MO HB2750

Requires all MO HealthNet managed care vendors to use uniform utilization review protocols and standards established by the Department of Social Services for determining medical necessity and authorizing payment, with preference given to protocols prevalent among Medicare and private health carriers

Mandates network adequacy standards ensuring access to adult and pediatric primary care, specialty care, and behavioral health services comparable to private insurance plans, and requires managed care vendors to maintain a medical loss ratio of at least 90%

Establishes financial penalties for vendors who fail to meet targets for reducing nonemergency use of hospital emergency departments or who consistently fail to issue timely utilization review decisions

Authorizes the Department of Social Services to accept regional proposals from provider-sponsored "coordinated care organizations" (CCOs) that would be accountable for quality, cost, and coordination of care using a shared savings and risk model with global payment methodology

Requires the State Auditor to conduct annual evaluations of savings and costs attributable to expanded prepaid capitated health services implementation occurring on or after May 1, 2017, including assessment of subcontractor use for behavioral health services