SB 306 Establishes the Show-Me Health Coverage Plan and modifies provisions relating to health care services
Sponsor: Dempsey Co-Sponsor(s)
LR Number: 0817L.10C Fiscal Note: 0817-10
Committee: Health, Mental Health, Seniors and Families
Last Action: 5/15/2009 - Requests to Recede or Grant Conference Calendar--SS for SCS for SB 306-Dempsey, et al, with HCS, as amended (Senate requests House recede or grant conference) Journal Page:
Title: HCS SS SCS SB 306 Calendar Position: 2
Effective Date: Varies
House Handler: Ervin

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Current Bill Summary


HCS/SS/SCS/SB 306 - This act modifies provisions relating to health care services.

INCOME TAX DEDUCTIONS

This act removes the deduction for a self-employed, Missouri resident's individual health insurance premiums from his or her adjusted gross income when computing his or her Missouri taxable income. SECTION 143.111

This provision is identical to a provision in SS/SCS/HB 229 (2009).

MISSOURI PATIENT PRIVACY ACT

This act establishes the Missouri Patient Privacy Act which prohibits the disclosure of patient-specific health information to any employer, public or private payer, or employee or agent of a state department or agency without the written consent of the patient and health care provider. Health information may be disclosed to a health insurer, employer, state employee or agent of the Missouri Consolidated Health Care Plan, the Department of Health and Senior Services, or the MO HealthNet Division within the Department of Social Services in connection with the employee's official duties including oversight of state health programs, tracking infectious diseases, administering state wellness initiatives and programs, and researching state medical trends. The act does not prohibit disclosure of persona health information consistent with federal law and does not require health care providers to obscure or remove the information when disclosing it. SECTION 191.015

This provision is similar to HCS/HB 497 (2009).

TRANSPORTATION AND ANCILLARY SERVICES FOR MEDICAL TREATMENT OF A CHILD

This act establishes the Evan de Mello Reimbursement Program within the departments of Health and Senior Services and Mental Health to provide financial assistance for the cost of transportation and ancillary services associated with the medical treatment of an eligible child. The program is the payer of last resort after all other available sources have been exhausted. Reimbursement is subject to appropriations. To be eligible for assistance under the program, a child must be suffering from a condition or impairment that results in severe physical illness or impairments, in need of transportation or ancillary services due to his or her condition, certified by a physician of the child's choice as a child who will likely benefit from medical services, and required to travel at least 100 miles for medical services and the child's parents or guardian are unable to pay the travel expenses. The departments must establish rules which include an application and review process, a cap on benefits that cannot be less than $5,000 per recipient, and household income eligibility limits which cannot exceed 350% of the federal poverty level. SECTION 191.940

This provision is identical to HB 61 (2009) and similar to HB 2486 (2008).

TRANSPARENCY OF HEALTH CARE INFORMATION

Under this act, insurers with programs that publicly assess and compare the quality and cost efficiency of health care providers must conform to specified criteria set forth in the act for the transparency of health care information (section 191.1005).

Any person who sells or distributes comparative health care

quality and cost-efficiency data for public disclosure must identify the measuring technique used to validate and analyze the data, except for articles or research studies published in peer-reviewed academic journals that do not receive funding from a health care insurer or state or local government. Individuals violating this provision will be investigated by the Department

of Health and Senior Services and may be subject to a penalty of up to $1,000. Health insurers violating this provision will be investigated by the Department of Insurance, Financial Institutions and Professional Registration and are subject to the department's enforcement powers of the state's insurance laws (sections 191.1008 and 191.1010).

These provisions are also contained in HB 497 (2009), SB 149 (2009) and SS/SCS/HB 229 (2009).

