HCS SB 1103 -- HEALTH INSURANCE COVERAGE

SPONSOR:  Goodman (Wasson)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Insurance
Policy by a vote of 13 to 2.

This substitute prohibits licensed health care professionals from
charging, billing, or soliciting payment for anatomic pathology
services unless the services are rendered personally by the
health care professional or under his or her direct supervision.
Any patient, insurer, third-party payor, hospital, public health
clinic, or nonprofit health clinic will not be required to
reimburse any licensed health care professional for charges or
claims submitted in violation of this provision.  Nothing will
prohibit the billing of a referring laboratory for services when
samples must be sent to another specialist.

State licensing boards which have jurisdiction over health care
professionals who request or provide services may revoke,
suspend, or deny a license to anyone who violates these
provisions.

The substitute changes the documentation a health insurer must
provide when it issues evidence of insurance coverage.  The
documentation must contain a summary of deductibles, co-payments,
co-insurance, and other cost-sharing features of the policy.
Contracts entered into prior to August 28, 2006, between health
maintenance organizations and providers may be renegotiated after
the date if the coverage has an enrollee deductible or
co-insurance obligation higher than what was authorized by law
prior to that date.

FISCAL NOTE:  Estimated Effect on General Revenue Fund of an
Income of Unknown to a Cost of Unknown in FY 2007, FY 2008, and
FY 2009.  Estimated Income on Other State Funds of $0 to $5,000
in FY 2007, $0 in FY 2008, and $0 in FY 2009.

PROPONENTS:  Supporters say that the bill will allow health
maintenance organizations to offer a high-deductible policy at
much more affordable rates and allow companies to offer more
products to consumers.

Testifying for the bill were Senator Goodman; Blue Cross Blue
Shield of Missouri; Missouri State Medical Association; America's
Health Insurance Plans; Aetna, Incorporated; Cigna Healthcare;
Missouri Insurance Coalition; and Coventry Health Care.

OPPONENTS:  Those who oppose the bill say that companies are
already allowed to sell high-deductible plans.  The bill needs to
allow companies to opt out of their current plan if it changes
after the effective date of the bill.

Testifying against the bill were Missouri Hospital Association;
United Healthcare; St. Luke's Health System; Missouri State
Chiropractors Association; Carondelet Health Network; and BJC
HealthCare.

OTHERS:  Others testifying on the bill say that there needs to be
an option to terminate the contract if either party does not
agree with the changes to the contract.  There needs to be a
level playing field on premium taxes for all insurers.

Others testifying on the bill were Department of Insurance; and
Wellpoint, Incorporated.

Marc Webb, Legislative Analyst

Missouri House of Representatives
93rd General Assembly, 2nd Regular Session
Last Updated November 29, 2006 at 9:47 am