MO HB867

Repeals and reenacts section 208.164, RSMo, relating to prior authorization requirements for medical assistance providers.

Defines key terms including "abuse," "fraud," "excessive use," "prior authorization," and "provider" in the context of medical assistance benefits.

Grants the Department of Social Services authority to suspend, revoke, or cancel provider contracts for abuse or fraud, and to impose prior authorization when reasonable cause exists or when determined by rule.

Authorizes the Department to review recipient cases for excessive use of services and restrict Medicaid identification cards to designated providers and services, with ability to terminate benefits for violations.

Adds new provision allowing providers to use clinical decision support tools as an alternative to prior authorization for determining clinical appropriateness of services or procedures.