SS#2 SCS HB 191 -- HEALTH AND MENTAL HEALTH INSURANCE; HIV
INFORMATION; HEALTH DISCLOSURE

This bill deals with several topics in health and mental health.

HEALTH INSURANCE FOR CERTAIN CANCER EXAMINATIONS

Health insurers and similar entities are required to provide
coverage for pelvic exams and pap smears for nonsymptomatic
women in accordance with American Cancer Society guidelines.
Prostate exams and laboratory tests will be covered for
nonsymptomatic men and colorectal cancer exams and laboratory
tests will be covered for nonsymptomatic persons in accordance
with American Cancer Society guidelines.  Coverage and benefits
related to the examinations and tests are subject to dollar
limits, deductibles, and copayments similar to those of other
covered benefits or services.  Accident-only, hospital
indemnity, Medicare supplement, long-term care, limited benefit
health insurance policies, and short-term major medical policies
of 6 months or less are exempted from these requirements.

DISCLOSURE OF HIV INFORMATION

This bill revises provisions concerning the disclosure of an
individual's HIV infection status or test results.  Peace
officers, the Attorney General, assistant attorneys general, and
prosecuting attorneys are authorized to receive the results.

Courts can grant orders for disclosure of confidential HIV
information to specified persons who document a compelling need
to adjudicate a legal proceeding; a clear and imminent danger to
an individual at risk of infection; or a clear and imminent
danger to public health.  Persons who are lawfully authorized
can receive the HIV information.  The bill also specifies the
procedures for the issuance of the court order, the response of
the parties to the court order, and the content of the court
order.

MENTAL HEALTH INSURANCE COVERAGE

The bill revises certain provisions pertaining to the offer of
insurance coverage for chemical dependency and recognized mental
illness.  Prescription rights of specified health care
practitioners only apply to medical physicians and doctors of
osteopathy.

If any individual, group, or contractholder rejects health
insurance policies containing benefits or coverage for mental
health treatment and chemical dependency, coverage is governed
by the provisions contained under the Mental Health and Chemical
Dependency Insurance Act.

MENTAL HEALTH AND CHEMICAL DEPENDENCY INSURANCE ACT

The bill prohibits health insurance policies that offer coverage
for specified mental health illnesses from establishing rates,
terms, or conditions which place greater financial burdens on an
insured for access to evaluation and treatment of mental illness
than for access to evaluation and treatment for physical
illness.  Rates and lifetime limits for alcohol and other drug
abuse services are specified in the bill.

Health insurance policies that contain a federally qualified
plan of benefits comply with the provisions of the act if such
policies adhere to the provisions of the act.  If the coverage
is rejected, the federally qualified health maintenance
organization is required to provide coverage for mental health
services as required by the Federal Public Health Service Act.

The Director of the Department of Insurance can disapprove any
policy that is inconsistent with the provisions of the act.
Coverages contained in this section can be administered through
a managed care program, and covered services can be provided
through a system of contractual arrangements.  Insurers can use
a case management program for the administration of mental
health benefits.  Insurers can also apply different limits or
exclude from coverage, care, treatments, and services as
specified in the bill.

The Director of the Department of Insurance is required to
conduct a study of the impact of the Act and to report the
findings to the General Assembly by January 1, 2004.  The
provisions of the act apply to applications for coverage made on
January 1, 2000, and thereafter and health insurance policies
issued or renewed to Missouri residents.  The provisions of the
Act apply to multiyear group policies.

The provisions of the act expire on January 1, 2005.

HEALTH INSURANCE REPORTING REQUIREMENTS

After January 1, 2002, all health insurance carriers offering
policies in Missouri are required to use standardized
information when providing an explanation of benefits to health
care providers.  Specified insurance policies are excluded from
the requirement.  The bill also requires health care providers
and health carriers to use standardized information for
referrals.

BREAST IMPLANTATION AWARENESS INFORMATION

The Department of Health is required to develop a standardized
written summary which informs patients of the advantages,
disadvantages, and risks associated with breast implantation.
Attending physicians are required to provide the written summary
to patients prior to a breast implantation operation.

Effective January 1, 2000, the Department of Health is required
to provide the standardized written summary to all hospitals,
clinics, and physician's offices that perform breast
implantation.

HEALTH INSURANCE ADVISORY COMMITTEE

The Department of Insurance is required to establish a Health
Insurance Advisory Committee for the purpose of discussing and
advising the department on issues relating to health care
insurance.  The bill specifies the composition of the committee
and requires that members serve on a voluntary basis.

HB 191 -- CANCER REPORTING AND DETECTION (Dougherty)

This bill revises provisions relating to the cancer information
reporting system in Missouri.  The Department of Health is
required to establish and maintain a cancer information
reporting system which includes a record of all Missouri cancer
cases and related information of inpatients and outpatients
diagnosed and treated in hospitals, pathology laboratories,
physician offices, ambulatory surgical centers, and free
standing cancer clinics and treatment centers.  Currently, the
Department of Health maintains records of hospitalized cancer
cases in Missouri.

