HB 2775 requires health insurance companies (health carriers) to pay anesthesia providers based on standard time-based billing without capping or excluding anesthesia time. It prohibits insurers from penalizing in-network providers for out-of-network services and mandates that reimbursement calculations follow established medical coding standards. The bill also requires all insurance contracts and related documents (like policies or protocols) to be clearly accessible electronically, with changes visually marked, for providers and patients. This affects health insurers, anesthesia providers, and patients covered by health plans. The law applies to contracts issued after August 2026.
HB 3136 restricts Missouri's ability to operate a state-run health insurance marketplace (often called a "health exchange" under federal law). It requires specific legislative approval - via bill, initiative, or referendum - before any state agency can establish, administer, or fund such a marketplace, banning executive orders or informal actions. The bill also prohibits state entities from using federal funds for these exchanges without explicit authorization and blocks agreements with federal authorities to create or operate a federal-facilitated exchange. This directly affects Missouri state departments, agencies, and political subdivisions that might otherwise engage with the federal health care law's marketplace system.
HB 3117 requires health insurance plans in the state to cap out-of-pocket costs for prescription insulin at $30 per 30-day supply for people with diabetes. It mandates that plans reduce the drug price by 100% of all rebates received (before applying cost-sharing), ensuring the $30 limit reflects the lowest possible price. The bill protects rebate information as trade secrets, preventing health plans from disclosing rebate details to the public or third parties. This law applies to all health benefit plans issued, renewed, or continued on or after January 1, 2027.
HB 1658 requires most health insurance plans in the state to cover orthotic and prosthetic devices (like braces, supports, or artificial limbs) prescribed by a doctor. It mandates that coverage must match the benefit levels, copayments, and deductibles applied to basic health care services, with no separate annual or lifetime limits unless the plan has none for basic care. This applies to standard health plans but excludes supplemental policies like Medicare supplements, short-term plans, or accident-only coverage. The bill directly affects patients needing these devices and insurers offering health coverage in the state.
HB 2597 sets minimum payment rates for out-of-network ambulance providers treating patients covered by health insurance plans. It requires insurance companies to pay these providers either the local government rate for ambulance services in that area or 325% of the Medicare rate for the same service (whichever is lower), but not more than the ambulance provider's billed charge. The bill mandates that payments be made directly to the ambulance provider within 30 days for complete claims, prohibits billing patients for additional amounts after payment, and limits patient cost-sharing to the same level as in-network services. This directly affects ambulance services (excluding air ambulances) and health insurance companies operating in the state.
HB 1894 prohibits health insurance plans and issuers from discriminating against healthcare providers based on their license type when determining participation or reimbursement. It requires equal reimbursement rates for the same service within a provider's scope of practice, while allowing varying rates based on quality measures. The bill applies to group health plans and individual insurance coverage but excludes physicians licensed under Chapter 334 of Missouri law. The Department of Commerce and Insurance will enforce these provisions, implementing federal nondiscrimination protections from Section 2706 of the Public Health Service Act.
HB 1965 updates Missouri law to clarify how health insurers pay athletic trainers. It requires insurers to pay athletic trainers directly for services when a patient receives out-of-network care authorized by their health plan, rather than paying the patient first. This applies to athletic trainers (defined as licensed providers under Chapter 334) who are not part of an insurer’s network but have prior authorization for care. The bill also establishes new credentialing rules for athletic trainers seeking to join health insurance networks. These changes directly affect athletic trainers, insurers, and patients seeking out-of-network care.
HB 2279 requires Missouri health benefit plans to include costs for non-generic medications in an enrollee's out-of-pocket maximum. This means if a generic drug isn't available for a prescribed medication, the full cost paid by the enrollee (or on their behalf) counts toward their annual limit on out-of-pocket expenses. The bill also prohibits plans from adjusting cost-sharing requirements based on whether a patient qualifies for drug cost assistance programs. It applies to most health plans (excluding certain union plans) starting August 28, 2026, and affects all Missouri residents enrolled in health insurance plans covering prescription drugs.
SB 1156 would require health insurance plans to cover prescription insulin with limited out-of-pocket costs for policyholders. It directly affects individuals with diabetes who rely on insulin, aiming to reduce their financial burden. The key provision would limit how much patients pay per insulin prescription, though specific cost thresholds aren't detailed in the abstract. The bill is pending review by the Senate Insurance and Banking Committee and has not yet been voted on. This legislation focuses on improving access to a critical medication through insurance coverage requirements.
SB 1114 would require health insurance plans to cover hair prostheses (like wigs or hair systems) for people experiencing hair loss as a side effect of cancer treatment. This directly affects cancer patients who currently may face significant out-of-pocket costs for these necessary items. The bill mandates that health benefit plans include coverage for these prostheses as part of standard benefits. The bill is currently pending in the Senate Insurance and Banking Committee after being prefaced and first read in early 2026.