PREMATURE INFANTS

The act requires the MO HealthNet program and the state children's health insurance program (SCHIP) to examine and improve hospital discharge and follow-up care procedures for premature infants born earlier than 37 weeks gestational age. The programs shall also urge hospitals serving infants eligible for MO HealthNet and SCHIP to report to the state the causes and incidence of all re-hospitalizations of premature infants. SECTION 191.1127

The Department of Health and Senior Services is required to prepare written educational materials containing information about possible complications, proper care and support associated with newborn infants who are born premature at earlier than 37 weeks gestational age. The act specifies the minimum information that shall be included in the publications and provides that the department shall distribute the publications to children's health providers, maternal care providers, hospitals, public health departments and medical organizations. SECTION 191.1130

These provisions are contained in SCS/HB 716 (2009).

INTERNET WEB-BASED PRIMARY CARE ACCESS PILOT PROJECT

This act requires the general assembly to appropriate 400,000 dollars from the health care technology fund to the department of social services to award a grant to implement an internet web-based primary care access pilot project designed as a collaboration between private and public sectors to connect, where appropriate, a patient with a primary care medical home, and schedule patients into available community-based appointments as an alternative to non-emergency use of the hospital emergency room as consistent with federal law and regulations. The criteria for the grant are specified in the act. SECTION 191.1200

This provision is contained in SS/HB 156 (2009), SB 149 (2009) and SS/SCS/SB 1283 (2008).

TELEHEALTH

This act expresses the state's recognition of the delivery of health care via telehealth as a safe, practical and necessary practice in the state. By January 1, 2010, the Department of Health and Senior Services shall promulgate quality control rules to be used in removing and improving the service of telehealth practitioners. SECTIONS 191.1250 to 191.1277

This provision is contained in SS/HB 156 (2009), SB 149 (2009) and SS/SCS/SB 1283 (2008).

REPORTING OF ADVERSE HEALTH EVENTS

Beginning January 1, 2010, hospitals must report all serious health care incidents resulting in serious adverse events to a federally designated patient safety organization (PSO) no later than one business day following the discovery of the incident. The report must describe the immediate actions taken to minimize patient risk and the prevention measures carried out in response to the event. The hospital will have 45 days after the incident was discovered to submit a root cause analysis report and prevention plan to the organization, with or without the technical assistance of the organization. If the organization finds any of the reports provided by the hospital to be insufficient, the hospital will have two attempts to make corrections. The Department of Health and Senior Services will assist hospitals with three or more insufficient reports and accept reports from a hospital that does not submit serious adverse events to an organization, if permissible by the Patient Safety & Quality Improvement Act of 2005.

The patient safety organization assessing reported incidents must provide the hospital with a report to prevent future incidents. SECTION 197.550 TO 197.559

These provisions are similar to those contained in HCS/HB 497 (2009).

If permitted by the Patient Safety & Quality Improvement Act of 2005, the department will publish an annual report on reportable incidents that indicates the number of reportable events by current National Quality Forum categories by rate per patient encounter by region, category and facility, and type of error, rate of error, death rate, and root cause analysis and prevention plan status by April 15th of every year for the previous year.

This act identifies PSO proceedings, discussion, records and meeting requirements. PSO proceedings, documents and records cannot be used as evidence in a civil action against the health care provider

Patient safety work product is guaranteed confidentiality when submitted to a PSO. Exchanging and disclosing patient safety work product is not a waiver of confidentiality of the health care provider. If a reference or evidence of the patient safety work product is brought to a jury, there is grounds for a mistrial. A PSO can disclose nonidentifiable data regarding number and types of patient safety events that have occurred and must publish educational infomation to improve patient care.

Beginning January 1, 2010, hospitals that report an incident of a serious adverse event cannot charge for or bill individuals or insurers for services related to the incident. If an insurer denies a claim because of lack of coverage for services that resulted from an incident of a serious adverse event, the health care provider or facility involved cannot bill the patient for the uncovered services. SECTION 197.562 TO 197.586

These provisions are contained in HCS/HB 497 (2009) and are similar to SB 382 (2009).

HOSPITAL DISTRICT SALES TAXES

Hospital districts in certain counties, including Ripley County, upon voter approval, are authorized to abolish the hospital district property tax and impose a retail sales tax of up to 1% for the purpose of funding the hospital district. Moneys collected from the tax will be deposited into the newly created Hospital District Sales Tax Fund with 1% retained and deposited into the General Revenue Fund by the Director of the Department of Revenue for the cost of collection. SECTION 205.202

This provision is similar to provisions in CCS/HCS/SS/SB 307 (2009), HB 1181 (2009), HCS/SCS/SB's 165, 164, 248 &168 (2009), HB 958 (2009) and HB 1129 (2009).

