HB 1570 -- Health Care Provider Contracts

Sponsor:  Stefanick

Effective January 1, 2005, health carriers, health benefit plans,
and entities that contract with health care providers to provide
health care services are prohibited from changing any insurance
code submitted by the provider for reimbursement purposes unless
the provider gives express written permission.

Exceptions which allow health carriers, health benefit plans, and
other entities to change an insurance code are:

(1)  If the change is consistent with correct coding initiative
guidelines that are related to current procedural terminology
(c.p.t.) guidelines; or

(2)  If the change is based on an examination of a patient's
medical record to determine the health care services provided.

Health carriers, health benefit plans, and other entities that
contract with health care providers for health care services are
required to attach the following information to provider
contracts upon execution:

(1)  Insurance codes and code modifiers that can be submitted by
providers for insurance reimbursement;

(2)  Fee schedules, reimbursement policies, and information
concerning the range of services reasonably expected to be
delivered by a contracting health care provider; and

(3)  Material addenda, schedules, exhibits, and policies
pertaining to a range of services delivered by a contracting
health care provider.

The bill also prohibits:

(1)  Amendments to provider contracts, addenda, and fee schedules
from taking effect until 60 days after health care providers have
been provided the same information; and

(2)  Health carriers from requiring that health care providers
pay a fee, commission, rebate, or other form of compensation as a
condition of becoming or remaining a participating health care
provider.  This provision will take effect August 28, 2004.

Missouri House of Representatives
92nd General Assembly, 2nd Regular Session
Last Updated September 23, 2004 at 11:15 am