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Legislation Signed into Law

2019

Primary Focus:  Mandated Benefit: MAT
Title/ Description:  MAT coverage and provider prescribing abilities
Citation: New section
Summary: The law requires every insurance company and health service corporation to offer, in all insurance policies, coverage for MAT. The law allows qualifying assistant physicians, advanced nurse practitioners, and physician assistants, under supervision, to prescribe buprenorphine for up to a thirty-day supply without refills for MAT patients.
Effective Date: N/A
Notes: Enacted through SB 951; SB 718  

2018

Primary Focus: Mandated Benefit: Provider
Title/Description: Mental health coverage, requirements — definitions — exclusions
Citation: § 376.1550 R.S.Mo.
Summary: Notwithstanding any other provision of law to the contrary, each health carrier that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2005, are to provide coverage for mental health conditions as defined. Specifically, mental health condition means any condition or disorder defined by categories listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
Effective Date: July 6, 2018
Notes: Enacted through SB 718 (99th General Assembly Second Regular Session)

2016

Primary Focus: Access to services/Eligibility
Title/Description: Medical services for which payment will be made — co-payments may be required — reimbursement for services
Citation: § 208.152 R.S.Mo
Summary: MO HealthNet payments will be made for mental health services. The state plan for providing medical assistance under the law is to include the following mental health services when such services are provided by community mental health facilities operated by the department of mental health or designated by the department of mental health as a community mental health facility or as an alcohol and drug abuse facility or as a child-serving agency within the comprehensive children’s mental health service system: outpatient mental health services, clinical mental health services, and rehabilitative mental health services. Beginning July 1, 2016, providers of behavioral, social, and psychophysiological services for the prevention, treatment, or management of physical health problems shall be reimbursed utilizing the behavior assessment and intervention reimbursement codes 96150 to 96154 or their successor codes under the Current Procedural Terminology (CPT) coding system. Providers eligible for such reimbursement shall include psychologists.
Effective Date: October 14, 2016
Notes: Enacted through SB 608 (2016 Regular Session)

2015

Primary Focus: Mandated Benefit: Eating Disorders
Title/Description: Insurance coverage for diagnosis and treatment
Citation: § 376.845 R.S.Mo
Summary: All health benefit plans that are delivered, issued for delivery, continued or renewed on or after January 1, 2017, if written inside the state of Missouri, or written outside the state of Missouri but covering Missouri residents, are to provide coverage for the diagnosis and treatment of eating disorders.
Effective Date: August 28, 2015
Notes: Enacted through SB 145 (2015 Regular Session)

2013

SB 262
Introduced: 2/2013
Sponsor: Sen. Pearce
Status: Signed into law 7/2013
Summary: This bill required the oversight division of the joint committee on legislative research to conduct a study to determine the financial impact of required insurance coverage for eating disorders (it also required the committee to study the financial impact of required coverage of an anti-cancer medication). The study was to assume the following:

  • Plans would be required to cover residential treatment
  • Plans would be required to cover nutrition counseling, physical therapy, dietician services, medical monitoring, and psychiatric monitoring
  • Plans would be required to use similar deductibles and copayments for eating disorder services as are in place for other medical services

This results of this study may have assisted in the passage of SB 145 from the 2015 legislative session, which required insurance plans to cover eating disorder treatment. This section of this bill is very similar to a section of SB 161, which passed in the same legislative session.

SB 161
Introduced: 1/2013
Sponsor: Sen. Pearce
Status: Signed into law 7/2013
Summary: This bill required the oversight division of the joint committee on legislative research to conduct a study to determine the financial impact of required insurance coverage for eating disorders (it also required the committee to study the financial impact of required coverage of an anti-cancer medication). The study was to assume the following:

  • Plans would be required to cover residential treatment
  • Plans would be required to cover nutrition counseling, physical therapy, dietician services, medical monitoring, and psychiatric monitoring
  • Plans would be required to use similar deductibles and copayments for eating disorder services as are in place for other medical services. This section of this bill is very similar to a section of SB 262, which passed in the same legislative session.

This results of this study may have assisted in the passage of SB 145 from the 2015 legislative session, which required insurance plans to cover eating disorder treatment.

2010

HB 1311 & (HB 1341)
Introduced: 12/2009 (prefiled)
Sponsor: Rep. Scharnhorst and Rep. Grill
Status: Signed into law 6/2010
Summary: This bill changed the section of the state insurance law about autism coverage to what it is currently. This section of the law is summarized near the bottom of this page. HB 1341 was initially a separate bill. The part of the bill about insurance coverage is a compromise between the original versions of HB 1311 and HB 1341. This section of the law was also a part of an early version of SB 583 but was removed before the bill was signed into law. This bill also changed the section of the state Occupations and Professionals law to create the Applied Behavior Analyst Advisory Board in addition to creating licensure standards for practitioners of applied behavior analysis.

