- House Substitute -

HS/HCS/SCS/SBs 1061 & 1062 - This act makes changes in the law relating to Health Services Corporations.

DEEMED APPROVAL - This act holds that whenever a health service corporation submits a policy form to the Director of Insurance, and the Director does not disapprove the form within 45 days (up from 30 days), the form is deemed approved and is not subject to disapproval for 12 months. If during the 12-month period the Director determines that any provision of the policy is contrary to statute, the Director shall notify the health service corporation of the specific provision that is contrary to statute and may request that it file an amendment within 30 days to modify the provision so that it conforms with the statute. Upon approval of the amendment by the Director, the health services corporation shall issue a copy of the amendment to each individual or entity in which the deemed policy form was previously issued. The health services corporation may issue the conforming amendment to the group contract holder so that it can distribute the amendment to its members or by including a copy of the amendment in the health services corporation's next scheduled mailing to its members. Such amendment have the force and effect as if the amendment was in the original filing or policy (Sections 354.085 and 354.405).

A similar procedure shall also be followed when an HMO files certain documents (pertaining to its certificate of authority with the Department of Insurance) (Section 354.405).

NETWORK ADEQUACY - This act deems a managed care plan's network as adequate if the managed care plan is:

(1) A Medicare + Choice coordinated care plan offered by the health carrier pursuant to a contract with the federal centers for medicare and medicaid services;

(2) A managed care plan that has been accredited by National Committee for Quality Assurance (NCQA), and such accreditation is in effect at the time the access plan is filed; or

(3) The managed care plan's network has been accredited by the Joint Commission on the Accreditation of Health Organizations at a level of accreditation without type I recommendations or better. If the accreditation applies only to a portion of the managed care plan's network, only the accredited portion will be deemed adequate (Section 354.603). This provision is similar to one contained in SS/SCS/HB 1446, but not identical.

INTERNET FORMS - This act allows any managed care entity to provide documents and materials to an enrollee via the entity's Internet site, instead of in printed form, upon securing a waiver from the enrollee. The enrollee may revoke the waiver at any time. This portion of the act is identical to SB 1004 (2002) (Section 354.1450).

MENTAL HEALTH PARITY - This act requires health carriers that offer health benefit plans, excluding individual health insurance policies which must include a mandatory offer of mental health benefits, in this state on or after January 1, 2003, to provide coverage for mental health conditions. Mental health conditions are defined as conditions or disorders, excluding chemical dependence, defined by categories listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. Coverage for mental health conditions cannot have rates, terms, or conditions that place a greater financial burden on an insured for mental health condition than for physical health condition. This mandated benefit shall not apply to supplemental insurance policies, life care contracts, accident-only policies, specified disease policies or other specific policies. The act also repeals various provisions of law related to mental health coverage. For example, the provision which places annual and lifetime limits on alcohol and drug abuse treatment services (Section 376.827) is repealed. (Sections 376.810, 376,811, 376.825, 376.1550) These provisions are similar to those contained in HB 1440 (2002).

STEPHEN WITTE

HA 1 - MAKES A TECHNICAL CHANGE

HA 2 - THIS ACT REQUIRES HEALTH INSURANCE ENTITIES TO PROVIDE COVERAGE FOR CHILDREN'S HEARING AIDS. HEALTH INSURANCE ENTITIES MAY LIMIT THE COVERAGE TO $1,250 IN BENEFITS COVERAGE FOR EACH EAR WITH A HEARING LOSS. DEDUCTIBLES OR CO-PAYMENTS CANNOT EXCEED 20% OF THE ACTUAL COVERED SERVICE COSTS. THIS PROVISION IS SIMILAR TO ONE CONTAINED IN HB 1396 (2002) (Section 376.1221). SIMILAR TO AN AMENDMENT ON SS/SCS/HB 1446.

HA 3 - THIS ACT REQUIRES HEALTH CARRIERS TO PROVIDE A STATEMENT OF THE ANNUAL CLAIMS HISTORY OF A HEALTH CARRIER WHEN REQUESTED BY THE EMPLOYER. THE INFORMATION MUST BE PROVIDED WITHIN 30 DAYS OF THE REQUEST. THE INFORMATION MAY BE USED BY THE EMPLOYER FOR THE SOLE PURPOSE OF EVALUATING AND MARKETING THE GROUP INSURANCE PROGRAM (Section 376.1600).

HA 4 - INCLUDES CHIROPRACTIC CARE IN DEFINITION OF BASIC HEALTH CARE SERVICES IN SECTION 354.400

HA 5 - THIS ACT REQUIRES HEALTH INSURANCE PLANS TO PROVIDE COVERAGE FOR ROUTINE PATIENT CARE COSTS INCURRED AS A RESULT OF PARTICIPATING IN CLINICAL TRIALS (PHASES III and IV) FOR THE PREVENTION AND TREATMENT OF CANCER. THE CLINICAL TRIAL MUST BE APPROVED OR FUNDED BY ONE OF THE ENTITIES WHICH ARE SPECIFIED IN THE ACT. ENTITIES SEEKING COVERAGE OF A CLINICAL TRIAL APPROVED BY AN ACADEMIC INSTITUTIONAL REVIEW BOARD IN MISSOURI ARE REQUIRED TO MAINTAIN AND ELECTRONICALLY LIST CLINICAL TRIALS WHICH MEET THE REQUIREMENTS OF THE SUBSTITUTE. PROVIDERS PARTICIPATING IN CLINICAL TRIALS ARE REQUIRED TO OBTAIN A PATIENT'S INFORMED CONSENT WHICH IS CONSISTENT WITH CURRENT LEGAL AND ETHICAL STANDARDS. INFORMATION REQUIRED BY THIS PROVISION WILL BE AVAILABLE TO THE HEALTH INSURER UPON REQUEST. A POLICY, PLAN, OR CONTRACT PAID UNDER TITLE 18 or TITLE 19 OF THE FEDERAL SOCIAL SECURITY ACT IS EXEMPT FROM THE REQUIREMENTS OF THIS ACT. THIS PROVISION IS SIMILAR TO ONE CONTAINED IN SCS/SB 1063 & 827 AND HB 1695 (2002) (Section 376.429). THIS PROVISION IS ALSO CONTAINED IN SS/SCS/HB 1446.