MO HEALTHNET PAYMENTS

Payments for MO HealthNet services provided by hospitals, physician offices, nursing homes, etc. will only be made if the service provider does not have in force as of January 1, 2011, any contracts with carriers that limit the use of health care transparency agreements such as medical claims data to payment of claims or otherwise preclude health carriers from responding to the need of consumers for comparative cost, quality, and efficiency information. SECTION 208.152

MO HEALTHNET-THIRD PARTY PAYER

Under this act any third party administrator, administrative service organization, health benefit plan and pharmacy benefits manager shall process and pay all properly submitted MO HealthNet subrogation claims for a period of three years from the date services were provided or rendered, regardless of any other timely filing requirement. The entity shall not deny such claims on the basis of the type or format of the claim form, failure to present proper documentation of coverage at the point of sale, or failure to obtain prior authorization. The MO HealthNet Division shall also enforce its rights within six years of a timely submission of a claim. SECTION 208.215

These provisions are contained in SB 552 (2009) and in SS/HB 156 (2009).

CO-PAYMENTS FOR PRESCRIPTION DRUGS

This act specifies that when the usual and customary retail price of a prescription drug is less than the co-payment applied by a health maintenance organization or health insurer, the enrollee is only required to pay the usual and customary retail price of the prescription drug and there will be no further charge to the enrollee or plan sponsor for the prescription. SECTION 354.535

This provision is contained in SS/HB 156 (2009) and HB 95 (2009).

HEALTH MAINTENANCE ORGANIZATIONS

This act requires proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the policy holder for support and maintenance to be submitted to the insured's HMO within 31 days after the child has attained the age when the child's coverage is to be terminated instead of the current at least 31 days. SECTION 354.536

This provision is contained in SS/HB 156 (2009) and SS/SCS/HCS/HB 229 (2009).

STANDARDIZED INSURANCE APPLICATIONS

Requires the Director of the Department of Insurance, Financial Institutions and Professional Registration to establish by rule uniform insurance application forms to be used by all insurers for group health insurance policies. These provisions will not apply to group health plans for small employers. SECTION 374.184

This provision is contained in SS/HB 156 (2009) and HB 372 (2009).

REIMBURSEMENT CLAIMS

By January 1, 2010, a health carrier responding to an electronic patient financial responsibility inquiry must respond with the eligibility or benefit information codes for co-payment, co-insurance, deductible, out-of-pocket maximum, remaining deductible amount, and other cost containment elements. SECTION 376.384

This provision is contained in SS/HB 156 (2009).

HEALTH INSURANCE CO-PAYMENTS AND CO-INSURANCE

This act prohibits health insurers from imposing any co-payment or co-insurance, or combination thereof that exceeds 50% of the total cost of providing the health care service to an enrollee. SECTION 376.391

This provision is contained CCS/SS/SCS/HCS/HB 577 (2009) and in HB 614 (2009).

DIAGNOSTIC IMAGING SERVICES

This act prohibits a health carrier or health benefit plan from denying reimbursement for diagnostic imaging services based solely on a licensed physician's specialty or professional board certification. SECTION 376.394

This provision is contained in HB 986 (2009).

GROUP HEALTH COVERAGE

This act provides that when a group health insurance policy is terminated, the group health insurers cannot refuse to convert a health insurance policy or coverage of an insured person if they are eligible for Medicare or any other state or federal benefit. SECTION 376.397

This provision is contained in SS/HB 156 (2009).

