COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0990H.01I Bill No.:HB 618 Subject:Health Care; Insurance - Health; Health Care Professionals Type:Original Date:January 23, 2025Bill Summary:This proposal creates provisions relating to prior authorization of health care
services.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028General Revenue
Fund
($831,500 -
$1,335,500)
($819,000 -
$1,323,000)
($819,000 -
$1,323,000)
Total Estimated Net
Effect on General
Revenue
($831,500 -
$1,335,500)
($819,000 -
$1,323,000)
($819,000 -
$1,323,000)
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028
Other State Funds($195,000 - $315,000)($195,000 - $315,000)($195,000 - $315,000)
State Road Fund*(Unknown)(Unknown)(Unknown)Conservation
Commission Fund*$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
Total Estimated Net
Effect on Other State
Funds
(Unknown,
Could exceed
$195,000 - $315,000)
(Unknown,
Could exceed
$195,000 - $315,000)
(Unknown,
Could exceed
$195,000 - $315,000)
*Oversight assumes increase costs for plan administrators will likely pass on costs to the
MoDOT-MSHP, the Missouri Department of Conservation and locals’ medical plans.
Numbers within parentheses: () indicate costs or losses. L.R. No. 0990H.01I
Bill No. HB 618
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January 23, 2025
KC:LR:OD
ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Federal Funds($298,500 - $474,500)($286,000 - $462,000)($286,000 - $462,000)Total Estimated Net
Effect on All Federal
Funds
($298,500 - $474,500)($286,000 - $462,000)($286,000 - $462,000)
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on FTE 000
☒ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Local Government*$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
*Oversight assumes increase costs for plan administrators will likely pass on costs to the
MoDOT-MSHP, the Missouri Department of Conservation and locals’ medical plans. L.R. No. 0990H.01I
Bill No. HB 618
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January 23, 2025
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FISCAL ANALYSIS
ASSUMPTION
Sections 376.2100 - 376.2108 - Prior Authorization Exemption
Officials from the Missouri Consolidated Health Care Plan (MCHCP) assume this legislation
creates a prior authorization exemption, which would allow providers to skip prior authorization
requirements if they qualify by meeting a 90% approval threshold in the 6 months prior. Once
this exemption is applied, payment can only be withheld for limited reasons that does not include
the service being later found not medically necessary in whole or in part.
It is unknown how many providers serving MCHCP members would qualify for this exemption.
For this calculation, it is assumed that 15% of providers would qualify. It is also unknown how
many cases would be authorized under the exemption that would otherwise be deemed not
medically necessary in whole or in part. It is assumed a 5% utilization increase once Prior
Authorization controls are off. HB 618 would have an estimated impact of $1,300,000 to
$2,100,000 for MCHCP.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
cost estimated provided by MCHCP, broken out as follows:
General Revenue Fund - $819,000 - $1,323,000 (63%)
Federal Fund - $286,000 - $ 462,000 (22%)
Other Fund - $195,000 - $ 315,000 (15%)
Total - $1,300,000 - $2,100,000 (100%)
Officials from the Missouri Department of Transportation (MODOT) state this bill may
increase costs for plan administrators, which will likely pass on costs to the MoDOT-MSHP
medical plan. This would have an unknown negative impact to the State Road Fund.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
cost estimate as “Unknown” to the State Road Fund. Oversight assumes this cost could be
greater than $250,000.
Officials from the Department of Social Services (DSS) assume this legislation applies to
Chapter 376 and states that a Medicaid managed care organization, as defined in section
208.431, shall be considered a health carrier for purposes of sections 376.2100 to 376.2108.
Subsequently, this legislation would apply to MO HealthNet Managed Care and there could be a
fiscal impact. L.R. No. 0990H.01I
Bill No. HB 618
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January 23, 2025
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The Managed Care Health Plans (HP) have prior authorization processes in place, and this
legislation would result in providers not needing to obtain prior authorization for services unless
the HP determines that it has approved or would have approved less than 90% of prior
authorization requests submitted by that provider for health care services in the most recent
evaluation period. MHD estimates that there could be an impact on the administrative component
of the rate for the additional reporting, reviewing, and monitoring of the prior authorizations.
However, MHD does not have enough information at this time to ascertain whether there would
be an impact on the service portion of the capitated rate. This will require an actuarial analysis
estimated to cost $25,000 for this program change.
FY26 Total: $25,000 (GR: $12,500; Federal: $12,500)
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
fiscal impact as estimated by DSS.
Officials from the Missouri Department of Conservation (MDC) assume the proposal will
have no fiscal impact on their organization.
Officials from Kansas City assume this legislation will have a negative fiscal impact of an
indeterminate amount
Oversight notes that although the MDC state this legislation would have no fiscal impact on
their organization, Oversight assumes this legislation could affect other insurance plans such as
the Missouri Department of Conservation and local political subdivisions. Oversight will reflect
a $0 to Unknown cost to the Conservation Commission Fund (0609) and local political
subdivisions.
Officials from the Department of Commerce and Insurance assume the proposal will have no
fiscal impact on their organization. Oversight does not have any information to the contrary.
