. With this information, the Department of Health is required to submit an annual report to the General Assembly beginning December 1, 2004. This act authorizes the Department of Health to develop a minimum standard for the provision of charity care and community benefits by nonprofit hospitals. This minimum standard will be used to assess whether nonprofit hospitals are eligible for MoHEFA bonds, appropriations from the tobacco fund, and appropriations from the Missouri disproportionate-share hospital program (192.1050 - 192.1062).

THE MISSOURI HEALTH CARE COST ANTITRUST TASK FORCE - This act establishes the Missouri Health Care Cost Antitrust Task Force. The task force shall be comprised of: the Director of the Department of Insurance, the Attorney General, the Director of the Department of Health, a member representing the interests of hospitals, a member representing the interests of health carriers, and two members representing the interests fo health care consumers. The task force shall conduct a study of the current status of market concentration of health care plans and hospitals in the state. The task force shall study the effect of how the consolidation of health carriers and hospitals in Missouri has translated into higher costs for health care consumers. The task force shall also study whether such consolidation has decreased access to health care consumers in various regions of the state. At the completion of the study, the task force shall submit a report of the findings of the study and recommendations for changes to the governor and the General Assembly. The report shall include recommendations for possible legislative proposals which would help ensure that there is competition amongst Missouri's health carriers and hospitals and to ensure that such markets forces provide an environment for affordable health care for Missouri's citizens. The report required by this section shall be submitted no later than April 1, 2003.

CANCER CLINICAL TRIALS - 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 equal to or superior non-investigational treatments 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 (SB 827) (Section 376.429).

The clinical trials will only be covered if they are approved or funded by the following entities:

1) One of the National Institutes of Health (NIH); 2) An NIH Cooperative Group of Center; 3) The FDA in the form of an investigational new drug application; 4) The federal Department of Veteran's Affairs of Defense; 5) A Missouri institutional review board which has a multiple project assurance contract approved by the Office of Protection for the Research Risks of the NIH; or 6) Research entities that meet the criteria for NIH Center support grant eligibility.

Providers participating in clinical trials shall obtain the patient's informed consent for participating in the clinical trial.

COVENANTS NOT TO COMPETE - This act clarifies the use of non- compete clauses in contracts between physicians and hospitals. A new section 334.113 is created and makes covenants not to compete enforceable except when they are part of a physician's contract with a not-for-profit health services corporation as defined in section 354.010. Covenants with other health care facilities are enforceable as long as they:

1. Do not deny the physician access to a list of patients the physician had seen within a year of termination;

2. Provide access to patient medical records with the patient's consent and in an accessible format;

3. Provide for a buy out of the covenant by the physician at a reasonable price; and

4. Provide that the physician will not be prohibited from providing continuing treatment to specific acutely ill patients after the contract has terminated (SB 713) (Section 334.113).