Also, Medicare or any other state or federal benefit cannot result in a reduction of coverage for a converted group health insurance policy. SECTION 376.401

This act repeals a provision of law which currently allows a group health insurer to exclude coverage on persons under policies insuring fewer than 10 employees as to whom there is evidence of unsatisfactory individual insurability. A similar rule is also repealed as to group health policies insuring greater than 10 employees where applications are made past 31 days after eligibility, the person voluntarily terminates coverage, or where the person fails to enroll during a period of open enrollment. SECTION 376.421 AND 376.424

Currently, group health insurance policies must contain a provision that specifies any exclusions and limitations to the policy with regard to a disease or physical condition that an individual was treated for during the 12 months prior to the enrollment date of an individual's policy. The act limits the exclusions and limitations to the prior six months before an individual becomes covered under the policy. Exclusions and limitations cannot apply to a loss or disability that occurred after the enrollment date or during the 18-month period thereafter in the case of a late enrollee. This act also requires proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the policy holder for support and maintenance to be submitted to the health insurer within 31 days after the dependent child has attained the age when coverage is to be terminated in order to sustain coverage instead of the current at least 31 days. SECTION 376.426

These provisions are contained in SS/HB 156 (2009) and SS/SCS/HB 229 (2009).

MINI-COBRA LAW

This act requires group insurance policies by a health carrier or health benefit plan to comply with the federal COBRA or the state continuation of coverage of law (section 376.428) and to offer such persons the option of continuation of coverage to an individual who has terminated employment or membership. SECTION 376.428

These provisions are contained in SS/HB 156 (2009).

CONTINUATION OF HEALTH INSURANCE COVERAGE FROM AGE 55

Under this act, every group health insurance policy issued or renewed on or after January 1, 2010, must contain a provision that allows an employee or group member, whose continuation coverage under the federal COBRA law or state's continuation law has expired, to continue coverage under that group policy provided the employee or group member was 55 years or older when coverage under COBRA or the state continuation law expired. The extended continuation coverage provided by this act will terminate upon the earliest of the following:

1) The date the employee or group member fails to pay premiums;

2) The date the group policy is terminated as to all group members;

3) The date on which the employee or group member becomes insured under another group policy;

4) The date on which the employee or group member becomes eligible for coverage under the federal Medicare program; or

5) The date on which the employee or group member turns 65. SECTION 376.437

This provision is contained in SS/HB 156 (2009), SB 415, and SB 547 (2009).

RATING OF MISSOURI CONTINUATION COVERAGE POLICIES - This act requires health insurance policies that are issued to individuals eligible for continuation coverage under state law to be pooled across all fully insured group business in Missouri. The rating system or methodology in which the premium for all persons covered under a continuation of coverage provision shall be based on the experience of all persons covered by a continuation of coverage provision with any cost of the pool experience spread over all fully insured premiums in Missouri on an equal percentage basis. SECTION 376.439

This provision is contained in SS/HB 156 (2009), SB 415 and SB 547 (2009).

CONTINUATION OF COVERAGE RIGHTS THROUGH A HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN

This act requires health carriers who provide group insurance policies to persons who are exercising their continuation of coverage rights under COBRA or the state continuation of coverage law (Section 376.428) to offer such persons the option of continuation of coverage through a HSA eligible high deductible plan rather than the underlying group policy. The premiums for the HSA eligible high deductible plans shall be consistent with the underlying group plans rated relative to the standard or manual rates for the benefits provided. SECTION 376.443

This provision is contained in SS/HB 156 (2009), SB 415 and SB 547 (2009).

CREDITABLE COVERAGE AND WAITING PERIOD DEFINITIONS

The act adds the SCHIP program to the categories of insurance that qualify as "creditable coverage" for purposes of health insurance portability. The act also modifies the definition for the term "waiting period" to include late enrollees and individuals seeking coverage in the individual health insurance market. The definition for "waiting period" as it relates to the Missouri Health Insurance Portability and Accountability Act is revised to be a time period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll in a group health plan becomes effective. Any time period before late or special enrollment is not considered a waiting period for late or special enrollees. A waiting period begins on the date an individual submits an application for coverage and ends when the application for coverage is approved, denied, or lapses. SECTION 376.450

This provision is contained in SS/HB 156 (2009) and SS/SCS/HB 229 (2009).

