Senate Substitute

SS/SCS/HCS/HB 399 - This act enacts provisions relating to private health insurance.

MEDICATION-ASSISTED TREATMENT (Sections 191.1164, 191.1165, 191.1167, and 191.1168)

This act establishes the "Ensuring Access to High Quality Care for the Treatment of Substance Use Disorders Act". These provisions specify that medication-assisted treatment (MAT) services shall include, but not be limited to, pharmacologic and behavioral therapies. Formularies used by a health insurer or managed by a pharmacy benefits manager, and medical benefit coverage in the case of medications dispensed through an opioid treatment program, shall include all certain specified medications. All MAT medications required for compliance with these provisions shall be placed on the lowest cost-sharing tier of the formulary.

MAT services provided for under these provisions shall not be subject to: annual or lifetime dollar limits; limits to predesignated facilities, specific numbers of visits, days of coverage, days in a waiting period, scope or duration of treatment, or other similar limits; financial requirements and quantitative treatment limitations that do not comply with the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA); step therapy or other similar strategies when it interferes with a prescribed or recommended course of treatment from a licensed health care professional; or prior authorization.

These provisions shall apply to all health insurance plans delivered in the state.

These provisions are similar to SB 507 (2019).


This act requires the Director of the Department of Health and Senior Services to have specified qualifications regarding education and experience.

This provision is identical to a provision in SS/SCS/SBs 70 & 128 (2019), and similar to provisions in SB 177 (2019).

CONSUMER-DIRECTED SERVICES (Sections 208.909, 208.918, 208.924, and 208.935)

Under current law, vendors of consumer-directed services shall monitor the performance of personal care assistance service plans. This act requires the consumer to permit the vendor to comply with its quality assurance and supervision process, including bi-annual face-to-face home visits and monthly case management activities. During the home visits, the vendor shall document if the attendant was present and providing services as set forth in the plan of care and report the Department if the attendant is not present or providing services, which may result in a suspension of services to the consumer.

This act repeals language permitting the Department of Health and Senior Services to establish certain pilot projects for telephone tracking systems.

This act also requires vendors to notify consumers during orientation that falsification of personal care attendant time sheets shall be considered and reported to the Department as fraud.

Under this act, a vendor shall submit an annual financial statement audit or annual financial statement review performed by a certified public accountant to the Department upon request. The Department shall require the vendor to maintain a business location in compliance with any and all city, county, state, and federal requirements. Additionally, this act requires the Department to create a consumer-directed services division provider certification manager course. No state or federal funds shall be authorized or expended for personal care assistance services if the person providing the personal care is the same as the person conducting the biannual face-to-face home visits.

Currently, a consumer's services may be discontinued if the consumer has falsified records. This act adds language to include providing false information of his or her condition, functional capacity, or level of care needs.

These provisions are identical to provisions in the perfected SS/SCS/SBs 70 & 128 (2019), substantially similar to provisions in HCS/HB 1885 (2018) and HB 2500 (2018), and similar to SB 969 (2018) and provisions of SB 526 (2017).

Finally, the Department shall, subject to appropriations, develop an interactive assessment tool for utilization by the Division of Senior and Disability Services when implementing the assessment and authorization process for home and community-based services authorized by the Division.

This provision is substantially similar to a provision in the perfected SS/SCS/SBs 70 & 128 (2019) and SB 441 (2019).


This act removes the expiration date of the personal care assistance services program for non-MO HealthNet eligible participants meeting certain eligibility requirements.

This provision contains an emergency clause.


Under this act, MO HealthNet benefits shall be suspended, rather than cancelled or terminated, for offenders entering into a correctional facility or jail if the Department of Social Services is notified of the person's entry into the correctional center or jail, the person was currently enrolled in MO HealthNet, and the person is otherwise eligible for MO HealthNet benefits but for his or her incarcerated status. Upon release from incarceration, the suspension shall end and the person shall continue to be eligible for MO HealthNet benefits until such time as he or she is otherwise ineligible.

The Department of Corrections shall notify the Department of Social Services within 20 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in a correctional center or jail and within 45 days prior to the release of such person whose benefits have been suspended under this act. City, county, and private jails shall notify the Department of Social Services within 10 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in the jail.

These provisions are identical to SB 393 (2019), provisions in the perfected SS/SCS/SBs 70 & 128 (2019), and provisions in SCS/HCS/HB 466 (2019).


This act specifies that a statute relating to direct payment of ambulance services and other health care providers applies to "ground ambulance service" rather than "ambulance service" generally.

This provision is identical to a provision in SCS/SB 267 (2019).


The act specifies that health care professionals shall, rather than may, utilize the process outlined in statute for claims for unanticipated out-of-network care.

This provision is identical to the perfected SB 103 (2019).


This act specifies that multiple-employer self-insured health plans may be offered or advertised to the public by insurance producers or third-party administrators, provided the plan has a certificate of authority to transact business in the state issued by the Director of the Department of Insurance, Financial Institutions, and Professional Registration. Health carriers acting as an administrator for a multiple-employer self-insured health plan shall permit any willing licensed broker to quote, sell, solicit, or market the plans, provided that the broker is appointed and in good standing with the health carrier and completes all required training.

These provisions are identical to HB 942 (2019).


This act adds therapeutic care for "developmental or physical disabilities", as such term is defined in the act, to the insurance coverage mandate for autism spectrum disorders, and makes the mandate applicable to policies issued or renewed on or after January 1, 2020, rather than to group policies only. The act specifies that autism spectrum disorder shall not be subject to any limits on the number of visits an individual may make to an autism service provider. Coverage for therapeutic care provided under the act for developmental and physical disabilities may be limited to a number of visits per calendar year, provided that additional visits shall be covered if approved and deemed medically necessary by the health benefit plan. Provisions requiring coverage for autism spectrum disorders and developmental or physical disabilities shall not apply to certain grandfathered, pre-empted, or supplemental plans as described in the act.

This act repeals a provision of law directing the Department of Insurance, Financial Institutions, and Professional Registration to grant small employers waivers from the coverage requirements under certain circumstances. The act also repeals a provision requiring the Department to submit annual reports to the legislature and requiring health carriers to supply certain diagnosis and coverage information for the report.

These provisions apply to policies issued, delivered, or renewed on or after January 1, 2020.

These provisions are similar to SCS/SB 45 (2019), SB 1074 (2018), HCS/HB 1658 (2018), SB 456 (2017), and HB 1011 (2017).


This act changes the title from "health care for persons with disabilities" to "health insurance".

The act also prohibits health carriers and entities acting on their behalf from restricting methods of reimbursement to a method requiring health care providers to pay a fee to redeem the amount of their claim for reimbursement.

Health carriers initiating or changing the method of reimbursement to a method that will require a fee, discount, or other remuneration to redeem the claim shall notify providers of the required fee, discount, or other remuneration. The notice shall provide clear instructions on how the provider can select an alternative payment method.

For health benefit plans issued, delivered, or renewed on or after August 28, 2019, a health carrier shall allow providers to select to be reimbursed by an electronic funds transfer through the Automated Clearing House Network as required under federal law, as specified in the act, and shall use such method to reimburse the provider until the provider requests otherwise.

Violation of these provisions shall be deemed an unfair trade practice under the Unfair Trade Practice Act.

These provisions are similar to SB 302 (2019) and HB 492 (2019).


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