MissouriSB792025 1st Extraordinary SessionSenateWALLET

Modifies provisions relating to health care

Sponsored By: Kurtis Gregory (Republican)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

20 provisions identified: 11 benefits, 4 costs, 5 mixed.

Fewer prior approvals for qualifying providers

Beginning January 1, 2026, plans can require prior approval only when a provider's approval rate is below 90%. Reviews use consecutive 12-month periods; providers must participate for a full period, and most MO HealthNet coverage is excluded except managed care. Hospitals can qualify through value-based agreements, CMS ratings of at least three stars, or approval rates of at least 91%; this hospital test excludes critical access and unrated hospitals. Exemptions exclude pharmacy or imaging services above specified $100,000 limits, unnecessary cosmetic procedures, and experimental treatments; dollar limits rise with inflation beginning January 1, 2027. Plans must give providers supported exemption decisions within 25 days, offer appeals and online records, and can audit or revoke exemptions.

Minimum benefits protect membership contract holders

Qualified membership health-benefit contracts must cover outpatient care, hospital stays, emergency care, and lab services. Any annual coverage limit must be at least $2 million. While a member remains covered, a medical event cannot trigger cancellation, refusal to renew, contract changes, or higher premiums. These protections do not make the contracts equivalent to ACA-compliant insurance or set members' out-of-pocket costs.

Health plans cover longer contraceptive supplies

Beginning January 1, 2026, Missouri plans covering self-administered hormonal contraceptives must pay for supplies intended to last up to one year. This applies to plans delivered, issued, continued, or renewed in Missouri on or after that date. Deductibles and copayments cannot be higher than for similar covered care. Emergency contraception and medicines approved to end an existing pregnancy are excluded from this requirement.

Medicaid covers medically needed hearing devices

MO HealthNet includes medically necessary cochlear implants and hearing instruments among services eligible for payment. An audiologist must prescribe the device, or a hearing instrument specialist must dispense it. This coverage applies to eligible people receiving MO HealthNet.

More infection screening during pregnancy

With the pregnant woman's consent, providers must take blood samples at 28 weeks and immediately after birth. These samples are in addition to the first prenatal exam sample. Tests include hepatitis C and HIV alongside existing required tests, and must be FDA-approved or accepted types. Providers must treat positive results for syphilis, hepatitis B, hepatitis C, or HIV using current accepted medical practice.

New protections for previously approved care

Plans and review groups cannot deny or reduce provider payment for care that received prior approval. Exceptions apply when providers deliberately misrepresent services to obtain unlawful payment or fail to substantially provide them. Patients with approval for a 90-day medication supply get a 90-day grace period starting when their health plan changes. This gives patients time to check the new plan's coverage; it does not guarantee medication payment.

Patients must consent before medical treatment

Health care providers must receive informed consent before giving treatment or performing a procedure. This protects patients' ability to make informed choices about their care.

Medicaid drops extra hearing aid listing

The law removes hearing aids from an additional MO HealthNet benefit list for needy children, pregnant women, and blind people. This narrows that specific benefit pathway. It does not establish that hearing aids lose coverage through every MO HealthNet pathway.

Membership health contracts are not insurance

Qualifying membership groups can offer health-benefit contracts exempt from Missouri's health insurance laws after members have belonged for 30 days. Groups must meet legal qualifications, register for five-year terms, pay $250 per application or renewal, and use licensed sellers and permitted administrators. Disclosures must warn that contracts are not insurance, may offer fewer benefits than ACA plans, may exclude preexisting conditions, and lack Missouri insurance guaranty protection. Members must sign an acknowledgment at enrollment and renewal; groups must keep it while claims can be filed and provide copies on request. Calling these contracts insurance in advertising or member messages is an unlawful practice.