HA 6 - ALLOWS FORMER MEMBERS OF THE GENERAL ASSEMBLY AND OTHER ELECTED OFFICIALS TO CONTINUE MCHCP INSURANCE BY PAYING THE SAME RATE AS CURRENT STATE OFFICIALS.

HA 7 - REQUIRES COVERAGE FOR LOW PROTEIN MODIFIED FOOD PRODUCTS INTENDED FOR THE TREATMENT OF INHERITED METABOLIC DISEASES - CONTAINED IN SS/SCS/HB 1446 and SCS/HB 1695.

HA 8 - MAKES A TECHNICAL CHANGE.

HA 9 - ADDS A SUBSECTION 4 TO SECTION 354.603 REGARDING DEEMED APPROVAL.

HA 10 - PROHIBITS THE DISCLOSURE OF NON-PUBLIC HEALTH INFORMATION. A NEW SECTION 191.890 IS CREATED TO DEFINE TERMS SUCH AS "FEDERAL PRIVACY RULES", "HEALTH INFORMATION", AND "NONPUBLIC PERSONAL HEALTH INFORMATION". THIS ACT PROHIBITS THE DISCLOSURE OF PERSONAL HEALTH INFORMATION FOR THE FOLLOWING PURPOSES: - FOR PROFIT; - FOR MARKETING OF GOODS OR SERVICES; - TO AID IN AN EMPLOYMENT DECISION; - FOR DECISIONS REGARDING A PERSONS' CREDIT; - TO DELIBERATELY OR MALICIOUSLY CAUSE HARM TO THE PERSON TO WHOM THE INFORMATION PERTAINS. ANY PERSON WHO KNOWINGLY VIOLATES THE PROVISIONS OF THIS SECTION WILL BE CHARGED AN ADMINISTRATIVE PENALTY OF UP TO $500 AND MAY BE CIVILLY LIABLE. THE DIRECTOR OF THE DEPARTMENT OF INSURANCE SHALL ENFORCE THIS ACT. LICENSEES (insurance companies) COMPLYING WITH HIPAA PRIVACY RULES WILL BE DEEMED IN COMPLIANCE WITH THIS ACT. UNTIL APRIL 14, 2003, NON-LICENSEES SUBJECT TO FEDERAL LAW WILL BE IN COMPLIANCE WITH THIS ACT UPON A SHOWING OF GOOD FAITH. PERSONAL HEALTH INFORMATION, HOWEVER, MAY NOT BE DISCLOSED FOR MARKETING PURPOSES EVEN IF COMPLIANCE IS ESTABLISHED. LICENSEES COMPLYING WITH THE MODEL REGULATION, "PRIVACY OF CONSUMER FINANCIAL AND HEALTH INFORMATION REGULATION", WILL ALSO BE DEEMED IN COMPLIANCE. THIS ACT DOES NOT APPLY TO INFORMATION DISCLOSED IN FOR THE FOLLOWING PURPOSES: - IF PRIOR WRITTEN CONSENT IS GIVEN; - IF DISCLOSURE IS PURSUANT TO STATE OR FEDERAL LAW; - FOR CONSUMER REPORTING PURPOSES; - IN CONNECTION WITH THE TRANSFER OF A BUSINESS, OPERATING UNIT, OR LOANS IF THE DISCLOSURE IS NOT THE PRIMARY REASON FOR THE TRANSFER. THIS ACT IS IDENTICAL TO HB 1425 and SB 1171 (2002).

HA 12 - THIS ACT REQUIRES HEALTH INSURANCE ENTITIES TO PROVIDE COVERAGE FOR AT LEAST FOUR MASTECTOMY BRASSIERES PER YEAR. THIS IS SIMILAR TO HB 1970 (2002) (Section 376.1209). ALSO IN SS/SCS/HB 1446.

HA 13 - THIS ACT REQUIRES HEALTH CARE ENTITIES TO PROVIDE COVERAGE FOR A SECOND MEDICAL OPINION BY AN APPROPRIATE SPECIALIST FOR PATIENTS WITH A NEWLY DIAGNOSED CANCER. EFFECTIVE JANUARY 1, 2003, THIS COVERAGE MUST BE PROVIDED EVEN IF THE APPROPRIATE SPECIALIST IS NOT IN THE PROVIDER'S NETWORK. THE COVERAGE REQUIRED BY THE SUBSTITUTE DOES NOT APPLY TO CERTAIN HEALTH INSURANCE POLICIES. THIS PROVISION IS SIMILAR TO ONE CONTAINED IN SB 1026 and HB 1695 (2002) (Section 376.1253). ALSO CONTAINED IN SS/SCS/HB 1446.