ER Claim Denials/Prudent Layperson/SB 982 
  • This new section of law requires insurers to reimburse emergency room claims based on the initial symptoms, not the patient’s final diagnosis.  It outlines a simple claim review process for post-stabilization services in the ER.  Furthermore, it dictates that the patient’s treating ER physician is the sole determinator of when the patient is stabilized under the prudent layperson standard.  Rather than billing an out-of-network patient, this legislation gives physicians the option to bill the patient’s insurance carrier for unanticipated care delivered through the ER of an in-network facility.  Submitting a bill to the insurer opens up a negotiation period, and the availability of arbitration, if needed.  The new law also requires insurance companies to pay the facility and/or physician directly for care provided to out-of-network patients when the insurer has given the patient authorization to seek out-of-network care.

Mammography/HB 1252
  • This legislation adds digital mammography and breast tomosynthesis to the definition of low-dose mammography screening.  It also lowers the age threshold for annual mammogram coverage to 40, in accordance with recommendations of the American College of Radiology.

Telehealth/HB 1617
  1. This bill requires the Department of Social Services to reimburse physicians for telehealth services on the same basis as in-person services.  It also reins in some overburdensome agency regulations.

Post-Partum Drug Treatment/HB 2280
  1. This bill extends substance abuse treatment services for MO HealthNet moms from two to twelve months after delivery.  It is subject to appropriations (it already received some funding in this year’s budget), and a federal CMS waiver.

Definition of Mental Health Professionals/SB 660
  1. The bill adds psychiatric physician assistants, psychiatric advanced practice registered nurses, and psychiatric assistant physicians to the definition of mental health professionals for the purposes of provisions of law relating to alcohol and drug abuse and comprehensive psychiatric services and adds a definition for each term.  It also creates Post-Traumatic Stress Awareness Day and establishes the Psychology Interjurisdictional Compact.