MISSOURI PATIENT PRIVACY ACT

This act establishes the Missouri Patient Privacy Act which prohibits the disclosure of patient-specific health information to any employer, public or private payer, or employee or agent of a state department or agency without the written consent of the patient and health care provider. Health information may be disclosed to a health insurer, employer, state employee or agent of the Missouri Consolidated Health Care Plan, the Department of Health and Senior Services, or the MO HealthNet Division within the Department of Social Services in connection with the employee's official duties including oversight of state health programs, tracking infectious diseases, administering state wellness initiatives and programs, and researching state medical trends. The act does not prohibit disclosure of persona health information consistent with federal law and does not require health care providers to obscure or remove the information when disclosing it. SECTION 191.015

This provision is similar to HCS/SS/SCS/SB 306 (2009) and HCS/HB 497 (2009).

TRANSPORTATION AND ANCILLARY SERVICES FOR MEDICAL TREATMENT OF A CHILD

This act establishes the Evan de Mello Reimbursement Program within the departments of Health and Senior Services and Mental Health to provide financial assistance for the cost of transportation and ancillary services associated with the medical treatment of an eligible child. The program is the payer of last resort after all other available sources have been exhausted. Reimbursement is subject to appropriations. To be eligible for assistance under the program, a child must be suffering from a condition or impairment that results in severe physical illness or impairments, in need of transportation or ancillary services due to his or her condition, certified by a physician of the child's choice as a child who will likely benefit from medical services, and required to travel at least 100 miles for medical services and the child's parents or guardian are unable to pay the travel expenses. The departments must establish rules which include an application and review process, a cap on benefits that cannot be less than $5,000 per recipient, and household income eligibility limits which cannot exceed 350% of the federal poverty level. SECTION 191.940

This provision is identical to HCS/SS/SCS/SB 306 (2009) and HB 61 (2009) and similar to HB 2486 (2008).

INTERNET WEB-BASED PRIMARY CARE ACCESS PILOT PROJECT

This act requires the department of social services to seek to acquire federal American Recovery and Reinvestment Funds for the purpose of awarding a grant to implement an internet web-based primary care access pilot project designed as a collaboration between private and public sectors to connect, where appropriate, a patient with a primary care medical home, and schedule patients into available community-based appointments as an alternative to non-emergency use of the hospital emergency room as consistent with federal law and regulations. The criteria for the grant are specified in the act. SECTION 191.1200

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SB 149 (2009) and SS/SCS/SB 1283 (2008).

TELEHEALTH

This act expresses the state's recognition of the delivery of health care via telehealth as a safe, practical and necessary practice in the state. By January 1, 2010, the Department of Health and Senior Services shall promulgate quality control rules to be used in removing and improving the service of telehealth practitioners. SECTIONS 191.1250 to 191.1277

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SB 149 (2009) and SS/SCS/SB 1283 (2008).

MO HEALTHNET DATA TRANSPARENCY

This act requires the MO HealthNet Division, by August 28, 2010, to implement a program to make available through its Internet web site nonaggregated data on MO HealthNet participants collected under the federal Medicaid Statistical Information System to the extent such data has already been de-identified in accordance with federal HIPAA privacy requirements.

In implementing the program the Division shall ensure that the information made available is in a format that is easily accessible, useable, and understandable to the public, including individuals interested in improving the quality of care provided to individuals eligible for programs and services under the MO HealthNet program, researchers, health care providers, and individuals interested in reducing the prevalence of waste and fraud under the program.

By August 28, 2011, and annually thereafter, the director shall submit to the General Assembly and the MO HealthNet oversight committee, a report on the progress of the program, including the extent to which information made available through the program is accessed and the extent to which comments received on the program were used during the year to improve the utility of the program.

The Division shall also report to the General Assembly the feasibility of expanding the transparency program for the health care for uninsured children program (SCHIP).

This program has a six-year sunset clause. SECTION 208.192

These provisions are contained in based on SB 549 (2009).

ASSISTED LIVING WAIVER

This act amends the provisions regarding personal care services and assisted living waivers to provide such provisions shall terminate for persons enrolled in the waiver upon receipt of relevant waivers from the federal Department of Health and Senior Services. SECTION 208.152

MO HEALTHNET-THIRD PARTY PAYER

Under this act any third party administrator, administrative service organization, health benefit plan and pharmacy benefits manager shall process and pay all properly submitted MO HealthNet subrogation claims for a period of three years from the date services were provided or rendered, regardless of any other timely filing requirement. The entity shall not deny such claims on the basis of the type or format of the claim form, failure to present proper documentation of coverage at the point of sale, or failure to obtain prior authorization. The MO HealthNet Division shall also enforce its rights within six years of a timely submission of a claim. SECTION 208.215

These provisions are contained in HCS/SS/SCS/SB 306 (2009) and SB 552 (2009).

