Missouri HB618: Creates provisions relating to prior authorization of health care services

What the bill says

To amend chapter 376, RSMo, by adding thereto five new sections relating to prior authorization of health care services. SectionA. Chapter376,RSMo,isamendedbyaddingtheretofivenewsections,tobe known as sections 376.2100, 376.2102, 376.2104, 376.2106, and 376.2108, to read as follows: 376.2100. 1. Except asotherwise provided in subsection 1 of section 376.2108, as used in sections 376.2100 to 376.2108, terms shall have the same meanings as are ascribed to them under section 376.1350. 2. As used in sections 376.2100 to 376.2108, the following terms (2) "Value-based care agreement", a contractual.

From the engrossed text:

To amend chapter 376, RSMo, by adding thereto five new sections relating to prior authorization of health care services. SectionA. Chapter376,RSMo,isamendedbyaddingtheretofivenewsections,tobe known as sections 376.2100, 376.2102, 376.2104, 376.2106, and 376.2108, to read as follows: 376.2100. 1. Except asotherwise provided in subsection 1 of section 376.2108, as used in sections 376.2100 to 376.2108, terms shall have the same meanings as are ascribed to them under section 376.1350. 2. As used in sections 376.2100 to 376.2108, the following terms (2) "Value-based care agreement", a contractual agreement between a health care provider, either directly or indirectly through a health care provider group or organization, and a health carrier that: (a) Incentivizes or rewards providers based on one or more of the b. Safety; c. Patient outcomes; d. Efficiency; e. Cost reduction; or f. Other factors; and EXPLANATION -- Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 618 (b) May, but is not required to, include shared financial risk and rewards based on performance metrics. 376.2102. 1. Except as otherwise provided in this section, beginning January 1, 2026,ahealthcarrierorutilizationreviewentityshallnotrequireahealthcareprovider to obtain prior authorization for a health care service unless the health carrier or utilizationreviewentitymakesadeterminationthatinthemostrecentevaluationperiod the health carrieror utilization review …

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