FIRSTREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNOS.1126&932
103RDGENERALASSEMBLY
2118H.02C JOSEPHENGLER,ChiefClerk
ANACT
Toamendchapter376,RSMo,byaddingtheretoonenewsectionrelatingtoinsurance
coverageofanesthesiaservices,withanemergencyclause.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Chapter376,RSMo,isamendedbyaddingtheretoonenewsection,tobe
2knownassection376.1245,toreadasfollows:
376.1245.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Anesthesiatime",theperiodduringwhichananesthesiapractitioneris
3presentwiththepatient,startingwhentheanesthesiapractitionerbeginstopreparethe
4patientforanesthesiaservicesintheoperatingroomoranequivalentareaandending
5whentheanesthesiapractitionerisnolongerfurnishinganesthesiaservicestothe
6patientbecausethepatientmaybeplacedsafelyunderpostoperativeorpostanesthesia
7care.Theterm"anesthesiatime"includes,ifcountedbytheanesthesiapractitioner,
8blocksoftimearoundaninterruptioninanesthesiatimeprovidedtheanesthesia
9practitionerisfurnishingcontinuousanesthesiacarewithinthetimeperiodsaroundthe
10interruption;
11 (2)"Anesthesiatimeunits",timeunitsrecognizedwithappropriatetime
12intervalsthatdonotexceedfifteenminutesinlengthforeachintervalandthat,taken
13together,representthetotalanesthesiatimeforaparticularanesthesiaservice;
14 (3)"Exceptedbenefitplan",thesamemeaninggiventotheterminsection
15376.998;
16 (4)"Healthbenefitplan",thesamemeaninggiventotheterminsection
17376.1350.Theterm"healthbenefitplan"shallalsoincludeMOHealthNet,the
18children'shealthinsuranceprogramauthorizedunderchapter208,theMissouri
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 19consolidatedhealthcareplanestablishedunderchapter103,andanyotherstate-
20sponsoredhealthinsuranceprogram;
21 (5)"Healthcarrier",thesamemeaninggiventotheterminsection376.1350.
22Theterm"healthcarrier"shallalsoincludetheMOHealthNetdivisionandany
23Medicaidmanagedcareorganizationasdefinedinsection208.431;
24 (6)"Paymentofanesthesiaservices",anamountpaidforanesthesiaservices:
25 (a)Determinedbyusingprevailingmedicalcodingandbillingstandardsinthe
26professionalmedicalbillingcommunity,suchastheCurrentProceduralTerminology
27codebookpublishedbytheAmericanMedicalAssociation,theMedicareClaims
28ProcessingManual,orguidancepublishedbytheAmericanSocietyof
29Anesthesiologists;and
30 (b)Calculatedastheproductobtainedbymultiplyingthefollowingtogether:
31 a.Thesumofthebaseunitsfortheappropriatemedicalcodeplusanesthesia
32timeunits;and
33 b.Ananesthesiaconversionfactorthatisdefinedintheindividualcontract
34betweenthehealthcarrierorhealthbenefitplanandtheanesthesiapractitioneror
35group.
36 2.Nohealthcarrierorhealthbenefitplanshallestablish,implement,orenforce
37anypolicy,practice,orprocedurethatimposesatimelimitforthepaymentof
38anesthesiaservicesprovidedduringamedicalorsurgicalprocedure.
39 3.Nohealthcarrierorhealthbenefitplanshallestablish,implement,orenforce
40anypolicy,practice,orprocedurethatrestrictsorexcludesallanesthesiatimein
41calculatingthepaymentofanesthesiaservices.
42 4.Exceptedbenefitplansshallbesubjecttotherequirementsofthissection.
SectionB.Becauseimmediateactionisnecessarytoprotecttheabilityofhealthcare
2providerstodelivermedicallynecessaryhealthcareservicestoMissourians,sectionAofthis
3actisdeemednecessaryfortheimmediatepreservationofthepublichealth,welfare,peace,
4andsafety,andisherebydeclaredtobeanemergencyactwithinthemeaningofthe
5constitution,andsectionAofthisactshallbeinfullforceandeffectuponitspassageand
6approval.
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HCSHBs1126&932 2