MO HB499

Reduces initial utilization review determination timeframe from two working days to four hours after obtaining all necessary information regarding proposed admissions, procedures, or services.

Expands coverage requirements to include services for "serious and urgent conditions," defined as inadequately controlled undiagnosed pain, conditions where diagnostic delays may cause disease progression or organ dysfunction, or diagnostic testing delays that put patient health at serious risk.

Prohibits health carriers from requiring prior authorization for emergency services or services for serious and urgent conditions.

Requires health carriers to provide authorization decisions within 60 minutes for post-evaluation or post-stabilization services following emergency or serious and urgent condition treatment; services are deemed approved if decision is not made within 30 minutes.

Serious and urgent condition coverage remains subject to applicable co-payments, coinsurance, and deductibles.