SS/SCS/HB 32 - This act would allow individual physicians to be designated as "Essential Community Providers" to serve medically underserved areas or in health professional shortage areas as designated by the Secretary of the Department of Health and Human Services.

Any physician seeking a designation of "Essential Community Provider" must apply to the Director of the Department of Health and document that at least 40% of their practice is comprised of (a) Medicaid or uninsured patients, or both; (b) a combination of Medicaid and uninsured patients and Medicare or underinsured patients; (c) serve a medically underserved area or a health professional shortage area; (d) serve a medically underserved population; (e) spend a minimum of 20 hours per week in the health professional shortage area; and (f) be available to patients evenings and weekends. The physicians must also have hospital staff privileges or be affiliated with other physicians who have such privileges.

The Essential Community Provider must meet quality standards in accordance with guidelines established by the National Committee for Quality Assurance.

The Department of Health shall issue a letter of designation as an Essential Community Provider to any physician who makes a written request and application, if such physician meets the qualifications of an essential community provider. The Department shall keep the names and addresses of all Essential Community Providers on record and shall release such information on request.

Health care insurers which market group policies or contracts for health care coverage shall allow each Essential Community Provider in such designated area to submit an application to the health care insurer and provide a copy of the letter of designation. The Department of Health shall issue one thousand letters of designation to qualified applicants.

The names of each Essential Community Provider shall appear in publications distributed to consumers or enrollees of the health care plan.

The requirements of this act will not apply to a health care insurer that is a medical group/staff model health maintenance organization that provides services to its enrollees through facilities that are owned or operated by the health maintenance organization.

The designation of an Essential Community Provider shall not be transferable to another physician, health care provider or entity. The Essential Community Provider shall submit an annual affidavit to the Department of Health stating that such community provider continues to meet the qualification for which the provider was certified.

The act also states that the limits provided in section 191.227, RSMo shall be increased or decreased on an annual basis effective January 1 of each year in accordance with the Health Care Financing Administration Market Basket Survey.
CHERYL GRAZIER

SENATE AMENDMENTS TO SS/SCS/HB 32

SA NO. 2 - Deleted quality assurance guidelines established by National Committee for Quality Assurance and inserted established by Missouri Board of Healing Arts.

SA NO. 3 - Providers allowed to charge a $25 dollar handling fee plus a fee of $0.35 per page for copies of medical documents made on a standard photocopy machine.

SA NO. 6 - A physician may not make a referral to any physical therapy services with whom the physician has a financial relationship.

SA NO. 7 - No health care insurer shall be required to offer a provider contract to an essential community provider.