HB618--PRIORAUTHORIZATIONOFHEALTHCARESERVICES
SPONSOR: Stinnett
COMMITTEEACTION:Voted"DoPass"bytheStandingCommitteeon
Insurancebyavoteof11to1.
Thisbillprovidesthatahealthcarrierorutilizationreview
entitycannotrequirehealthcareproviderstoobtainprior
authorizationforhealthcareservices,exceptundercertain
circumstances.
Priorauthorizationisnotrequiredunlessadeterminationismade
thatlessthan90%ofpriorauthorizationrequestssubmittedbythe
healthcareproviderinthepreviousevaluationperiod,asdefined
inthebill,wereorwouldhavebeenapproved.
Thebillestablishesseparatethresholdsforrequiringprior
authorizationforindividualhealthcareservicesorrequiring
priorauthorizationforallhealthcareservices.
Thebillspecifiesrequirementsfornotifyingtheproviderof
determinations inthebill,requirescarriersandutilization
reviewentitiestomaintainanonlineportalgivingproviders
accesstocertaininformation,andprovidesthatprior
authorizations mayberequiredbeginning25businessdaysafter
noticetotheprovideruntiltheendoftheevaluationperiod.
Failuretonotifyprovidersofadeterminationasrequiredinthe
billwillconstitutepriorauthorizationoftheapplicablehealth
careservices.
Lastly,nohealthcarrierorutilizationreviewentitycandenyor
reducepaymentstoahealthcareproviderwhohadaprior
authorization, unlesstheprovidermadeaknowingandmaterial
misrepresentation withtheintenttodeceivethecarrieror
utilizationreviewentity,orunlessthehealthcareservicewas
notsubstantiallyperformed.
ThisbillwillnotapplytoMedicaid,exceptwithregardtoa
Medicaidmanagedcareorganizationasdefinedbylaw.Thebill
alsodoesnotapplytoproviderswhohavenotparticipatedina
healthbenefitplanofferedbythecarrierforatleastonefull
evaluationperiod.
Thisbillshouldnotbeconstruedtoauthorizeproviderstoprovide
servicesoutsidethescopeoftheirlicenses,nortorequirehealth
carriersorutilizationreviewentitiestopayforcareprovided
outsidethescopeofaprovider'slicense. ThisbillisthesameasHB1976(2024).
PROPONENTS: Supporterssaythatthepatientsaresufferingdueto
longwaittimesforpriorauthorization. Thebureaucratichurdles
anddelaysoftenresultincriticaltreatmentbeingpostponed,
leadingtoadversehealthoutcomes,particularlyinruralareas
whereaccesstohealthcareisalreadylimited. Thisbillwill
alsocutdownontimephysiciansarespendingongetting
authorizationforaprescription.
TestifyinginpersonforthebillwereRepresentative Stinnett;
MissouriRuralHealthAssociation;MissouriStateOrthopaedic
Association;MissouriStateMedicalAssociation;SSMHealth;
MissouriAssociationofOsteopathicPhysiciansandSurgeons;
MissouriGastroenterology Society;MissouriSocietyofEye
PhysiciansandSurgeons;MercyHealthcareSystems;Missouri
HospitalAssociation;AmyZguta,MissouriStateMedical
Association;BriannaCope,UniversityofMissouriHealthcare;
HannahThrower,BarnesJewishHospital;NorthKansasCityHospital;
JoanneLoethen;JosephineGlaserMD,FAAFP;SusanGraves,Cox
Health;WilliamBridges,TexasCountyMemorialHospital;Golden
ValleyMemorialHospital;HannibalRegionalHealthcareSystem;
UniversityHealth;MissouriChapterofTheAmericanAcademyof
Pediatrics;MissouriPsychologicalAssociation;ReachHealthcare
Foundation,MOAssociationofRuralHealthClinics,RankenJordan,
NationalAssociationofSocialWorkersMOChapter;MosaicLife
Care,MissouriAmbulanceAssociation;MissouriNursesAssociation,
MissouriOccupationalTherapistsAssociation;KateLichtenberg,
MissouriAcademyofFamilyPhysicians;LaraBrisenoKenney;Matias
Hernandez;AmericanCollegeofObstetriciansandGynecologists,
QuestDiagnostics.
OPPONENTS: Thosewhoopposethebillsaythatthiswouldallowbad
practitionerstousetheoverallgoodstandingofthehospitalto
getawaywithbadserviceandharmfulprescribing. Thisbillwould
raisethecostofhealthinsurance.Thisbilldoesnothave
provisionsforfollowupappointmentstoseeifthetreatmentwas
correctandisworking.
TestifyinginpersonagainstthebillwereMissouriHealthPlan
Association;MissouriInsuranceCoalition;PCMA;America'sHealth
InsurancePlans,BCBSofKansasCity.
Writtentestimonyhasbeensubmittedforthisbill.Thefull
writtentestimonyandwitnessestestifyingonlinecanbefound
underTestimonyonthebillpageontheHousewebsite.