Healthcare (Insurance)

HB 1875 requires health care providers in Missouri to notify patients before providing nonemergency care if they are out-of-network for the patient's health insurance plan. Before such care, providers must check the patient's insurance coverage and their own network status, and if out-of-network, they must inform the patient or the person consenting for the patient. This notification must occur prior to treatment and complements existing federal protections like the No Surprises Act. The bill directly affects health care providers and patients receiving nonemergency care in Missouri.

SB 1350 requires health insurance plans in Missouri to cover non-opioid medications for acute pain without restrictions, effective January 1, 2027. It directly affects enrollees (insurance policyholders) prescribed non-opioid drugs for pain expected to last 30 days or less. The bill prohibits insurers from denying coverage for these medications, forcing patients to try opioids first, or charging higher out-of-pocket costs for non-opioid drugs compared to opioids. This applies to all health benefit plans issued or renewed after the effective date, aiming to expand access to non-opioid pain treatment options.

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).

HB 1879 requires Missouri health insurance plans to cover genetic counseling and genetic testing for cancer risk starting January 1, 2027. It applies to individuals assessed as high-risk for harmful gene mutations based on personal or family cancer history. The law mandates that coverage includes all associated costs with no deductibles, copays, or other cost-sharing, and prohibits insurers from using genetic test results to deny coverage, adjust premiums, or limit benefits. This policy directly affects Missourians seeking cancer risk assessment and their health insurers.