Overview
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).
State Action
Latest Legislative Session: 1/6/2021 - 5/30/2021 (2021 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1020 – Missouri
Introduced: 2019 Status: Inactive / Dead
Changes provisions relating to short term limited duration insurance. Provides that cost-sharing must be the same for services provided through telehealth as if the same services were provided in-person. Insurers shall reimburse providers for diagnosis, …
HB 1030 – Missouri
Introduced: 2019 Status: Inactive / Dead
This bill creates the “Missouri Health Insurance Innovation Task Force.” The purpose of the task force is to solicit concepts on potential forms of innovation in the health insurance marketplace which may qualify the state …
HB 1110 – Missouri
Introduced: 2021 Status: Inactive / Dead
Creates provisions relating to telemedicine benefits offered by employers. The bill provides that telemedicine benefits offered by employers are not insurance and shall not be treated as insurance or an insurance product in this state.
HB 1146 – Missouri
Introduced: 2021 Status: Inactive / Dead
Creates provisions relating to payments for prescription drugs. Beginning March 1, 2023, and annually thereafter, a pharmacy benefits manager (PBM) utilized by the Missouri Consolidated Health Care Plan (the Plan) shall file a report with …
HB 1165 (see companion bill SB 413) – Missouri
Introduced: 2019 Status: Inactive / Dead
This bill requires pharmacy benefits managers (PBMs) to notify health carriers and pharmacies of any potential conflict of interest, including but not limited to common ownership or any other relationship between the PBM and any …
Mo. Rev. Stat. § 376.433. Self-insurance plans for health care, public entities–subject to Medicaid rights, obligations, and remedies: Life, Health and Accident Insurance – Missouri
Introduced: Status: Enacted
Any public entity which provides, furnishes, or pays for hospital, medical, surgical, or other health care services under a plan of self-insurance to an employee or to any other person covered under the public entity’s …
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Mo. Rev. Stat. § 376.446. Enrollee cost-sharing responsibilities, health carriers to provide timely information–exceptions: Life, Health and Accident Insurance – Missouri
Introduced: Status: Enacted
Health carriers shall permit individuals to learn the amount of cost-sharing, including deductibles, copayments, and coinsurance, under the individual’s health benefit plan or coverage that the individual would be responsible for paying with respect to …
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Mo. Rev. Stat. § 376.465. Missouri health insurance rate transparency act–intent, definitions–filing of rates–rates for grandfathered plans–public availability–determination of unreasonability, notice–publishing of final rates–rulemaking authority–applicability of section: Missouri Health Insurance Rate Transparency Act – Missouri
Introduced: Status: Enacted
It is the intent of the Missouri general assembly that the review of health insurance rates as specified in this section is consistent with the general powers of the department as outlined under section 374.010.
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Mo. Rev. Stat. § 376.685. Agreement between health carrier and optometrist–fees not to be set by health carrier, exception–reimbursement requirements–vision car insurance plan, prohibited limits–definitions: Life, Health and Accident Insurance – Missouri
Introduced: Status: Enacted
No agreement between a health carrier or other insurer that writes vision insurance and an optometrist for the provision of vision services on a preferred or in-network basis to plan members or insurance subscribers in …
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Mo. Rev. Stat. § 376.690. Unanticipated out-of-network care, claim procedure–definitions–limitation on amount billed to patient–external arbitration process–rulemaking authority: Missouri Health Insurance Rate Transparency Act – Missouri
Introduced: Status: Enacted
Health care professionals shall send any claim for charges incurred for unanticipated out-of-network care to the patient’s health carrier within one hundred eighty days of the delivery of the unanticipated out-of-network care. No health care …
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Precision Rx Compounding, LLC et al. v. Express Scripts Holding Company et al. – Missouri
District Court: E.D. Missouri Status: Pending
In January 2016, several independent compounding pharmacies sued pharmacy benefit manager Express Scripts, accusing it and CVS Health Corp., OptumRx Inc. and Prime Therapeutics LLC …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
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.
KEY RESOURCES