SB 370 – Missouri

Status: Inactive / Dead
Year Introduced: 2019
Link: https://www.senate.mo.gov/19info/BTS_Web/Bill.aspx?SessionType=R&BillID=3511516

Under this act, any contract between the state and a vendor of prepaid capitated health services issued, reauthorized, or renewed after August 28, 2019, shall incorporate the standards specified in this act, including: (1) utilization review protocols, standards for determining medical necessity for services, and payment authorizations; (2) timely appeals of utilization reviews and payment authorizations; (3) network adequacy standards; (4) standardized administrative requirements; (5) alternative or supplemental payments made to hospitals if Medicaid upper limit payments are prevented by federal statutory or regulatory requirements; (6) actuarially-sound capitation rates; (7) financial penalties for failure to reduce non-emergency use of hospital emergency departments; (8) maintenance of a medical loss ratio of at least 90%; (9) the provision of monitoring data; (10) shared savings and risk-and-gain-sharing arrangements between vendors and health care providers; (11) prohibitions on compelling or coercing health care providers to participate in a health care system; and (12) timely payment of providers.


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