SHOW ME HEALTH COVERAGE

This act establishes the Show-Me Health Coverage plan within the Department of Social Services to provide health care coverage through the private insurance market to low-income working individuals in the state. The Department of Insurance, Financial Institutions and Professional Registration shall provide oversight of the marketing practices of the plan while the Department of Social Services shall establish standards for consumer protection for the plan. The maximum enrollment of plan participants is dependent on the moneys appropriated by the General Assembly, and the eligibility for the plan is phased in incrementally based on appropriations. The plan is subject to approval by the United States Department of Health and Human Services.

The eligibility requirements and the services to be provided by the plan are specified in the act. The act provides coverage for individuals with incomes up to 50% of the federal poverty level without regard to type of income and for custodial parents with earned income up to 100% of the federal poverty level. There are caps for income disregards for child support, a child’s old-age survivors or disability insurance (OASDI) benefit, and unemployment benefits for persons with earned income for those with earned income between 50% and 225% of the federal poverty level, subject to appropriation. The combined amount of earned and unearned income shall not exceed 100% of the federal poverty level. Custodial parents with earned income up to 100% of the federal poverty level shall be eligible for the Show-Me Health Coverage benefit package under a Medicaid State Plan Amendment rather than through a Medicaid waiver.

In addition, an individual who is eligible for coverage under the health insurance pool and who does not have income above 225% of the federal poverty level as well as other specified eligibility requirements shall also be eligible for the plan.

The plan shall also provide for qualifying individuals as specified in the act a health care home. Under the plan, a health care account is established for each individual, except for the custodial parent population under the state plan amendment, and payments for his or her participation can be made by the individual, an employer, the state, or any philanthropic of other charitable contributor. An individual's health care account shall be used to pay the individual's deductible for health care services under the plan. A participant will be terminated from participation in the plan if his or her required payment is not made within 60 days after the required date, however the participant may reapply to participate in the plan six months after termination from the plan. Approved participants are eligible for a 12-month period but must file a renewal application to remain in the plan.

The show-me health coverage plan shall be void and of no effect if there are no funds appropriated by Congress or if there are no disproportionate share hospital funds applied to the program.

The MO HealthNet division is required by December 28, 2009 to identify and report to the general assembly a strategy through which at least some portion of the individuals participating in this plan using the health care accounts are included in the Missouri consolidated health care plan (MCHCP) population using a health savings account model, or whether MCHCP could administer those individuals in this plan participating in the health care accounts using the current structure in place for MCHCP participants using such model. The department and the Board of Trustees of the MCHCP shall convene a working group to assist with the development of such strategy.

These provisions have a six-year sunset clause.

These provisions are contained in SS/SCS/SB 306 and similar to a portion of SS/SCS/SB 1283 (2008). SECTIONS 208.1300 TO 208.1345

CO-PAYMENTS FOR PRESCRIPTION DRUGS

This act specifies that when the usual and customary retail price of a prescription drug is less than the co-payment applied by a health maintenance organization or health insurer, the enrollee is only required to pay the usual and customary retail price of the prescription drug and there will be no further charge to the enrollee or plan sponsor for the prescription. SECTION 354.535

This provision is contained in HCS/SS/SCS/SB 306 (2009) and HB 95 (2009).

HEALTH MAINTENANCE ORGANIZATIONS

This act requires proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the policy holder for support and maintenance to be submitted to the insured's HMO within 31 days after the child has attained the age when the child's coverage is to be terminated instead of the current at least 31 days. SECTION 354.536

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HCS/HB 229 (2009).

STANDARDIZED INSURANCE APPLICATIONS

Requires the Director of the Department of Insurance, Financial Institutions and Professional Registration to establish by rule uniform insurance application forms to be used by all insurers for group health insurance policies. These provisions will not apply to group health plans for small employers. SECTION 374.184

This provision is contained in HCS/SS/SCS/SB 306 (2009) and HB 372 (2009).

REIMBURSEMENT CLAIMS

By January 1, 2010, a health carrier responding to an electronic patient financial responsibility inquiry must respond with the eligibility or benefit information codes for co-payment, co-insurance, deductible, out-of-pocket maximum, remaining deductible amount, and other cost containment elements. SECTION 376.384

This provision is contained in HCS/SS/SCS/SB 306 (2009).

