MO SB1111

Requires all MO HealthNet managed care vendors to use uniform utilization review protocols established by the Department of Social Services for determining medical necessity, with active engagement from network health care providers including behavioral health providers

Mandates managed care vendors maintain a medical loss ratio of at least 90% and imposes financial penalties for vendors who fail to meet targets for reducing non-emergency use of hospital emergency departments

Establishes network adequacy standards requiring comparable access to primary care, specialty care, and behavioral health services as provided to private insurance enrollees

Authorizes the Department of Social Services to accept regional proposals from provider-sponsored Coordinated Care Organizations (CCOs) using shared savings models with global payment methodologies and performance incentive payments beginning in their second year of operation

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