To amend chapter 376, RSMo, by adding one new section relating to health insurance for children.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI,

AS FOLLOWS:

Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.419, to read as follows:

376.419. 1. The department of health shall develop a program to assure basic health care to all children in this state eighteen years of age or younger. The program shall meet the requirements set out in this section. The director of the department shall define a minimum health benefit plan at least equal to the combination of benefits currently available to children on medicaid.

2. The director shall assign each child who is:

(1) not eligible for medicaid under section 208.151, RSMo;

(2) not insured for health care by any private or public plan; and

(3) living in a household with an income of less than two hundred fifty percent of the federal poverty level to a health maintenance organization, health services corporation or insurer, hereinafter referred to as health assurance entities, as insured clients thereof. The health assurance entity shall provide each child benefits at least equal to the minimum health benefit plan defined by the director. Children enrolled pursuant to this section shall be enrolled at a premium rate of not more than thirty percent of the average premium rate for insured children based on a sliding scale in relation to family income as established by regulation of the department of health. The department may provide for the waiver of premium payment when it is in the best interest of the child.

3. The director shall assign children to health assurance entities serving the community where the child resides. If a parent of the child is a client of a health assurance entity, then the director shall assign the child to the same entity as the parent.

4. The director shall establish an assignment process which fairly distributes the risk of coverage for uninsured children among all health assurance entities.

5. The director shall seek the assistance of all public, private and parochial schools and all licensed hospitals and health professionals in identifying and enrolling uninsured children.

6. The director in consultation with the director of the division of medical services of the department of social services shall develop and promote model cooperative arrangements between health assurance entities and schools participating in administrative case management or direct services under medicaid. The goal of such arrangements is to integrate efficient delivery of health care to children and to provide health access to all children without publicly identifying the source of payment whether it is medicaid, private plans or benefits under this section. The director of the division of medical services shall require health maintenance organizations which enroll medicaid eligible children to demonstrate support of school health initiative provisions found in sections 167.600 to 167.621, RSMo, in their service area.

7. In order to share the burden of assuring health care to all children between health providers as well as health assurance entities, the health assurance entity may discount payments to health providers for services in behalf of all clients by a percent set by regulation by the director. The discount rate shall be set at an amount estimated to produce fifty percent of the overall cost of providing benefits to uninsured children under this section less premiums received under subsection 2 of this section but in no event shall the discount rate exceed one percent of the payment to the provider.

8. A health assurance entity which fails to comply with the provisions of this section shall be suspended from doing business in this state by the director of the department of insurance.