PLACEMENT FOR ADOPTION

Health insurance issuers offering group coverage will be required to provide a special enrollment period for a dependent in the case of a placement for adoption. SECTION 376.450.6

This provision is contained in SS/HB 156 (2009) and SS/SCS/HB 229 (2009).

EMPLOYER REQUIREMENTS

This act provides that if an employer provides health insurance to an employee and the employee pays any portion of the cost of the premium, the employer must also provide a premium-only cafeteria plan or a health reimbursement arrangement. SECTION 376.453

This provision is contained in SS/HB 156 (2009) and SS/SCS/HB 229 (2009).

DEPENDENT COVERAGE

Under current law, proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the insured for support and maintenance must be furnished to the health insurer at least 31 days after the dependent child has attained the age when coverage would normally be terminated in order to continue receiving the extended coverage provided by the statutes. This act requires the proof of incapacity and dependency to be furnished within 31 days after the child's attainment of the limiting age. This modification applies to group policies, individual polices and health maintenance organization polices. SECTION 376.776

This provision is contained in SS/HB 156 (2009) and SS/SCS/HB 229 (2009).

HIGH RISK POOL ELIGIBILITY

Add the terms "waiting period" and "affiliation period". A person's eligibility for COBRA or continuation rights under state law cannot render the person ineligible for coverage under the high risk pool. SECTION 376.960

This provision is contained in SS/HB 156 (2009).

This act requires all health insurers to notify an insured person when he or she has exhausted 85% of his or her total lifetime health insurance benefits and of the person's eligibility for and the methods of applying for coverage under the Missouri Health Insurance Pool (MHIP). Notification must be repeated when an insured has exhausted 100% of his or her total lifetime health insurance benefits. SECTION 376.966

This provision is contained in SS/HB 156 (2009).

By January 1, 2010, MHIP must offer at least 2 health benefit plans for Show-Me Health Coverage Plan participants. Subject to funding, the MHIP board can create a subsidy program for low-income persons. SECTION 376.985

An individual who has exceeded his or her total lifetime health insurance benefits from his or her insurer is eligible for the pool which has a $2 million lifetime benefit. An individual who is eligible and has an income of less than 350% of the federal poverty level will receive a 50% discount off the pool's premiums. The term "gap" is replaced with "break." SECTION 376.985 and 376.986

Requires the high risk pool to offer high deductible health plans, offered in conjunction with HSAs to be offered on a guaranteed-issue basis. SECTION 376.987

This provision is contained in SS/HB 156 (2009),

HB 497, SB 415, HB 60, and HB 229 (2009).

LIMITED MANDATE HEALTH INSURANCE POLICIES

This act repeals the current marketing restriction placed upon the sale of limited mandate health insurance policies which limits the sale of such policies to individuals that do not have health insurance or employers who certify that they will terminate their current coverage because of current cost. SECTION 376.995.

This provision is contained in SS/SCS/HB 229 (2009).

COVERAGE FOR PROSTHETIC DEVICES

This act requires every health carrier or health benefit plan, delivered, issued, continued, or renewed on or after January 1, 2010, to offer coverage for prosthetic devices and services. SECTION 376.1232

This provision is contained in CCS/SS/SCS/HCS/HB 577 (2009).

RIGHT TO RECEIVE DOCUMENTS

Currently, a health insurance plan enrollee can opt out from receiving documents from his or her managed care entity in print form and access the documents electronically. The act specifies that the enrollee must, upon request, receive the documents in print form. SECTION 376.1450

This provision is contained in SS/HB 156 (2009).

HEALTH REIMBURSEMENT ARRANGEMENT

Under this act, employees are allowed to use funds from one or more employer health reimbursement arrangement only plans to help pay for individual health insurance coverage. HRAs are employee benefit plans provided by an employer which establish an account funded solely by the employer to reimburse the employee for qualified medical expenses incurred by the employee or his or her family. HRAs allow the employee to carry forward any unused funds at the end of the coverage period to subsequent coverage periods (Section 376.1600). A similar provision is contained in SB 415 (2009). SECTION 376.1600.