Therefore, Oversight will reflect a zero impact in the fiscal note for this agency.
Officials from the Department of Public Safety - Missouri Highway Patrol defer to the
Missouri Department of Transportation for the potential fiscal impact of this proposal.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other cities were requested to respond to this proposed legislation but did not. A listing
of political subdivisions included in the Missouri Legislative Information System database is
available upon request. L.R. No. 0990H.01I
Bill No. HB 618
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FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVENUE FUNDCost – MCHCP §§376.2100 - 376.2108
Prior Authorization Exemptions p.3
($819,000 -
$1,323,000)
($819,000 -
$1,323,000)
($819,000 -
$1,323,000)
Cost – DSS -§§376.2100 - 376.2108
Actuarial Analysis p. 4($12,500)$0$0
ESTIMATED NET EFFECT TO
THE GENERAL REVENUE FUND
($831,500 -
$1,335,500)
($819,000 -
$1,323,000)
($819,000 -
$1,323,000)
FEDERAL FUNDSCost – MCHCP§§376.2100 - 376.2108
Prior Authorization Exemptions p.3
($286,000 -
$462,000)
($286,000 -
$462,000)
($286,000 -
$462,000)
Cost – DSS -§§376.2100 - 376.2108
Actuarial Analysis p. 4($12,500)$0$0
ESTIMATED NET EFFECT TO
FEDERAL FUNDS
($298,500 -
$474,500)
($286,000 -
$462,000)
($286,000 -
$462,000)
OTHER STATE FUNDSCost – MCHCP §§376.2100 - 376.2108
Prior Authorization Exemptions p.3
($195,000 -
$315,000)
($195,000 -
$315,000)
($195,000 -
$315,000)
ESTIMATED NET EFFECT TO
OTHER STATE FUNDS
($195,000 -
$315,000)
($195,000 -
$315,000)
($195,000 -
$315,000) L.R. No. 0990H.01I
Bill No. HB 618
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FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028CONSERVATION COMMISSION
FUND (0609)
Cost – MDC §§376.2100 - 376.2108
Prior Authorization Exemptions p.3
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT TO
THE CONSERVATION
COMMISSION FUND
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
STATE ROAD FUNDCost – MoDOT §§376.2100 - 376.2108
Prior Authorization Exemptions p.3(Unknown)(Unknown)(Unknown)
ESTIMATED NET EFFECT TO
OTHER STATE FUNDS(Unknown)(Unknown)(Unknown)
*Oversight assumes increase costs for plan administrators will likely pass on costs to the
MoDOT-MSHP, the Missouri Department of Conservation and locals’ medical plans.
FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028LOCAL POLITICAL
SUBDIVISIONS
Cost – Local Political Subdivisions
§§376.2100 - 376.2108
Prior Authorization Exemptions p.3
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT TO
LOCAL POLITICAL
SUBDIVISIONS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
*Oversight assumes increase costs for plan administrators will likely pass on costs to the
MoDOT-MSHP, the Missouri Department of Conservation and locals’ medical plans. L.R. No. 0990H.01I
Bill No. HB 618
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January 23, 2025
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FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
FISCAL DESCRIPTION
This bill provides that a health carrier or utilization review entity cannot require health care
providers to obtain prior authorization for health care services, except under certain
circumstances. Prior authorization shall not be required unless an individual licensed to practice
medicine in this state makes a determination that less than 90% of prior authorization requests
submitted by the health care provider in the previous evaluation period, as defined in the bill,
were or would have been approved.
The bill establishes separate 90% thresholds for requiring prior authorization for individual
health care services or requiring prior authorization for all health care services. If the provider is
a licensed physician, the determination must be made by a licensed physician with the same or
similar specialty.
The bill specifies requirements for notifying the provider of determinations in the bill, requires
carriers and utilization review entities to maintain an online portal giving providers access to
certain information, and provides that prior authorizations may be required beginning 15
business days after notice to the provider until the end of the evaluation period. Failure to notify
providers of a determination as required in the bill will constitute prior authorization of the
applicable health care services.
Lastly, no health carrier or utilization review entity can deny or reduce payments to a health care
provider who had a prior authorization, unless the provider made a knowing and material
misrepresentation with the intent to deceive the carrier or utilization review entity, or unless the
health care service was not substantially performed.
This bill will not apply to Medicaid, except with regard to a Medicaid managed care organization
as defined by law. The bill also does not apply to providers who have not participated in a health
benefit plan offered by the carrier for at least one full evaluation period.
This bill will not be construed to authorize providers to provide services outside the scope of
their licenses, nor to require health carriers or utilization review entities to pay for care provided
outside the scope of a provider's license
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space. L.R. No. 0990H.01I
Bill No. HB 618
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SOURCES OF INFORMATION
Department of Commerce and Insurance
Department of Public Safety - Missouri Highway Patrol
Department of Social Services
Missouri Department of Conservation
Missouri Department of Transportation
Missouri Consolidated Health Care Plan
Kansas City
Julie MorffJessica HarrisDirectorAssistant DirectorJanuary 23, 2025January 23, 2025