SB 699 - This act creates additional protections for health care consumers. Currently, Section 354.443, RSMo, requires all health maintenance organizations (HMO) to disclose all financial arrangements to the Department of Insurance. This act prohibits HMOs that operate financial incentive plans from entering into agreements with providers or pharmaceutical manufacturers that would cause them to limit or reduce services or treatment to a patient.

This act also requires certain insurance companies to cover the cost of a patient's participation in a clinical trial if it involves treatment, prevention, or early detection of a life- threatening condition, including cancer. This requirement applies if studies are conducted in federally-approved Phase I through Phase IV clinical trials, if the trials are conducted by capable personnel, and if there is no superior noninvestigational treatment alternative.

Currently, Section 354.618, RSMo, allows female enrollees of health plans to seek health care services from an obstetrician/ gynecologist (OB/GYN) once a year without a referral from her primary care provider. This act allows a female enrollee to designate an OB/GYN as her primary care provider, if such status is accepted by the OB/GYN. Female enrollees who do not choose OB/ GYNs as their primary care providers will not be required to obtain referrals before seeking their services.

Finally, this act provides that an HMO has the duty to exercise ordinary care when making health care treatment decisions and will be liable for failure to carry out this duty. An HMO is also liable for harm caused by treatment decisions made by its employees, agents, or representatives. A defense exists if the HMO did not control or influence the treatment decision or if payment was not delayed for the treatment. This act does not create an obligation for the HMO to provide services which are not covered by the plan.
ERIN MOTLEY