HB 2398 -- Insure Missouri Plan

Sponsor:  Schaaf

This bill changes the laws regarding health care services and
establishes the Insure Missouri Plan in the MO HealthNet Division
within the Department of Social Services.

MISSOURI HEALTH FACILITIES REVIEW COMMITTEE

Currently, the Missouri Health Facilities Review Committee for
the Certificate of Need Program is composed of two members of the
Senate, two members of the House of Representatives, and five
members appointed by the Governor.  The bill changes the
membership of the committee to:

(1)  One member who is professionally qualified in health
insurance plan sales and administration;

(2)  One member who has professionally qualified experience in
commercial development, financing, and lending;

(3)  Two members with a doctorate of philosophy in economics;

(4)  Two members who are professionally qualified as medical
doctors or doctors of osteopathy, but who are not employees of a
hospital or consultants to a hospital;

(5)  Two members who are professionally experienced in hospital
administration, but are not employed by a hospital or as
consultants to a hospital; and

(6)  One member who is a registered nurse, but who is not an
employee of a hospital or a consultant to a hospital.

All members will be appointed by the Governor with the advice and
consent of the Senate and serve a four-year term.  No more than
five members can be from the same political party.

For all hearings held by the committee, the bill:

(1)  Requires all testimony and other evidence taken during the
hearings to be under oath and subject to the penalty of perjury;

(2)  Specifies that the committee can, upon a majority vote of
the committee, subpoena witnesses and require the attendance of
witnesses, the giving of testimony, and the production of
records;

(3)  Prohibits all ex parte communications between members of the
committee and any interested party or witness regarding the
subject matter of the hearing at any time prior to, during, or
after the hearing;

(4)  Requires any party opposing the issuance of a certificate of
need to show by clear and convincing evidence that the need does
not exist or that the new facility will cause a substantial and
continuing loss of medical services within the affected region or
community;

(5)  Specifies that all committee hearings will be governed by
rules adopted by the committee but not be bound by the technical
rules of evidence; and

(6)  Authorizes the committee, upon a majority vote, to assess
the costs of court reporting transcription or the issuance of
subpoenas to one or both of the involved parties.

MO HEALTHNET OVERSIGHT COMMITTEE

The bill increases from 18 to 22 the number of members on the MO
HealthNet Oversight Committee by adding two representatives of
rural health clinics, one licensed podiatrist, and one licensed
nurse.

The oversight committee is required to approve health insurance
plans for the Insure Missouri Plan.

INSURE MISSOURI PLAN

The bill:

(1)  Requires the Department of Insurance, Financial
Institutions, and Professional Registration and the MO HealthNet
Division within the Department of Social to oversee the marketing
practices of the plan;

(2)  Requires the division to promote the plan, provide
information to eligible individuals, ensure that enrollment is
distributed throughout the state, and establish standards for
consumer protection;

(3)  Requires the plan to provide participants with a health care
home;

(4)  Specifies covered, medically necessary services;

(5)  Requires the plan to provide, at no cost to a participant,
$500 of qualifying preventative care services per year.  The plan
must consult with the federal Centers for Disease Control and
Prevention for a list of recommended preventative care services.
Any additional preventative care services covered under the plan
will be subject to the deductible and payment requirements of the
plan;

(6)  Specifies that at least 85% of the moneys appropriated by
the General Assembly for the plan must be used to pay for health
care services;

(7)  Specifies that the plan is not an entitlement program for
noncustodial parents, custodial parents, or other participants
with incomes over 85% of the federal poverty level.  The maximum
enrollment of plan participants is dependent on the moneys
appropriated by the General Assembly, and eligibility for the
plan can be phased in incrementally based on appropriations;

(8)  Lists eligibility requirements for plan participants and
requires them to be subject to approval by the United States
Department of Health and Human Services;

(9)  Establishes a health care account for an individual with an
income over 85% of the federal poverty level into which payments
for his or her participation can be made by the participant, an
employer, the state, or any philanthropic or charitable
contributor.  The account will be used to pay the individual's
deductible under the plan;

(10)  Specifies that an individual's participation in the plan
does not begin until the participant makes an initial payment of
at least one-twelfth of the annual required payment;

(11)  Specifies that a participant's annual required payment is
the lesser of $1,000 less any payments under the MO HealthNet
Program, the Children's Health Insurance Program, and the federal
Medicare Program or a certain percentage of his or her household
income as determined by the department;

(12)  Requires the state to contribute the difference to the
participant's account if his or her annual required payment is
less than $1,000;

(13)  Specifies that a participant can be terminated from
participation in the plan if his or her required payment is not
made within 60 days after the required date.  Written notice must
be given before a participant can be terminated from the plan;

(14)  Specifies that approved participants are eligible for a
12-month plan period but must file a renewal application to
remain in the plan;

(15)  Requires any moneys remaining in the health care account to
be used to reduce the participant's payments for the subsequent
plan period if the individual renews his or her participation.
The division must refund any amount remaining in the health care
account to a participant who is no longer eligible, has not
renewed participation, or is terminated from the plan;

(16)  Prohibits the deductible for any qualified plan under the
Insure Missouri Plan from exceeding $2,500;

(17)  Specifies that a participant who is medically uninsurable
will receive health insurance coverage through the Missouri
Health Insurance Pool; and

(18)  Requires the division to apply to the United States
Department of Health and Human Services for a waiver to develop
and implement the plan and to submit the proposed waiver
application to the Joint Committee on MO HealthNet for its review
and recommendations prior to submitting the application for the
waiver.

STANDARDIZED INSURANCE APPLICATIONS

The Director of the Department of Insurance, Financial
Institutions, and Professional Registration must establish by
rule uniform insurance application forms to be used by all
insurers.

RECOMMENDATIONS FOR SWITCHING MEDICATIONS

The Department of Health and Senior Services is required to
establish rules governing switch communications from health
benefit plans and specifies that the term "switch communication"
is a communication that recommends a patient's medication be
switched to a different medication than originally prescribed by
the primary health care professional.

The department's rules must include:

(1)  Requirements for the review and approval of the switch
communication by the department;

(2)  Procedures for verifying the accuracy of the switch
communication;

(3)  A requirement that all switch communications contain a
statement that the message is a promotional announcement from the
participant's health care insurer; and

(4)  A requirement that if the switch communication contains
information regarding potential therapeutic substitution, the
communication must explain that medications in the same
therapeutic class have different risks and benefits and may work
differently on different patients.

All switch communications must clearly disclose any financial
interest that the health care insurer, pharmacy benefits manager,
prescriber, or their agent has in the patient's decision to
switch medications.  Any person who issues or delivers or causes
to be issued or delivered a switch communication that has not
been approved, provides a misrepresentation or false statement in
a switch communication, or commits any other material violation
of the provisions of the bill will be subject to a fine of up to
$25,000.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:12 pm