2009

Primary Focus: Mandated Benefit: Provider
Title/Description: Coverage required for chemical dependency by all insurance and health service corporations—minimum standards—offer of coverage may be accepted or rejected by policyholders, companies may offer as standard coverage—mental health benefits provided, when—exclusions
Citation: § 376.811 R.S.Mo
Summary: Every insurance company and health services corporation doing business in the state is to offer in all health insurance policies benefits or coverage for chemical dependency meeting certain minimum standards. Further, every insurance company, health services corporation and health maintenance organization doing business in the is to offer in all health insurance policies, benefits or coverages for recognized mental illness, excluding chemical dependency, meeting certain minimum standards.
Effective Date: August 28, 2009
Notes: Enacted through HB 326 (2009 Regular Session)

Missouri Parity Law

There are multiple sections of Missouri’s insurance law that are relevant to parity:

Each section will be described separately with explanations of its relationship with other sections, when necessary.

Section 376.1550

This section requires all small employer fully-insured plans, large employer fully-insured plans and state employee plans to cover all mental health conditions in the DSM; it specifically exempts coverage for substance use disorders instead stating that plans have to comply with 376.811. It forbids plans from having any lifetime limits, annual limits, copayments, coinsurance, outpatient visit limits for mental health services that are more expensive or restrictive than those in place for other medical services. It requires plans to have one deductible or out-of-pocket limit for both mental health services and other medical services. It does not address inpatient day limits.
This section allows plans to use managed care for mental health coverage even if they do not use managed care for other medical coverage. It also allows plans to use a more involved form of managed care for mental health coverage than what they use for other medical coverage. However, it does state that administrative and clinical procedures should “not serve to reduce access to medically necessary treatment”. This could be interpreted as addressing non-quantitative treatment limitations such as medical necessity review, prior authorization, and step therapy.
This section also allows employers to apply for a waiver exempting them from this section of the law if they can show that their plan’s compliance with this section caused premiums to increase by at least 2%.

Section 376.811

This section requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to offer optional behavioral health coverage that individuals and employers can accept or reject.
Because section 376.1550 requires small employer fully-insured plans and large employer fully-insured plans to cover mental health services, the parts of this section about mental health coverage only apply to individual plans, with some possible exceptions (explained below).
The offered coverage for substance use disorder services must meet the following requirements:

  • 26 visits of outpatient care and partial hospitalization
  • 21 days of residential treatment
  • 6 days of detoxification
  • A lifetime limit of 10 episodes of treatment, with episode defined as “a distinct course of chemical dependency treatment separated by at least thirty days without treatment”
  • Financial requirements that are equal to those used for other medical services

The offered coverage for mental health services must meet the following requirements:

It is possible that the last two parts about residential treatment are relevant for small employer fully-insured plans and large employer fully-insured plans because section 376.1550 does not list any requirements about residential treatment or inpatient care.
This section of the law also has an outdated subsection that requires plans to comply with sections of the law that expired in 2011 if an individual or employer rejects the behavioral health coverage offer.

Section 376.779

This section only applies to individual plans and requires them to cover at least 30 days of inpatient or residential treatment for alcoholism. Plans are not allowed to deny coverage for any services at a facility certified by the state’s Department of Mental Health. This section is superseded by section 376.811 if an individual accepts the offer of behavioral health coverage as part of his plan, as described in section 376.811.

Section 376.1224

This section requires autism coverage for small employer fully-insured plans, large employer fully-insured plans, self-insured governmental plans, self-insured school district plans, and several other forms of self-insured plans that are not under ERISA. Some of the most significant requirements of this section are:

  • Coverage for Autistic Disorder, Asperger’s Disorder; Pervasive Developmental Disorder not Otherwise Specified, Rett’s Disorder, and Childhood Disintegrative Disorder
  • $40,000 annual maximum for applied behavior analysis for children through age 18; other treatments are not subject to this annual maximum or age limitation (dollar amount is adjusted for inflation each year)
  • No outpatient visit limits
  • Coverage of psychiatric care, psychological care, habilitative or rehabilitative care, therapeutic care, and pharmacy care (all of these are defined in the section)
  • Insurance plans can only review a treatment plan once every six months
  • Financial requirements must be the same as what are in place for other medical services

Individual plans are not required to cover autism services, but they must offer it as optional coverage.
All plans are exempt from covering any services that are classified as a Part C early intervention program.
Small employers can apply for an exemption if they can show their premium costs increased by at least 2.5% in any 12-month period.
The section does not apply to Missouri HealthNet plans (Medicaid).

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