Missouri Senate

House Committee Substitute

HEALTH CARE COST AND TRANSPARENCY ACT (Section 197.170)

This provision, known as the "Health Care Cost Reduction and Transparency Act," requires, beginning January 1, 2018, each ambulatory surgical center and imaging center to make available to the public an estimate of the most current direct payment price information for the 25 most common surgical procedures or 20 most common imaging procedures. By July 1, 2017, hospitals shall make available to the public the amount that would be charged without discounts for each of the 100 most prevalent diagnosis-related groups.

Upon written request of a patient for the direct payment cost of a particular health care service or procedure, a health care provider, hospital, ambulatory surgical center, or imaging center shall provide a written estimate to the patient, either electronically, by mail, or in person, within 3 business days after receiving the request. The health care provider, hospital, ambulatory surgical center, or imaging center may comply with this requirement by providing the patient a specific link to such estimated prices and posting such estimated prices on its website.

No health care provider shall be required to report information under this provision if such reporting could reasonably lead to the identification of a person receiving health care services in violation of the Health Insurance Portability and Accountability Act of 1996 or other federal law. These provisions shall not apply to emergency departments that are required to comply with the Emergency Medical Treatment and Active Labor Act.

Finally, this act requires health care providers located in certain Kansas border counties to comply with these provisions in order to become a MO HealthNet provider.

This provision is identical to HCS/HB 2269 (2016) and similar to SS/SB 806 (2016), SB 900 (2016) and 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.

MO HealthNet Pharmacy (Section 208.800)

Under this act, the Department of Social Services may utilize best clinical practices to achieve cost efficacy when administering MO HealthNet's pharmacy program.

SARAH HASKINS