The director of the Department of Health will establish
regulations regarding the reporting of cases of malignant
neoplasms and relevant information.  The reported cases must be
filed with the director within 6 months of diagnosis or
treatment.  Currently, the reported cases are filed within 4
months.

Administrators or designated representatives of hospitals and
related medical facilities are required to report to the
Department of Health every case of malignant neoplasm.
Attending physicians or other health care providers who diagnose
or treat a patient's malignant neoplasm are required to report
the cancer case to administrators or a designated
representative.  Duplicate reporting of malignant neoplasms to
the Department of Health is not required if the administrators
or designated representatives are currently submitting the
reports.

The Department of Health is required to protect the identity of
patients, physicians, health care providers, and related medical
facilities required to report cancer cases.  The department can
disclose their identities with written consent and can request
consent for releases from patients, physicians, health care
providers, and related medical facilities if applicants
conducting worthwhile cancer research can show that the
identities are necessary.  Reports used or published by the
Department of Health are based on information obtained according
to the provisions of this bill.

The department can enter into exchange of data agreements with
other federal, state, or local government cancer registries.
The disclosure of the identity of patients, physicians, health
care providers, and related medical facilities is not required
if the agreement prevents such disclosure.

Health insurers and similar entities are required to provide
coverage for pelvic exams and pap smears for nonsymptomatic
women in accordance with American Cancer Society guidelines.
Prostate exams and laboratory tests will be covered for
nonsymptomatic men and colorectal cancer exams and laboratory
tests will be covered for nonsymptomatic persons in accordance
with American Cancer Society guidelines.  Coverage and benefits
related to the examinations and tests are subject to dollar
limits, deductibles, and co-payments similar to those of other
covered benefits or services.  Accident-only, hospital
indemnity, Medicare supplement, long-term care, limited benefit
health insurance policies and short term major medical policies
of 6 months or less are excluded from the provisions of this
bill.

FISCAL NOTE:  Estimated Net Cost to All Funds of $0 to 482,092
in FY 2000, $0 to $602,785 in FY 2001, and $628,097 to
$1,320,000 in FY 2002.  Estimated Net Increase to Insurance
Dedicated Fund of $14,450 to $21,900 in FY 2000, $0 in FY 2001,
and $0 in FY 2002.

HB 191, HCA 1 -- INSURANCE COVERAGE FOR CANCER EARLY DETECTION

SPONSOR:  Dougherty

COMMITTEE ACTION:  Voted "do pass" by the Committee on Public
Health by a vote of 11 to 0.

This bill requires health insurers and similar entities to
provide coverage for pelvic exams and pap smears for
nonsymptomatic women in accordance with American Cancer Society
guidelines.  Prostate exams and laboratory tests will be covered
for nonsymptomatic men and colorectal cancer exams and
laboratory tests will be covered for nonsymptomatic persons in
accordance with American Cancer Society guidelines.  The
coverage is not subject to deductible limits but patients will
be responsible for a copayment not to exceed $25, if required.
Accident-only, hospital indemnity, Medicare supplement, long--
term care, and limited benefit health insurance policies are
excluded from the provisions of this bill.

HCA 1 -- Requires that coverage and benefits related to the
examinations and tests are subject to dollar limits,
deductibles, and co-payments similar to those of other covered
benefits or services.

FISCAL NOTE:  Estimated Net Cost to All Funds of $0 to
$1,169,703 for FY 2000, $0 to $1,471,366 in FY 2001, and $0 to
$647,508 in FY 2002.  Estimated Net Income to Insurance
Dedicated Fund of $14,450 to $28,900 in FY 2000, and $0 in FY
2001 and FY 2002.

PROPONENTS:  Supporters say that screening for cancer can result
in the detection of the cancer at an early stage and can reduce
disability and the loss of life.

Testifying for the bill were Representative Dougherty; American
Cancer Society; Missouri State Medical Association; Missouri
Nurses Association; Department of Health; American Association
of Retired Persons; and Ned Rodes, M.D.

OPPONENTS:  There was no opposition voiced to the committee.

Joseph Deering, Legislative Analyst

HB 191 -- Early Cancer Detection

Sponsor:  Dougherty

This bill requires health insurers and similar entities to
provide coverage for pelvic exams and pap smears for
nonsymptomatic women in accordance with American Cancer Society
guidelines.  Prostate exams and laboratory tests will be covered
for nonsymptomatic men and colorectal cancer exams and
laboratory tests will be covered for nonsymptomatic persons in
accordance with American Cancer Society guidelines.  The
coverage is not subject to deductible limits but patients will
be responsible for a copayment not to exceed $25, if required.
Accident-only, hospital indemnity, Medicare supplement, long--
term care and limited benefit health insurance policies are
excluded from the provisions of this bill.