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SB 507 - 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. At a minimum, 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 current and new formulations and medications approved by the FDA for the treatment of substance use disorders. 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 offered to consumers in the state. Any treatment program shall use American Society of Addiction Medicine (ASAM) criteria for patient placement and review of treatment and disclose the MAT services it provides. MO HealthNet shall cover the MAT medications and services provided for in this section. The Department of Corrections, including drug courts and other diversion programs, shall ensure that all persons under their care are assessed for substance use disorders and make available MAT services. All health insurance companies shall disclose online and in any print provider directories identifying which providers in its network provide MAT services and what level of care is provided. Each health insurance plan shall have a process to ensure that an enrollee obtains a covered benefit for MAT services at an in-network level of coverage. The Department of Insurance, within the Department of Insurance, Financial Institutions and Professional Registration (DIFP), shall require that provider networks meet time and distance standards and minimum wait time standards for providers of MAT services. When a health insurance plan is deemed inadequate under the requirements of the bill, the health insurer shall treat the health care services an enrollee receives from an out-of-network provider as if the services were provided by an in-network provider. A health insurer shall provide a determination to an enrollee for covered benefits for MAT services and for urgent care services for MAT from an out-of-network provider within 24 hours. All health coverage payers shall submit an annual report to the DIFP. The DIFP shall also develop a mechanism on its website to explain the requirements of this bill and have a feedback process. Any entity that holds itself out as a treatment program or that applies for licensure by the state to provide clinical treatment services for substance use disorders shall be required to: use American Society of Addiction Medicine (ASAM) or other nationally recognized criteria for patient placement and review of need for treatment, meet or exceed the applicable standards for the levels of care being provided by the program, disclose the MAT services it provides, and disclose which of its levels of care have been certified by an independent and neutral organization that has competencies in the use of the applicable placement guidelines and level of care standards. Finally, specified health benefit plan shall provide coverage for mental health in compliance with federal mental health parity law. By September 1, 2020, the DIFP shall issue a report to the General Assembly as specified in the act. Coverage for treatment of a mental condition shall not be denied for care for confinement provided in certain hospitals owned or operated by the state. SARAH HASKINS
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