HB 1675 limits when health insurance companies (health carriers) can require doctors and hospitals (health care providers) to get prior authorization for medical services. Specifically, insurers cannot demand prior approval unless they approved less than 90% of similar requests from that provider in the previous six-month period (either January-June or July-December). The bill requires insurers to notify providers within 25 days after each period, provide appeal options, and maintain an online portal showing all authorization decisions. It applies to most health plans but excludes Medicaid managed care organizations and providers who haven’t participated in a plan for a full six-month period. The law does not change what services are covered or allow providers to exceed their licensed scope.
HB 2309, titled the "End Organ Harvesting Act of 2026," prohibits Missouri health insurance plans and Medicaid programs (including MO HealthNet and Medicaid managed care) from covering organ transplants or post-transplant care under two specific conditions: if the transplant occurs in China, or if the organ was obtained through sale or donation originating in China. The bill directly affects health insurers, patients seeking transplants involving China, and healthcare providers billing these insurers. Key provisions require health carriers to deny coverage for transplants meeting either of these China-related criteria. This is a policy change restricting insurance coverage for specific transplant scenarios, not a procedural measure.
SB 1236 requires physicians to disclose to their patients any free products, payments, or other benefits they receive from drug or medical device manufacturers. This directly affects physicians who accept such benefits and their patients during medical consultations. The key mechanism is a mandatory disclosure requirement at the point of care, ensuring patients are informed about potential financial ties. The bill aims to increase transparency in physician-patient relationships regarding manufacturer influences.
HB 2570 requires health insurers and health benefit plans (including MO HealthNet and Medicaid managed care) to pay for anesthesia services based on defined "anesthesia time" units without imposing time limits or restricting how that time is calculated. The bill prohibits insurers from setting arbitrary time caps on anesthesia payment or excluding all anesthesia time when determining reimbursement. It specifically affects anesthesia providers (like anesthesiologists and nurse anesthetists) by mandating payment based on standardized time units and prevailing medical billing standards. The law passed as an emergency measure to ensure timely payment for these medically necessary services.
HB 2065 repeals Missouri's current laws specifically addressing gender transition procedures (sections 191.1720, 208.152, 217.230, and 221.120) and replaces them with general Medicaid coverage rules. The new provisions, codified as sections 208.152, 217.230, and 221.120, integrate gender transition procedures into standard Medicaid coverage criteria like medical necessity, without explicit reference to gender transition. This bill removes the prior specific legal framework for gender transition services and subjects them to the same general Medicaid process as other medical treatments. It does not explicitly exclude gender transition procedures from coverage but changes their legal basis to align with standard Medicaid rules.
HB 1822 expands Missouri's MO HealthNet program to include children diagnosed with certain medical conditions by adding a new eligibility category for children aged one to six. This change aligns with federal standards under the Omnibus Budget Reconciliation Act of 1989, which covers children meeting specific income and medical criteria. The bill directly affects young children in Missouri who qualify under these federal guidelines but previously faced eligibility gaps. It ensures these children can access state health coverage without requiring additional state-specific documentation.
HB 2413 modifies regulations for assisted living facilities and residential care facilities. It allows facilities licensed as "Residential Care Facility II" as of 2006 to transition to "Assisted Living Facility" status without immediate compliance with new standards, but they must meet full requirements when Medicaid reimbursement for residents reaches $41 per day. The bill requires facilities to create individualized care plans, maintain 24-hour staffing, develop disaster evacuation plans, and prohibit admission of residents needing skilled nursing care, physical or chemical restraints, or who cannot safely evacuate without significant assistance. Facilities must also disclose services, costs, and discharge conditions to prospective residents and conduct medical screenings upon admission. These changes directly affect assisted living facilities and their residents, particularly those with disabilities requiring specialized care.
HB 1945 modifies Missouri's health care payment system for clinical pathology services under MO HealthNet (the state's Medicaid program). It requires MO HealthNet to pay hospital-based pathologists 30% of Medicare's rate for the "professional component" of their services (interpretation and diagnosis), with payments going directly to the hospital if the pathologist is employed there, or to the third-party provider if not. This affects hospitals, pathologists, and MO HealthNet patients by standardizing reimbursement for these diagnostic services. The bill also adds licensing requirements for drug distributors (section 338.333), but the primary focus is on pathology billing changes.
SB 1479 allows state health agencies to adopt existing Medicaid regulations by simply referencing them in new rules, rather than rewriting the full text. This directly affects agencies that create Medicaid-related rules, such as the Department of Health, by streamlining their rulemaking process. The key mechanism is "incorporating by reference," meaning agencies can cite approved Medicaid rules from other sources instead of duplicating them. This reduces administrative burden and ensures consistency with established Medicaid standards. The bill does not change Medicaid benefits or eligibility, only the process for agencies to update their rules.
SB 897 limits when health insurance companies can require prior authorization for medical services. It mandates that insurers must approve at least 90% of prior authorization requests from a provider for a specific service in the previous six-month period before requiring authorization. The bill also requires insurers to notify providers within 25 days of such determinations, establish appeal processes, and maintain an online portal for tracking authorization decisions. This primarily affects health insurance companies and healthcare providers in Missouri who participate in commercial health plans (excluding Medicaid managed care).
