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MO SB406
Bill
Status
2/27/2013
Primary Sponsor
Wayne Wallingford
Click for details
AI Summary
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Accelerates initial utilization review determinations from two working days to four hours of obtaining all necessary information for proposed admissions, procedures, or services.
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Eliminates prior authorization requirements for emergency services necessary to screen and stabilize enrollees.
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Eliminates prior authorization requirements for services involving serious and urgent conditions, defined as inadequately controlled undiagnosed pain, conditions where delayed diagnosis may cause disease progression or bodily dysfunction, or conditions where delayed diagnostic testing will place patient health at serious risk.
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Requires health carriers to provide authorization decisions within 60 minutes for post-evaluation or post-stabilization services following emergency care or treatment of serious and urgent conditions, with automatic approval if decision is not made within 30 minutes.
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Maintains applicability of co-payments, coinsurance, and deductibles for coverage of emergency and serious and urgent condition services.
Legislative Description
Prohibits health carriers from requiring prior authorization for serious and urgent conditions and requires certain health benefit determinations to be made within 4 hours rather than 2 working days
Last Action
SCS Voted Do Pass S Small Business, Insurance and Industry Committee - (1864S.02C)
4/16/2013