HB 899 Summary

• Repeals and reenacts sections 376.1350 through 376.1399 of Missouri law governing health care utilization review procedures for health carriers and managed care plans.

• Expands definitions and requirements for utilization review organizations, clinical review criteria, and evidence-based standards based on peer-reviewed medical literature and federal research agencies.

• Establishes strict timelines for utilization review decisions: two working days for initial determinations, one working day for concurrent review, and thirty working days for retrospective review.

• Requires health carriers to establish grievance procedures with first-level review within twenty working days and second-level review by advisory panels; allows expedited review for situations that could jeopardize enrollee health with notification within twenty-four hours.

• Creates external review process through independent review organizations for final adverse determinations and prohibits health carriers from charging providers for health record reproduction when requested by the Division of Consumer Affairs for complaint investigations or appeals.