GROUP HEALTH COVERAGE

This act provides that when a group health insurance policy is terminated, the group health insurers cannot refuse to convert a health insurance policy or coverage of an insured person if they are eligible for Medicare or any other state or federal benefit. SECTION 376.397

Currently, group health insurance policies must contain a provision that specifies any exclusions and limitations to the policy with regard to a disease or physical condition that an individual was treated for during the 12 months prior to the enrollment date of an individual's policy. The act limits the exclusions and limitations to the prior six months before an individual becomes covered under the policy. Exclusions and limitations cannot apply to a loss or disability that occurred after the enrollment date or during the 18-month period thereafter in the case of a late enrollee. This act also requires proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the policy holder for support and maintenance to be submitted to the health insurer within 31 days after the dependent child has attained the age when coverage is to be terminated in order to sustain coverage instead of the current at least 31 days. SECTION 376.426

These provisions are contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HB 229 (2009).

MINI-COBRA LAW

This act requires group insurance policies by a health carrier or health benefit plan to comply with the federal COBRA or the state continuation of coverage of law (section 376.428) and to offer such persons the option of continuation of coverage to an individual who has terminated employment or membership. SECTION 376.428

This provision is contained in HCS/SS/SCS/SB 306 (2009).

CONTINUATION OF HEALTH INSURANCE COVERAGE FROM AGE 55

Under this act, every group health insurance policy issued or renewed on or after January 1, 2010, must contain a provision that allows an employee or group member, whose continuation coverage under the federal COBRA law or state's continuation law has expired, to continue coverage under that group policy provided the employee or group member was 55 years or older when coverage under COBRA or the state continuation law expired. The extended continuation coverage provided by this act will terminate upon the earliest of the following:

1) The date the employee or group member fails to pay premiums;

2) The date the group policy is terminated as to all group members;

3) The date on which the employee or group member becomes insured under another group policy;

4) The date on which the employee or group member becomes eligible for coverage under the federal Medicare program; or

5) The date on which the employee or group member turns 65.

These provisions shall not apply to employers with less than 100 employees. The department shall study the effect of implementing the provisions of this section to such employers and submit a report to the general assembly by December 31, 2009. The provisions of this section shall only apply to employers with with less than 100 employees after passage of a concurrent resolution by the general assembly authorizing the implementation of the plan. SECTION 376.437

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SB 415 and SB 547 (2009).

RATING OF MISSOURI CONTINUATION COVERAGE POLICIES - This act requires health insurance policies that are issued to individuals eligible for continuation coverage under state law to be pooled across all fully insured group business in Missouri. The rating system or methodology in which the premium for all persons covered under a continuation of coverage provision shall be based on the experience of all persons covered by a continuation of coverage provision with any cost of the pool experience spread over all fully insured premiums in Missouri on an equal percentage basis. SECTION 376.439

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SB 415 and SB 547 (2009).

CONTINUATION OF COVERAGE RIGHTS THROUGH A HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN

This act requires health carriers who provide group insurance policies to persons who are exercising their continuation of coverage rights under COBRA or the state continuation of coverage law (Section 376.428) to offer such persons the option of continuation of coverage through a HSA eligible high deductible plan rather than the underlying group policy. The premiums for the HSA eligible high deductible plans shall be consistent with the underlying group plans rated relative to the standard or manual rates for the benefits provided. SECTION 376.443

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SB 415 and SB 547 (2009).

CREDITABLE COVERAGE AND WAITING PERIOD DEFINITIONS

The act adds the SCHIP program to the categories of insurance that qualify as "creditable coverage" for purposes of health insurance portability. The act also modifies the definition for the term "waiting period" to include late enrollees and individuals seeking coverage in the individual health insurance market. The definition for "waiting period" as it relates to the Missouri Health Insurance Portability and Accountability Act is revised to be a time period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll in a group health plan becomes effective. Any time period before late or special enrollment is not considered a waiting period for late or special enrollees. A waiting period begins on the date an individual submits an application for coverage and ends when the application for coverage is approved, denied, or lapses. SECTION 376.450

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HB 229 (2009).

PLACEMENT FOR ADOPTION

Health insurance issuers offering group coverage will be required to provide a special enrollment period for a dependent in the case of a placement for adoption. SECTION 376.450.6

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HB 229 (2009).

EMPLOYER REQUIREMENTS

This act provides that if an employer provides health insurance to an employee and the employee pays any portion of the cost of the premium, the employer must also provide a premium-only cafeteria plan or a health reimbursement arrangement. SECTION 376.453

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HB 229 (2009).

