MO HB926

Repeals and replaces section 208.166 of Missouri law to authorize the Missouri Department of Social Services to maximize use of existing contracted prepaid health plans and alternative service delivery methods, including primary care physician sponsors and specialty physician services arrangements.

Requires prepaid health plans to have full control over formulary and preferred drug list (PDL) development for pharmacy benefits and services to plan members.

Authorizes the department to seek a Centers for Medicare and Medicaid Services (CMS) waiver to implement a pilot program and demonstration project in Phelps County (Eastern Region) and Jackson County (Western Region) covering institutionalized individuals, qualified Medicare beneficiaries, disabled workers, workers with potentially severe disabilities, elderly and disabled individuals, and individuals entitled to Medicare Part D with specified income limits.

Grants the department authority to purchase medical services from various providers on a prepaid capitated or primary care case-management basis, while ensuring reasonable geographic access, utilization of community health clinics when possible, and full freedom of choice for prescription drugs at participating pharmacies.

Prohibits the department from limiting recipients' freedom to select among contracted health care plans or primary care physician sponsors, except in cases of service overutilization.