SB 0772 Requires Fair Treatment by Health Care Plans
LR Number:S2995.01I Fiscal Note:2995-01
Committee:Public Health and Welfare
Last Action:02/12/96 - Hearing Conducted S Public Health & Welfare Committee
Effective Date:January 1, 1998
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Current Bill Summary

SB 772 - This act requires the certification of all managed health care plans operating in Missouri by January 1, 1998. The Department of Insurance shall make the certifications, and the following requirements are to be certified:

(1) Prospective enrollees shall be provided with information on coverage, authorization procedures, financial arrangements, participating providers and other topics;

(2) Screening for emergencies shall be covered;

(3) 90 days notice is required to drop health providers;

(4) Financial incentives may not be used to limit medically necessary services;

(5) Primary care physician selection is regulated;

(6) Providers must be given reasons for denial or termination from any network, and they shall have a right to a review;

(7) Plans may refuse admission if they have enough providers;

(8) Referrals out of a network shall be allowed if covered services are not otherwise available;

(9) Employers may cancel if material changes are made in the plan;

(10) Plans must pass savings on to enrollees;

(11) Plans may not retaliate because of complaints; and

(12) Plans must give providers input into medical policy.

Standards shall be set up by the Department of Insurance within one year, and all entities shall be certified by January 1, 1998. CHERYL GRAZIER/JON HAGLER