CCS HS SCS SB 1026 -- HEALTH INSURANCE; ORGAN DONATIONS

This bill makes various changes to laws pertaining to health
insurance coverage and health treatments.

HEALTH INSURANCE COVERAGE FOR CLINICAL TRIALS

The bill requires health insurance plans to provide coverage for
routine patient care costs incurred as a result of participating
in clinical trials for the prevention and treatment of cancer.
The clinical trial must be approved or funded by one of the
entities which are specified in the bill.

Entities seeking coverage of a clinical trial approved by an
academic institutional review board in Missouri are required to
maintain and electronically list clinical trials which meet
certain requirements contained in the bill.  Providers
participating in clinical trials are required to obtain a
patient's informed consent which is consistent with current legal
and ethical standards.

Information required by this provision will be available to a
health insurer upon request.  A policy, plan, or contract paid
under Title 18 or Title 19 of the federal Social Security Act is
exempt from the requirements of the bill.

HEALTH INSURANCE COVERAGE FOR INHERITED DISEASES

The bill requires health insurers to pay for low protein modified
food products that are recommended by a physician for treatment
of patients less than six years old with certain inherited
diseases.

Insurance coverage provided under this provision may be subject
to the same deductible for similar services provided by a policy
or contract.  Insured persons will be subject to a reasonable
co-insurance or co-payment amount which will not exceed 50% of
the cost of formula and food products.  A total annual benefit
maximum amount is established which cannot be lower than $5,000
per covered child.

Insurance carriers are not prohibited from using individual case
management or from contracting with vendors of formula and food
products.  The coverage required by the bill does not apply to
certain health insurance policies.

HEALTH INSURANCE COVERAGE FOR SECOND MEDICAL OPINIONS

The bill requires health care entities to provide coverage for a
second medical opinion by an appropriate specialist for patients
with a newly diagnosed cancer.  Effective January 1, 2003, this
coverage must be provided even if the appropriate specialist is
not in the provider's network and will be subject to the same
deductible and co-insurance conditions applied to other
specialist referrals, including prior authorizations or referral
authorizations.

The coverage required by the bill does not apply to certain
health insurance policies.

HEALTH INSURANCE COVERAGE FOR BONE MARROW TESTING

The bill requires health benefit plans to include coverage for
bone marrow testing when the testing is done in a licensed
facility and is performed as part of the National Bone Marrow
Donor Program.  The coverage can be limited to the testing of a
health plan member, and reimbursement for the testing may be
capped at $75.  The coverage required by the bill does not apply
to certain health insurance policies.

ORGAN DONATION

The bill revises a provision pertaining to the Anatomical Gift
Act.  Minors who are at least 16 years of age can make an
anatomical gift with parental or guardian consent.  This
provision will take effect July 1, 2003.

Missouri House of Representatives
Last Updated October 11, 2002 at 9:04 am