Remote care options with evaluation safeguards

Telemedicine can establish a doctor-patient relationship when an in-person visit is not needed and evidence-based standards are followed. A treating clinician must review questionnaires containing enough information for an evaluation equal to an in-person visit. Questionnaire providers must work for or contract with a business licensed to provide Missouri health care; doctors must review history and examine patients sufficiently before treatment. Prescribing generally requires a proper care relationship; listed clinicians can prescribe solely through telemedicine when the physician-patient relationship is already ongoing, with physical exams when needed. When patients supply their primary provider's details, questionnaire providers must send that provider an evaluation, diagnosis, treatment, and instructions report within 14 days.

Partners can get faster infection treatment

Eligible licensed prescribers can treat partners of people with certain sexually transmitted infections without first examining those partners. They do not need to establish a separate provider-patient relationship with the partner. The infection must meet Missouri health department criteria or current CDC guidelines recommending this treatment. Providers choose whether to offer this option.

Phone and video care with privacy

The law recognizes both video visits and audio-only calls as telehealth. Providers can choose their platforms, but services must follow federal health privacy rules. Records for telemedicine prescriptions and treatment must also follow those rules, including permitted sharing for treatment, payment, and health care operations. These changes do not require providers to offer remote care or guarantee coverage.

Hospital districts can operate more facilities

Hospital districts gain broader authority to establish and operate health facilities in third- or fourth-class counties. An existing hospital organized under chapters 96 or 205 no longer blocks that authority. An existing chapter 206 hospital still limits expansion, except within the expanding district's own boundaries. The law does not require districts to open facilities.

Qualifying hospitals get broader investment choices

Qualifying hospitals and hospital districts can invest up to 50% of available funds in specified mutual funds, bonds, and money markets. Eligible municipal hospitals must receive under 3% of annual revenue from public taxes and under 3% from municipal appropriations. Districts must receive under 3% from district or state taxes, and invested funds cannot be needed for immediate payments or operations. Bonds must meet credit-rating rules and mature within 10 years; district bonds need a top-five long-term or highest short-term rating. Remaining available funds must follow Missouri state treasurer investment rules.

State drops dense breast notice requirement

The law removes Missouri's required notice about dense breast tissue and possible extra screening after mammograms at certified facilities. This removes the state notice requirement, not a requirement that facilities stop giving information. It does not change coverage for mammograms or extra screening.

Health plans lose scheduled examination requirement

The law removes the requirement to examine health maintenance organizations at least once every five years. The director can still examine them as often as needed to protect the public. There is no longer a fixed minimum examination schedule.

Membership health groups pay claims fee

Qualified membership organizations or their administrators must pay an annual fee before April 1. The fee equals 1% of Missouri claims paid under their contracts during the prior year. Money goes to the Insurance Dedicated Fund. The law does not directly charge members or say whether contract prices change.

Specialty hospitals get assault care exemption

Specialty hospitals designated by Missouri as something other than general acute care hospitals can receive an exemption from specified care requirements. They must have a policy for transferring sexual-assault victims to an appropriate hospital with an emergency department. The rule pairs reduced duties at the specialty hospital with a required transfer policy.

Ambulance districts face training and audits

Ambulance district board members must complete three hours of continuing education each term, in addition to initial training. Missing required training by the election or appointment anniversary disqualifies the member and leaves the seat vacant. Districts must arrange a CPA or accounting-firm audit at least every three years, in addition to annual audits. They must make the audit free to read online or through other electronic means.

Community paramedics get standards and boundaries

Missouri sets standards and issues five-year certifications for entities providing nonemergency community paramedic care separate from 911. Individual community paramedics must hold a paramedic license and complete an approved program. Standards cover medical oversight, records, training, primary care relationships as needed, and quality improvement. Ambulance services entering another service's area need an agreement if local community paramedic care already exists; otherwise, they must notify it. Response agencies can serve their designated areas when the ground ambulance service does not offer this care, with coordination when both do.

Sponsors & Cosponsors

Sponsor

Kurtis Gregory
Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 28 • No: 1

House vote • 5/7/2025

Reported Do Pass

Yes: 6 • No: 0

House vote • 4/30/2025