Missouri has long recognized the benefits of telehealth in increasing access to healthcare. To encourage providers to adopt telehealth services, the state has passed parity laws requiring health plans to provide coverage and reimbursement for telehealth services at the same basis and rate as they would for in-person services. Access to telehealth services was further expanded for Medicaid enrollees in recent sessions where the Medicaid program would reimburse providers for telehealth services if the providers can ensure that the services meet the same standard of care as those provided in person.
Missouri state law provides protection against surprise medical bills by prohibiting balance billing for services provided by an out-of-network physician at an in-network emergency room. The law also outlines a specific process for arbitration between insurers and providers to settle costs owed in cases where emergency out-of-network bills arise. Although there is no consumer website available to facilitate price comparisons between providers and facilities, Missouri has collected inpatient and outpatient charge and utilization data since 1993. In another demonstrated effort to increase transparency, the state proposed the Missouri Right to Shop Act, which would allow patients to compare the prices of non-emergency procedures. Insurance companies would provide financial incentives to enrollees who “shop” for cheaper services.
To ensure market competition, Missouri’s merger review statute requires nonprofit entities to provide pre-transaction notice to the state’s attorney general. Additionally, as part of a system-wide cost containment strategy, legislators have sought to establish a state-based single payer healthcare system. The proposal outlined plans to establish the “Missouri Health Assurance Program,” a publicly financed, statewide program to provide comprehensive necessary health, mental health, and dental care services and preventive screenings for Missouri residents.
See below for an overview of existing Missouri state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
Latest Legislative Session: 1/6/2021 - 5/30/2021 (2021 term). *Current session bill updates are ongoing. Check back weekly for updates.
Missouri’s fiscal year begins on July 1 and ends on June 30 of the following year. The Missouri legislature enacts its annual state budget during the regular legislative session. View the state budget information and appropriation bill here.
REGULATION & ENFORCEMENT
- Consumers Council of Missouri v. Department of Health and Human Services: In August 2015, the U.S. District Court for the Eastern District of Missouri Oct. 1, 2014, the Consumer Council of Missouri filed a federal complaint against the HHS’s Centers for Medicare and Medicaid Services alleging that federal law (principally, the Freedom of Information Act) requires that the agency make rate information public so consumers have the chance to challenge the costs they pay for health insurance. In response to the complaint, in March 2015 HHS fully responded to Plaintiff’s FOIA request. The district court found that because HHS released the information to the Consumers Council, the case was rendered moot.