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SECOND REGULAR SESSION
HOUSE BILL NO. 2775
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE HRUZA.
6432H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 376, RSMo, by adding thereto three new sections relating to health
insurance.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto three new sections, to
2 be known as sections 376.464, 376.2099, and 376.2120, to read as follows:
376.464. 1. As used in this section, terms shall have the same meanings given to
2 them in section 376.1350, except that the term "health carrier" shall also include any
3 MO HealthNet managed care organization and any health services corporation or
4 health maintenance organization as defined in chapter 354.
5 2. No health carrier shall impose any penalty or fee on an in-network health car e
6 pr ovider based on the pr ovision of a health care service by an out-of-network health
7 car e pr ovider .
376.2099. 1. As used in this section, the following terms mean:
2 (1) "Anesthesia practitioner", an anesthesiologist or an anesthesiologist
3 assistant, as such terms ar e defined in section 334.400;
4 (2) "Anesthesia time", the period during which an anesthesia practitioner is
5 pr esent with the patient, beginning when the anesthesia practitioner begins to prepa re
6 the patient for anesthesia in an operating room or equivalent ar ea and ending when the
7 anesthesia practitioner is no longer delivering anesthesia services to the patient and the
8 patient may be placed safely under postoperative or postanesthesia care. In calculating
9 anesthesia time, an anesthesia practitioner may include blocks of time ar ound
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.
10 interruptions, pr ovided that the anesthesia practitioner is delivering continuous
11 anesthesia care in the time periods before and after each interruption;
12 (3) "Health carrier", the same meaning given to the term in section 376.1350.
13 The term "health carrier" shall also include any MO HealthNet managed car e
14 organization and any health services corporation or health maintenance organization as
15 defined in chapter 354.
16 2. Reimbursement amounts fr om a health carrier for anesthesia services shall be
17 calculated under the pr evailing medical coding and billing standards in the pr ofessional
18 medical billing community . Reimbursement amounts for anesthesia services shall be
19 calculated based on a base, plus time units, multiplied by an anesthesia conversion
20 factor as defined in the individual contract between the health carrier and anesthesia
21 practitioner or group of anesthesia practitioners. Anesthesia time shall be r ecognized
22 with time units no mor e than fifteen minutes in duration. The sum of the anesthesia
23 time units shall equal the anesthesia time.
24 3. No health carrier shall dir ectly or indirect ly impose a maximum duration of
25 anesthesia time for which r eimbursement will be made for anesthesia pr ovided during a
26 health car e service for which anesthesia is cover ed.
27 4. No health carrier shall dir ectly or indir ectly res trict or exclude all anesthesia
28 time fr om r eimbursement for a health care service for which anesthesia is covered .
376.2120. 1. As used in this section, terms shall have the same meanings given to
2 them in section 376.1350, except that the term "health carrier" shall also include any
3 MO HealthNet managed care organization and any health services corporation or
4 health maintenance organization as defined in chapter 354.
5 2. No contract issued, amended, continued, or renewe d on or after August 28,
6 2026, between a health carrier and an enr ollee, or between a health carrier and a health
7 car e pr ovider for the pr ovision of health car e services to enrol lees, shall authorize the
8 health carrier to modify or add to the contract, including any manual, policy , pr otocol,
9 pr ocedur e, pr ogram, or other document r eferr ed to in the contract, except that the
10 contract, manual, policy , pr otocol, pro cedur e, progra m, or other document may be
11 modified or added to the contract if:
12 (1) The modification or addition is:
13 (a) Subsequently negotiated and agr eed to in writing by the parties to the
14 contract;
15 (b) Required by or necessary to comply with applicable state or federal law ,
16 r egulation, or order;
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17 (c) Made to ref lect changes to the uniform format and standard medical code
18 sets pr omulgated by the department of commer ce and insurance in accordance with
19 subsection 7 of section 376.384; or
20 (d) Made to ref lect changes to the Medicar e or MO HealthNet fee schedule; and
21 (2) The modification or addition is made r eadily available to each party in an
22 electr onic format at or before the time the amendment takes effect and for the duration
23 for which claims may be submitted for reim bursement under the contract.
24 3. Except as otherwise pro vided in subsection 2 of this section, for contracts
25 issued, amended, continued, or ren ewed on or after August 28, 2026, between a health
26 carrier and an enr ollee, or between a health carrier and a health car e pr ovider for the
27 pr ovision of health care services to enr ollees, no manual, policy , pr otocol, pr ocedur e,
28 pr ogram, or other document shall be binding upon the pr ovider or enr ollee unless it is
29 r eferr ed to in the contract, is in effect at the time the contract is signed, and is made
30 r eadily available to each party in an electr onic format at or before the time the contract
31 is signed and for the duration for which claims may be submitted for rei mbursement
32 under the contract.
33 4. Requirem ents under this section that a contract or document be made readi ly
34 available to each party in an electr onic format shall be satisfied by the health carrier
35 pr oviding each party with electr onic access to a copy of the contract or document
36 without amendments and, for purposes of modifications and additions, with electr onic
37 access to a copy of the contract or document with any amendments indicated by
38 underlining and bolding any added language and by visually striking thr ough any
39 deleted language.
40 5. Any contractual pr ovision waiving or violating the pr ovisions of this section
41 shall be null and void as against the public policy of this state.
✔
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