Summary of the House Committee Version of the Bill

HCS SB 894 -- INSURANCE COVERAGE

SPONSOR:  Dempsey (Wilson, 130)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
Health Insurance by a vote of 13 to 0.

This substitute changes the laws regarding health insurance
coverage for Medicare-eligible state employees and coverage for
autism spectrum disorder.

HEALTH INSURANCE COVERAGE FOR MEDICARE-ELIGIBLE STATE EMPLOYEES

Currently, when a state employee becomes eligible for the
Missouri Medicare Program, the employee's primary health benefit
plan is the state-sponsored health benefit plan and Medicare is
the supplemental plan; however, the state-sponsored plan must
provide the same benefits as those provided by the Medicare plan.
The substitute requires the state plan to provide actuarially
equivalent benefits as compared to Medicare, but Medicare must
act as the primary benefit plan when Medicare would provide equal
or better benefits than the state-sponsored health benefit plan.

HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER

The substitute establishes provisions regarding health insurance
coverage for the diagnosis and treatment of autism spectrum
disorder (ASD).  The substitute:

(1)  Establishes the Behavior Analyst Advisory Board under the
State Committee of Psychologists within the Department of
Insurance, Financial Institutions and Professional Registration
to establish licensure and registration requirements for behavior
analysts, assistant behavior analysts, and line therapists who
provide applied behavior analysis therapies to children with ASD;

(2)  Requires all group health benefit plans that are delivered,
issued, continued, or renewed on or after January 1, 2011,
written inside or outside the state, to provide coverage for the
diagnosis and treatment of ASD;

(3)  Requires the department director to grant a small employer
who offers a group health plan a waiver from offering ASD
coverage if the employer demonstrates by actual experience over
any consecutive 12-month period that the cost of providing the
coverage has resulted in at least a 2.5% increase in health plan
premium costs to the employer over a calendar year;

(4)  Prohibits carriers from denying or refusing to issue
insurance coverage on, refusing to contract with, refusing to
renew or reissue coverage on, or terminating or restricting
coverage on an individual or his or her dependent because the
individual is diagnosed with ASD;

(5)  Limits the coverage provided by an insurance carrier for ASD
to medically necessary treatment that is ordered by the insured
individual's licensed treating physician or psychologist in
accordance with a treatment plan.  An ASD treatment plan must
include all elements necessary for a health benefit plan or
carrier to pay the claim.  Except for inpatient services, the
health benefit plan or carrier can review, at its expense, the
treatment plan not more than once every three months unless the
individual's treating physician or psychologist agrees that a
more frequent review is necessary;

(6)  Specifies that coverage for an individual younger than 19
years of age for the applied behavior analysis (ABA) services
will have a maximum benefit of $36,000 per year with no limit on
the number of visits to an ASD service provider.  No coverage
will be required for an individual older than 18 years of age.
Coverage of services may be subject to general exclusions and
limitations of the contract or benefit plan including
coordination of benefits, services provided by family members,
and utilization review of health care services but cannot be
denied on the basis that it is educational or habilitative in
nature;

(7)  Prohibits ASD services from being subject to any greater
deductible, co-insurance, or co-payment than other physical
health care services provided by the health benefit plan.
Payments and reimbursements for ABA services can only be made to
an ASD service provider with certain specified exceptions;

(8)  Requires these provisions to apply to any healthcare plan
issued to employees and their dependents under the Missouri
Consolidated Health Care Plan that is delivered, issued,
continued, or renewed on or after January 1, 2011.  These
provisions also apply to plans that are established, extended,
modified, or renewed on or after January 1, 2011, by self-insured
governmental plans, self-insured group arrangements, multiple
employer welfare arrangements, and self-insured school district
health plans;

(9)  Exempts the MO HealthNet Program and supplemental insurance
policies from the provisions of the substitute;

(10)  Specifies that a health carrier or other entity that is
subject to these provisions is not required to reimburse for ASD
services provided by any school-based service;

(11)  Requires individual health benefit plans to offer ASD
coverage as an option but will not automatically be applied to an
individually underwritten health benefit plan; and

(12)  Requires, beginning February 1, 2012, the department to
submit an annual report to the General Assembly regarding the
implementation of the coverage and specified cost analysis data
for ASD service claims from health insurers.

FISCAL NOTE:  Estimated Income on General Revenue Fund of Unknown
exceeding $288,496 in FY 2011, Unknown exceeding $576,992 in FY
2012, and Unknown exceeding $576,992 in FY 2012.  Estimated
Effect on Other State Funds of a cost of Unknown to an income of
Unknown in FY 2011, FY 2012, and FY 2013.

PROPONENTS:  Supporters say that the bill will allow the Missouri
Consolidated Health Care Plan to design a benefit package for
retirees that is equal or better than what they currently have.
It will also save the state between $2 and $3 million by
utilizing the federal government's Medicare Program.  Retirees'
benefits should be the same as active employees which eliminates
the ability to utilize Medicare benefits.  The bill will still
provide that same benefit package for retirees, but will allow a
cost savings by utilizing federal programs administered through
Medicare instead of using the health carrier as the intermediary
and will include full vision and dental benefits, which is not
currently offered.  The bill will make Medicare the primary payor
or the first payor of the plan benefits instead of the health
carrier.  Currently, the law prohibits the Missouri Consolidated
Health Care Plan from enforcing these provisions without a change
in statute.

Testifying for the bill were Senator Dempsey; and Missouri
Consolidated Health Care Plan.

OPPONENTS:  There was no opposition voiced to the committee.

Copyright (c) Missouri House of Representatives


Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:15 pm