FIRST REGULAR SESSION
SENATE BILL NO. 567
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR GREGORY (21).
1873S.01I KRISTINA MARTIN, Secretary
AN ACT
To amend chapter 376, RSMo, by adding thereto one new section relating to insurance coverage
for mental health services.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapter 376, RSMo, is amende d by adding thereto 1
one new section, to be known as section 376.1553, to read as 2
follows:3
376.1553. 1. As used in this section, terms shall 1
have the same meanings as ascribed to them in section 2
376.1350; and the term "cost -sharing" shall include any co- 3
payment, coinsurance, deductible, amount paid by an enrollee 4
for health care services in excess of a coverage limitation, 5
or similar charge required by or on behalf of an enrollee in 6
order to receive a specific health care service covered by a 7
health benefit plan. 8
2. If an enrollee is admitted to a hospital emergency 9
room with a behavioral or mental health condition and the 10
hospital is not a participating provider for that condition 11
under the enrollee's health benefit plan, or if the en rollee 12
is transferred to another hospital that is not a 13
participating provider for that condition under the 14
patient's health benefit plan: 15
(1) The health carrier shall not impose cost -sharing 16
requirements for treatment of the behavioral or mental 17
health condition that are greater than the cost -sharing 18 SB 567 2
requirements would be for treatment of the behavioral or 19
mental health condition by a participating provider; and 20
(2) The health carrier shall reimburse the hospital 21
for treatment of the be havioral or mental health condition 22
at the same rate the hospital would be reimbursed by MO 23
HealthNet. 24
3. It shall constitute an unlawful practice within the 25
meaning of section 407.020, and any action authorized in 26
sections 407.010 to 407.130 may be taken, if a health 27
benefit plan's provider network for treatment of behavioral 28
or mental health conditions is so inadequate that it 29
threatens the life of its enrollees. It shall be a 30
rebuttable presumption that the health benefit plan's 31
provider network is so inadequate that it threatens the life 32
of its enrollees if more than fifteen percent of its 33
enrollees treated for a behavioral or mental health 34
condition are treated for the condition outside of the 35
health benefit plan's provider network. 36