Missouri Senate

Perfected

HEALTH CARE COST AND TRANSPARENCY ACT (Section 191.875)

This provision, known as the "Health Care Cost Reduction and Transparency Act," requires hospitals to submit to the Department of Health and Senior Services prices for 140 of the most common procedures, including 100 of the most common procedures in hospital inpatient settings as well as 20 of the most common surgery and 20 of the most common imaging procedures conducted in outpatient hospital settings.

Additionally, health care providers and health carriers must provide, within 5 days of a written patient or consumer request, an estimate of cost of health care services. This estimate shall be accompanied by specified language. If a hospital provides the reporting data to the Department and such data is placed on the Department's website, the hospital does not have to provide cost estimates to patients upon written request. Health care providers must also make available the percentage or amount of any discounts for cash payment of incurred charges through the provider's website or at the provider's location.

Any data disclosed to the Department by a hospital under this provision shall be the sole property of the hospital or center that submitted the data. Any data or product derived from the data disclosed pursuant to this provision, including a consolidation or analysis of the data, shall be the sole property of the state. The Department shall not allow proprietary information it receives pursuant to this provision to be used by any person or entity for commercial purposes.

The information regarding hospital inpatient procedures and outpatient surgical and imaging procedures shall be submitted beginning with the quarter ending June 30, 2017, and quarterly thereafter. The Department shall provide such information on its website in a manner that is easily understood by the public. Information for each hospital shall be listed separately and hospitals shall be listed in groups by category as determined by the Department through the promulgation of rules.

This provision is identical to SB 900 (2016) and similar to SB 46 (2015).

MO HEALTHNET COPAYMENTS (Section 208.142)

Beginning October 1, 2016, the Department of Social Services shall require MO HealthNet participants to pay an eight dollar copayment fee for use of a hospital emergency department for the treatment of a condition that is not an emergency medical condition. The Department shall promulgate rules for the implementation of this provision.

This provision is identical to SB 118 (2015).

MO HEALTHNET MISSED PAYMENT FEES (Section 208.148)

This provision permits fee-for-service MO HealthNet health care providers, to the extent permitted by laws pertaining to the termination of patient care, to charge a missed appointment fee to MO HealthNet participants that such participants must pay before scheduling another appointment with that provider. The fee may be charged for missed appointments or for failing to cancel an appointment within 24 hours prior to the appointment. The permissible fees are as follows: No charge for the first missed appointment in a three-year period, $5 for the second missed appointment in a three-year period, $10 for the third missed appointment in a three-year period, and $20 for the fourth and each subsequent missed appointment in a three-year period. Health care providers shall waive the fee in cases of inclement weather. The health care provider shall not charge to nor shall the MO HealthNet participant be reimbursed by the MO HealthNet program for the missed appointment fee.

HEALTH CARE PRICE TRANSPARENCY (Section 376.2020)

Under this provision, no contract provision between a health carrier and a health care provider shall be enforceable if such provision prohibits, conditions, or in any way restricts any party to such contract from disclosing to an enrollee, patient, or potential patient the contractual payment amount for a health care service if such payment amount is less than the health care provider's usual charge for the health care service, and if such contractual provision prevents the determination of the potential out-of-pocket cost for the health care service by the enrollee, patient, or potential patient.

This provision is identical to SB 581 (2016), SCS/SB 8 (2015) and substantially similar to a provision in SCS/SB 167 (2015), SB 847 (2014), SCS/SB 739 (2014), and HB 1793 (2014). This provision is substantially similar to SB 307 (2013).

SARAH HASKINS