DEPENDENT COVERAGE

Under current law, proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the insured for support and maintenance must be furnished to the health insurer at least 31 days after the dependent child has attained the age when coverage would normally be terminated in order to continue receiving the extended coverage provided by the statutes. This act requires the proof of incapacity and dependency to be furnished within 31 days after the child's attainment of the limiting age. This modification applies to group policies, individual polices and health maintenance organization polices. SECTION 376.776

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HB 229 (2009).

HIGH RISK POOL ELIGIBILITY

Add the terms "waiting period" and "affiliation period". A person's eligibility for COBRA or continuation rights under state law cannot render the person ineligible for coverage under the high risk pool. SECTION 376.960

This act requires all health insurers to notify an insured person when he or she has exhausted 85% of his or her total lifetime health insurance benefits and of the person's eligibility for and the methods of applying for coverage under the Missouri Health Insurance Pool (MHIP). Notification must be repeated when an insured has exhausted 100% of his or her total lifetime health insurance benefits. SECTION 376.966

Requires the high risk pool to offer high deductible health plans, offered in conjunction with HSAs to be offered on a guaranteed-issue basis. SECTION 376.987

These provisions are contained in HCS/SS/SCS/SB 306 (2009) and HB 497, SB 415, HB 60, and HB 229 (2009).

RIGHT TO RECEIVE DOCUMENTS

Currently, a health insurance plan enrollee can opt out from receiving documents from his or her managed care entity in print form and access the documents electronically. The act specifies that the enrollee must, upon request, receive the documents in print form. SECTION 376.1450

This provision is contained in HCS/SS/SCS/SB 306 (2009).

HEALTH REIMBURSEMENT ARRANGEMENT

Under this act, employees are allowed to use funds from one or more employer health reimbursement arrangement only plans to help pay for individual health insurance coverage. HRAs are employee benefit plans provided by an employer which establish an account funded solely by the employer to reimburse the employee for qualified medical expenses incurred by the employee or his or her family. HRAs allow the employee to carry forward any unused funds at the end of the coverage period to subsequent coverage periods (Section 376.1600). A similar provision is contained in SB 415 (2009). SECTION 376.1600.

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HB 229 (2009).

PROMOTION AND APPROVAL OF HSA HEALTH PLANS

Under the act, the Director of the Department of Insurance is expressly authorized to adopt policies to promote, approve, and encourage health savings account eligible high deductible plans in Missouri. The act directs the director to conduct a national study of health savings account eligible high deductible health plans available in other states and determine if and how these plans serve the uninsured. The act also directs the Director to develop a fast track approval process for health savings account eligible high deductible plans. Section 376.1603

This provision is contained in HCS/SS/SCS/SB 306 (2009) and SB 415 (2009).

STUDY TO IDENTIFY ADMINISTRATIVE AND REGULATORY BARRIERS FOR NEW INSURANCE PRODUCTS

By January 1, 2010, the Director of the Department of Insurance, Financial Institutions and Professional Registration must provide recommendations to the General Assembly of changes to remove any unnecessary barriers that limit the entry of new health insurance products into the Missouri insurance market. The director must also examine proposals adopted in other states that streamline the regulatory processes to allow insurance companies to market new and existing products more easily. SECTION 376.1618

This section is contained in HCS/SS/SCS/SB 306 (2009) and SB 415 (2009) and SS/SCS/HB 229 (2009).

SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT

The definition of "dependent" is changed in the Small Employer Health Insurance Availability Act to mirror the definition of dependent contained in the HMO, individual and group policy statutes. The definition of "dependent" is revised to be a person that is a spouse, an unmarried child who resides in Missouri and is younger than 25 years of age and is not covered by any group or individual health benefit plan or entitled to federal Social Security assistance benefits, or an unmarried child of any age who is disabled and dependent upon his or her parent. SECTION 379.930.2

A small employer must reasonably compensate an agent or broker for the sale of any small employer health benefit plan, and a small employer carrier must maintain and issue all health benefit plans it actively markets to small employers in the state. SECTION 379.940.

Under this act, when an insurer charges a reduced premium rate for employees who do not smoke or use tobacco, the insurer must comply with the nondiscrimination provisions of HIPAA. SECTION 379.952

These provisions are contained in HCS/SS/SCS/SB 306 (2009) and SS/SCS/HB 229 (2009).

MO HEALTHNET FOR KIDS PROGRAM

For taxpayers with less than 150% federal poverty and who do not report health coverage for a dependent child, the Department of Revenue must send a notice to the taxpayer to inform him or her about MO HealthNet for Kids program. SECTION 1

This provision is contained in HCS/SS/SCS/SB 306 (2009).

This act contains an emergency clause for the provisions regarding group policies to comply with federal COBRA law.

ADRIANE CROUSE