SS SCS HS HCS HB 121 -- CHIROPRACTIC CARE; MANAGED CARE; LIENS OF
HOSPITALS AND HEALTH CARE PROFESSIONALS

This bill contains provisions pertaining to insurance coverage
for chiropractic care, managed care entities, and liens filed by
hospitals and health care professionals.

INSURANCE COVERAGE FOR CHIROPRACTIC CARE

The bill requires health insurers to provide coverage for
chiropractic care delivered by a licensed chiropractor acting
within the scope of Chapter 331, RSMo.

The coverage will include initial diagnosis and clinically
appropriate and medically necessary services and supplies
required to treat a diagnosed disorder, subject to conditions of
the policy.  The coverage may be limited to chiropractors within
the health carrier's network.  Health carriers are not required
to contract with a chiropractor outside the health carrier's
network nor are carriers required to reimburse for services
provided by a non-network chiropractor, unless prior approval has
been obtained from the health carrier by the enrollee.

Enrollees may access chiropractic care within the health
carrier's network for a total of 26 chiropractic office visits
per policy period and may be required to provide the health
carrier with notice prior to any additional visits as a condition
of coverage.  In addition, health carriers may require prior
authorization or notification before any follow-up diagnostic
tests are ordered by a chiropractor or for any office visits for
treatments in excess of 26 office visits in a policy period.

Certificates of coverage for any health benefit plan are required
to state the availability of chiropractic coverage under the
policy and any exclusions, limitations, or conditions of
coverage.  The insurance coverage contained in the bill excludes
benefits provided under the Medicaid program and other specified
insurance policies.

Health carriers are prohibited from establishing rates, terms,
and conditions of coverage for enrollees which cause a greater
financial burden than for enrollees who access treatment for
other physical conditions.

MANAGED CARE ENTITIES

The bill revises certain provisions pertaining to health services
corporations, health maintenance organizations, and managed care
plan networks.

Pertaining to health services corporations, the bill:

(1)  Extends the approval or disapproval period from 30 days to
45 days during which the Director of the Department of Insurance
is required to review and approve or disapprove submitted policy
forms by a health services corporation.  A non-determination on
the submitted policy forms by the director during this period
constitutes approval of the forms;

(2)  Prohibits the director from disapproving a filed policy form
for a period of one year.  During the one-year period, if the
director determines that any provision of the policy form
violates state law, the director is required to notify the health
services corporation of the specific provision of the policy form
which is contrary to state law and the state law used to
determine the illegality of the policy form and request that the
health services corporation file an amendment with the department
within 30 days; and

(3)  Requires that the amendment approved by the director will
have the effect of the original filing or policy filed with the
department.

Pertaining to health maintenance organizations, the bill:

(1)  Extends the approval or disapproval period from 30 days to
45 days during which the Director of the Department of Insurance
is required to review and approve or disapprove modifications of
various documents, including articles of incorporation, financial
statements, policies, and marketing plans submitted by health
maintenance organizations.   A non-determination on the submitted
documents by the director during this period constitutes an
approval of the modified documents;

(2)  Prohibits the director from disapproving a filing of
specific information by health maintenance organizations deemed
approved for a period of one year.  During the one-year period,
if the director determines that any provision of the required
filing violates state law, the director is required to notify the
health maintenance organization of the specific provision of the
required filing which is contrary to state law and the state law
used to determine the illegality of the required filing and
request that the health maintenance organization file an
amendment with the department within 30 days; and

(3)  Requires the health maintenance organization to issue a copy
of the amendment approved by the director to individuals and
entities which received the previous filing.  The amendment will
have the effect of the original filing or policy filed with the
department.

Pertaining to managed health plan networks, the bill requires the
Director of the Department of Insurance to deem a managed care
plan network adequate based on certain criteria which are
detailed.

LIENS OF HOSPITALS AND HEALTH CARE PROFESSIONALS

The bill revises Section 430.225, the definition section
pertaining to liens of hospitals and certain health care
providers.

Missouri House of Representatives
Last Updated July 25, 2003 at 10:10 am