HB 618 Missouri House · 2025 Regular Session

Creates provisions relating to prior authorization of health care services

HB 618 limits health insurers' ability to require prior authorization for medical services starting January 1, 2026. Insurers must approve at least 90% of a provider's past requests for a service before requiring prior authorization, or the provider qualifies for an exemption. Hospitals may qualify for exemptions by entering value-based care agreements with insurers, achieving a 3+ star CMS rating, or having a high prior-authorization approval rate. The bill excludes pharmacy, imaging, cosmetic, and experimental services from exemptions (with annual $100,000 cost limits adjusted for inflation) and requires insurers to provide a 90-day medication coverage grace period if a patient's insurance changes.

Issues: ✓ Healthcare

Bill status passed 3 of 5 stages cleared

Introduction

Dec 2024

Committee Review

May 2025

House Passage

Mar 2025

Senate Passage

Governor

Introduced Dec 18, 2024 Last action May 7, 2025

Maddy AI version diff · 1 comparison

What changed between versions

Introduced → Perfected · 5 edits

MODERATE

HB 618 was amended to modernize prior authorization rules by replacing a rigid six-month evaluation period with a flexible twelve-month period and adding new exemptions for high-performing hospitals and value-based care agreements. The bill also establishes a phased implementation starting January 1, 2026, with annual adjustments to exemption limits based on inflation.

Scope change

The bill now applies to all health carriers and utilization review entities but includes new exemptions for hospitals meeting specific quality metrics or participating in value-based care agreements, while excluding certain services like pharmacy, imaging, cosmetic procedures, and experimental treatments.

DEFINITION

Changed the evaluation period from six months to any consecutive twelve months to provide more flexibility in assessing prior authorization performance.

ELIGIBILITY

Added exemptions for hospitals that enter value-based care agreements, achieve high quality ratings, or maintain high approval rates for prior authorization requests.

REQUIREMENT

Established a January 1, 2026 start date for new prior authorization requirements and added annual inflation adjustments to exemption dollar limits.

Added specific exclusions for pharmacy services, imaging services, cosmetic procedures, and experimental treatments from the prior authorization exemption.

ENFORCEMENT

Created an internal audit mechanism allowing carriers to review hospital compliance up to twice per year and rescind exemptions if approval rates fall below thresholds.

Floor votes

How they voted

This bill passed the House by voice vote (no roll call recorded).

Full legislative history

Actions timeline

Total actions

Key actions

Committee

May 7, 2025

Upper · Passed

Voted Do Pass (S)

upper

Apr 28, 2025

Committee

Referred: Fiscal Oversight(S)

upper

Apr 24, 2025

Upper · Passed

Reported Do Pass (S)

upper

Apr 23, 2025

Upper · Passed

Voted Do Pass (S)

upper

Mar 24, 2025

Committee

Second read and referred: Insurance and Banking(S)

upper

Mar 13, 2025

Lower · Passed

Third Read and Passed (H) - AYES: 148 NOES: 4 PRESENT: 0

lower

Mar 13, 2025

Lower · Passed

Reported Do Pass (H) - AYES: 7 NOES: 0 PRESENT: 0

lower

Mar 13, 2025

Lower · Passed

Voted Do Pass (H)

lower

Mar 12, 2025

Committee

Referred: Fiscal Review(H)

lower

Mar 11, 2025

Lower · Passed

Perfected with Amendments (H) - HA 1, adopted

lower

Mar 5, 2025

Lower · Passed

Reported Do Pass (H) - AYES: 10 NOES: 0 PRESENT: 0

lower

Mar 4, 2025

Lower · Passed

Voted Do Pass (H)

lower

Mar 3, 2025

Committee

Referred: Rules - Administrative(H)

lower

Feb 26, 2025

Lower · Passed

Reported Do Pass (H) - AYES: 11 NOES: 1 PRESENT: 0

lower

Feb 24, 2025

Lower · Passed

Voted Do Pass (H)

lower

Jan 22, 2025

Committee

Referred: Insurance(H)

lower

Dec 18, 2024

Introduced

Prefiled (H)

lower

1 primary · 6 co-sponsors