Creates provisions relating to insurance coverage of anesthesia services

SECOND REGULAR SESSION
HOUSE BILL NO. 2570
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE SMITH (46).
5738H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 376, RSMo, by adding thereto one new section relating to insurance
coverage of anesthesia services, with an emer gency clause.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be
2 known as section 376.1245, to read as follows:
376.1245. 1. As used in this section, the following terms mean:
2 (1) "Anesthesia time", the period during which an anesthesia practitioner is
3 pr esent with the patient, starting when the anesthesia practitioner begins to prep are the
4 patient for anesthesia services in the operating ro om or an equivalent area and ending
5 when the anesthesia practitioner is no longer furnishing anesthesia services to the
6 patient because the patient may be placed safely under postoperative or postanesthesia
7 car e. The term "anesthesia time" includes, if counted by the anesthesia practitioner ,
8 blocks of time aro und an interruption in anesthesia time pr ovided the anesthesia
9 practitioner is furnishing continuous anesthesia care within the time periods aroun d the
10 interruption;
11 (2) "Anesthesia time units", time units re cognized with appr opriate time
12 intervals that do not exceed fifteen minutes in length for each interval and that, taken
13 together , r epresent the total anesthesia time for a particular anesthesia service;
14 (3) "Excepted benefit plan", the same meaning given to the term in section
15 376.998;
16 (4) "Health benefit plan", the same meaning given to the term in section
17 376.1350. The term "health benefit plan" shall also include MO HealthNet, the
EXPLANA TION — 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.
18 childr en's health insurance pro gram authorized under chapter 208, the Missouri
19 consolidated health car e plan established under chapter 103, and any other state-
20 sponsor ed health insurance pr ogram;
21 (5) "Health carrier", the same meaning given to the term in section 376.1350.
22 The term "health carrier" shall also include the MO HealthNet division and any
23 Medicaid managed care organization as defined in section 208.431;
24 (6) "Payment of anesthesia services", an amount paid for anesthesia services:
25 (a) Determined by using pr evailing medical coding and billing standards in the
26 pr ofessional medical billing community , such as the Curr ent Pr ocedural T erminology
27 code book published by the American Medical Association, the Medicare Claims
28 Pr ocessing Manual, or guidance published by the American Society of
2 9 Anesthesiologists; and
30 (b) Calculated as the prod uct obtained by multiplying the following together:
31 a. The sum of the base units for the appr opriate medical code plus anesthesia
32 time units; and
33 b. An anesthesia conversion factor that is defined in the individual contract
34 between the health carrier or health benefit plan and the anesthesia practitioner or
35 gr oup.
36 2. No health carrier or health benefit plan shall establish, implement, or enforce
37 any policy , practice, or pro cedur e that imposes a time limit for the payment of
38 anesthesia services pr ovided during a medical or surgical proced ure.
39 3. No health carrier or health benefit plan shall establish, implement, or enforce
40 any policy , practice, or proc edure that res tricts or excludes all anesthesia time in
41 calculating the payment of anesthesia services.
42 4. Excepted benefit plans shall be subject to the requ irem ents of this section.
Section B. Because immediate action is necessary to protect the ability of health care
2 providers to deliver medically necessary health care services to Missourians, section A of this
3 act is deemed necessary for the immediate preservation of the public health, welfare, peace,
4 and safety , and is hereby declared to be an emer gency act within the meaning of the
5 constitution, and section A of this act shall be in full force and ef fect upon its passage and
6 approval.
✔
HB 2570 2