FIRST REGULAR SESSION
93RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE SHOEMYER.
Read 1st time January 18, 2005 and copies ordered printed.
STEPHEN S. DAVIS, Chief Clerk
AN ACT
To amend chapter 376, RSMo, by adding thereto one new section relating to durable medical equipment providers.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.1175, to read as follows:
376.1175. 1. Every health carrier and health benefit plan, as defined in section 376.1350, shall include in its network of service providers any durable medical equipment provider that:
(1) Has a main office located in a Missouri community with a population of twenty-five thousand or less; and
(2) Is certified as a Medicare and/or Medicaid provider, and by the Missouri board of pharmacy; and
(3) Registers with the department of insurance as provided in subsection 2 of this section.
2. To be included in a health carrier's or health benefit plan's network of providers, a durable medical equipment provider that meets the requirements in subdivisions (1) and (2) of subsection 1 of this section shall register with the department of insurance as an eligible durable medical equipment provider. The department of insurance, in consultation with the department of social services, shall verify the eligibility of any durable medical equipment provider requesting to register with the department and, upon verification of eligibility, shall include such provider in a durable medical provider registry, which shall be made available to all health carriers and health benefit plans licensed to do business in the state.
3. Every health carrier and health benefit plan licensed to do business in the state of Missouri shall include any durable medical equipment provider that registers with department of insurance under this section in its network of providers.
4. All durable medical equipment providers that register under this section prior to November first shall be included in the network of providers for the following calendar year. After a provider's initial registration, the provider shall remain on the registry so long as the provider provides notice to the department of insurance by November first of the provider's continued eligibility and desire to remain on the registry. On or before January first of each year, all health carriers and health benefit plans shall provide each provider that registers with the department of insurance by November first of the provider's inclusion in the carrier's or plan's network of providers.
5. The department of insurance shall promulgate rules to implement the provisions of this section, including but not limited to forms for registration and renewal of registration. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2005, shall be invalid and void.
6. Any health carrier or health benefit plan that violates the provisions of this section shall have its license to do business in the state of Missouri subject to sanction by the department of insurance.