HCS HB 1495 -- HEALTH INSURANCE AND POLICIES OF THE DEPARTMENT OF
SOCIAL SERVICES

SPONSOR:  Schaaf

COMMITTEE ACTION:  Voted "do pass" by the Committee on Healthcare
Transformation by a vote of 9 to 2.

This substitute changes the laws regarding the policies of the
Department of Social Services, co-payments for prescription
drugs, and standardized insurance application forms.

POLICIES OF THE DEPARTMENT OF SOCIAL SERVICES (Section 208.024,
RSMo)

The Department of Social Services will be required to develop,
implement, enforce, and distribute to its staff a policy by
September 30, 2010, which subjects any department employee to
immediate termination if he or she fails to report the suspected
illegal drug use or the suspected fraudulent reporting of total
household size or income by a recipient or potential recipient of
benefits under any public assistance program administered by the
department including the Temporary Assistance for Needy Families
(TANF) Program.

Supervisory department employees with hiring authority cannot use
or threaten to use his or her authority to knowingly discriminate
against, dismiss, penalize, or in any way retaliate against or
harass an employee because he or she in good faith reported or
disclosed this information and cannot in any way attempt to
dissuade, prevent, or interfere with an employee wishing to
report or disclose the information.

CO-PAYMENTS FOR PRESCRIPTION DRUGS (Sections 354.535 and 376.387)

When the usual and customary retail price of a prescription drug
is less than the co-payment applied by a health maintenance
organization or health insurer, the enrollee will only be
required to pay the usual and customary retail price of the
prescription drug and there will be no further charge to the
enrollee or plan sponsor for the prescription.  If the price is
more than the co-payment, the enrollee will only be required to
pay the usual and customary retail price of the prescription drug
and there will be no further charge to the enrollee or plan
sponsor for the prescription.

STANDARDIZED INSURANCE APPLICATION FORMS (Section 374.184)

The substitute requires the Director of the Department of
Insurance, Financial Institutions and Professional Registration,
after consultation with specified health insurers and health
maintenance organizations and a public hearing, to establish by
rule uniform insurance application forms to be used by all
insurers for group health insurance policies, except for certain
group health plans for small employers.

FISCAL NOTE:  No impact on state funds in FY 2011, FY 2012, and
FY 2013.

PROPONENTS:  Supporters say that in an effort to control health
care costs, specifically prescription drug costs, we need
legislation which specifies that if the actual cost of a
prescription is less than an individual's health insurance
co-pay, the individual should only be charged the actual cost.
Uniform insurance application forms help control costs and
increase efficiency.  Most-favored nations clauses are a way for
insurance companies to make more money by locking out lower cost
insurers and to ensure that there is no single set price.  The
bill prohibits these contract clauses and allows physicians to
set different prices for services with different contracts.  Any
willing provider laws are good for competition and give more
consideration to the doctor-patient relationship than to health
insurance contracts made between hospitals and health insurance
carriers.  Requiring a patient to be tied to a specific provider
market instead of to the care increases health care and
administrative costs and is a burden to the care of the patient.
These laws also open up free market and competition and create
transparency by changing the policies that govern health care
insurance contracting.

Testifying for the bill were Representative Schaaf; Marsha
Taylor; Missouri Association of Osteopathic Physicians and
Surgeons; Missouri Optometric Association; Missouri State Medical
Association; and Missouri Academy of Family Physicians.

OPPONENTS:  Those who oppose the bill say that the any willing
provider provisions will increase health care costs because not
having a fixed set of providers will increase costs and decrease
the quality of care.  Employer-based health care is driven by the
employer's need to find the cheapest insurance plan.  Limiting an
employer's ability to negotiate health care insurance rates is
not good policy.

Testifying against the bill were Anthem Blue Cross and Blue
Shield; Blue Cross Blue Shield of Kansas City; Missouri Insurance
Coalition; United Healthcare Services, Incorporated; Missouri
Hospital Association; Associated Industries of Missouri; and
Express Scripts.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:11 pm