This provision is contained in SS/HB 156 (2009)and SS/SCS/HB 229 (2009).

PROMOTION AND APPROVAL OF HSA HEALTH PLANS

Under the act, the Director of the Department of Insurance is expressly authorized to adopt policies to promote, approve, and encourage health savings account eligible high deductible plans in Missouri. The act directs the director to conduct a national study of health savings account eligible high deductible health plans available in other states and determine if and how these plans serve the uninsured. The act also directs the Director to develop a fast track approval process for health savings account eligible high deductible plans. Section 376.1603

This provision is contained in SS/HB 156 (2009)and SB 415 (2009).

STUDY TO IDENTIFY ADMINISTRATIVE AND REGULATORY BARRIERS FOR NEW INSURANCE PRODUCTS

By January 1, 2010, the Director of the Department of Insurance, Financial Institutions and Professional Registration must provide recommendations to the General Assembly of changes to remove any unnecessary barriers that limit the entry of new health insurance products into the Missouri insurance market. The director must also examine proposals adopted in other states that streamline the regulatory processes to allow insurance companies to market new and existing products more easily. SECTION 376.1618

This section is contained in SS/HB 156 (2009), SB 415 (2009) and SS/SCS/HB 229 (2009).

SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT

The definition of "dependent" is changed in the Small Employer Health Insurance Availability Act to mirror the definition of dependent contained in the HMO, individual and group policy statutes. The definition of "dependent" is revised to be a person that is a spouse, an unmarried child who resides in Missouri and is younger than 25 years of age and is not covered by any group or individual health benefit plan or entitled to federal Social Security assistance benefits, or an unmarried child of any age who is disabled and dependent upon his or her parent. SECTION 379.930.2

A small employer must reasonably compensate an agent or broker for the sale of any small employer health benefit plan, and a small employer carrier must maintain and issue all health benefit plans it actively markets to small employers in the state. SECTION 379.940.

Under this act, when an insurer charges a reduced premium rate for employees who do not smoke or use tobacco, the insurer must comply with the nondiscrimination provisions of HIPAA. SECTION 379.952

These provisions are contained in SS/HB 156 (2009)and SS/SCS/HB 229 (2009).

SHOW ME HEALTH COVERAGE

Subject to appropriations, the Department of Social Services shall establish the "Show-Me Health Coverage Plan" to provide health care coverage to low income adults through the Missouri Health Insurance Pool (MHIP). In order to operate the program, the department must apply for a CMS Section 1115 demonstration waiver to develop and implement the Show-Me Health Coverage Plan, provided that any reduction of disproportionate share of hospital funds (DSH) applied to the cost of the plan (as required by the waiver) will not negatively affect the low-income uninsured. The plan will be void if there are no federal funds given to the state or if no funds are applied to the program. The department must get approval by the Joint Committee on MO HealthNet before applying for the CMS waiver. The Department of Insurance, Financial Institutions and Professional Registration and the MO HealthNet Division will provide oversight of the plan. The department of Social Services and MHIP will promote the plan. The plan is not an entitlement program and maximum enrollment is subject to funding and may be phased in incrementally. The act specifies the eligibility requirements for participants in the plan. The Department of Social Services and MHIP will conduct enrollment into the plan. SECTIONS 1 through 10

These provisions are similar to provisions in SS/HB 156 (2009).

MO HEALTHNET FOR KIDS PROGRAM

For taxpayers with less than 150% federal poverty and who do not report health coverage for a dependent child, the Department of Revenue must send a notice to the taxpayer to inform him or her about MO HealthNet for Kids program. SECTION 11

These provisions are similar to provisions in SS/HB 156 (2009).

MO HEALTHNET PROGRAM REIMBURSEMENTS

Subject to appropriations the Department must set a rate of reimbursement for certain doctors for MO HealthNet services provided that it is equal to reimbursement for similar services provided.

This act contains an emergency clause for the provisions regarding group policies to comply with federal COBRA law and for certain hospital districts to lower their property tax levies.

ADRIANE CROUSE