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MASCA Legislative Report 1/21/2018


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Key Legislative Updates

No Public Hearing This Week on Work Comp Fee Schedule: Senator Doug Libla (R-Poplar Bluff), Chairman of the Senate Small Business & Industry Committee has chosen not to hold a public hearing on SB 601, an act that would create a medical fee schedule for workers compensation claims. His office initially indicated they might hold a hearing on the bill this week, but a combination of your emails/calls into his office and concerns we’ve relayed to him and his staff have likely played a role in his decision to delay the public hearing. The committee has posted a hearing SB 735, which is another workers compensation related bill that is also sponsored by Sen. Dave Schatz (R-Sullivan). SB 735 is specific to the Department of Insurance’s approval of premiums, but we will monitor the bill closely to ensure no amendments are added regarding medical fee schedules. Note that the committee is still likely to hold a public hearing on the medical fee schedule legislation, but we benefit from every week that the hearing is delayed as we try to run out the clock and prevent the bill from advancing before the May 18th deadline to pass legislation.

Onder Introduces Health Care Benefit Determinations Bill: On Thursday, Sen. Bob Onder, MD (R-Lake St. Louis) passionately introduced legislation aimed at Anthem in response to their recent attempt to retroactively deny authorization of procedures. The bill also seeks to fix the most recent issues with Anthem’s restriction on modifier 25, a billing code used by providers when performing separate procedures during the same day/visit. Anthem’s announcement that they will be restricting the use of modifier 25 is likely to have a significant impact on any dermatologists practicing in ASCs. Link to Senate Bill 928.

Official Bill Summary – Senate Bill 928 (Onder)

SB 928 - This act specifies that necessity of emergency services to screen and stabilize a patient shall be determined by the treating physician.

Before a health carrier retrospectively denies payment for an emergency service, a qualified physician shall review the enrollee's medical records regarding the emergency condition at issue. Carriers shall not deny payment based predominantly on current procedural terminology or International Classification of Diseases (ICD) codes.

This act allows health carriers to recapture from enrollees payments made to health care providers for emergency services if it is determined the enrollee did not have an emergency condition.

Payments shall be paid directly to the health care provider by the health carrier regardless of whether the provider participates in the carrier's network.

The act prohibits carriers from reducing payments for evaluation and management services that are otherwise eligible for reimbursement when reported by the same provider on the same day as a procedure, and specifies that contract provisions to the contrary shall be void.

The act specifies that payment for all services shall be made directly to providers when the carrier has authorized the patient to seek such services from a provider outside the carrier's network.

Statewide Public Opinion Poll Source: Missouri Scout – Click Here to View Crosstabs

Next Week’s Public Hearings on Tracked Legislation:

Senate-Insurance and Banking TUESDAY - 01/23/18 8:12 AM, Senate Lounge

Sater, David

This act lowers, from fifty to twenty-five, the minimum number of members an association must have in order to purchase group health insurance

Senate-Small Business and Industry TUESDAY - 01/23/18 10:15 AM, SCR 1

Schatz, Dave

Modifies provisions relating to workers' compensation premiums

Senate-Appropriations TUESDAY - 01/23/18 10:30 AM, SCR 2

Brown, Dan

Extends the sunset on certain healthcare provider reimbursement allowance taxes

House-Insurance Policy TUESDAY - 01/23/18 12:00 PM or Upon Morning Adj., whichever is later, HR 4 Public Hearing:

White, William

Modifies the law regarding health insurance adverse determination appeals.

Executive Session:

Hill, Justin

Changes the law relating to short term medical policies sold in the state of Missouri.

House-Workforce Development WEDNESDAY - 01/24/18 8:00 AM, HR 4 Public Hearing:

Frederick, Keith

Prohibits covenants not to compete.

Senate-Government Reform WEDNESDAY - 01/24/18 8:00 AM, SCR 1

Rowden, Caleb

Provides that an insurer who deposits the limits of coverage amount with the court shall not be liable for an amount in excess of the insurer's contractual coverage limits in an inter-pleader action.

Senate-Seniors/Families and Children WEDNESDAY - 01/24/18 8:00 AM, Senate Lounge

Sater, David

Modifies provisions relating to the disposal of unused controlled substances

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