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.
SB 413 (see companion bill HB 1165) – 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 …
SB 414 – Missouri
Introduced: 2019 Status: Inactive / Dead
This act creates the “Missouri Health Insurance Innovation Task Force” with the purpose of soliciting concepts and making recommendations for a section 1332 innovation waiver application under the Affordable Care Act. The task force shall …
SB 432 (see companion bill HB 1132) – Missouri
Introduced: 2019 Status: Inactive / Dead
This act changes the Ticket to Work Health Assurance Program in the following ways: (1) excludes retirement accounts from asset limit calculations; (2) modifies the income calculation from a net/gross calculation to a broader definition …
SB 48 – Missouri
Introduced: 2019 Status: Inactive / Dead
Modifies provisions relating to short-term major medical policies. 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, consultation, …
SB 48 – Missouri
Introduced: 2019 Status: Inactive / Dead
This act specifies that all short-term major medical policies sold in the state shall include on applications and fact pages a conspicuous and clearly labeled paragraph stating that the policy may not cover preexisting conditions …
Mo. Code Regs. Ann. tit. 15, §§ 60-8.010 through 60-8.030: Unfair Practices – Missouri
Introduced: Status: Enacted
Regulations ban unfair practices and price gouging in Missouri.
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Mo. Rev. Stat. § 103.003. Definitions: Health Plan for State Employees – Missouri
Introduced: Status: Enacted
Definitions related to health plans for state employees in Missouri.
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Mo. Rev. Stat. § 103.080. Definitions–high deductible health plan, premiums–promotion of consumer-driven health care plans: Health Plan for State Employees – Missouri
Introduced: Status: Enacted
Definitions related to high deductible plans and health savings accounts in MO.
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Mo. Rev. Stat. § 189.075. Payments on actual cost and fair and reasonable cost basis: Aid to Local Governmental Health Facilities – Missouri
Introduced: Status: Enacted
Funds appropriated under sections 189.010 to 189.085 shall be paid only to providers meeting standards promulgated under sections 189.010 to 189.085. Reimbursement for facilities and equipment approved by the department shall be on the basis …
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Mo. Rev. Stat. § 190.060. Powers of district: Comprehensive Emergency Medical Services Systems – Missouri
Introduced: Status: Enacted
An ambulance district shall have the following governmental powers, and all other powers incidental, necessary, convenient or desireable to carry out and effectuate the express powers: to fix, charge and collect reasonable fees and compensation …
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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