Creates provisions relating to insurance coverage of preventive health care services

SECOND REGULAR SESSION
HOUSE BILL NO. 3450
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE MANSUR.
7361H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 376, RSMo, by adding thereto one new section relating to insurance
coverage of preventive health care services.
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 376.1 180, to read as follows:
376.1 180 . 1. As used in this section, the following terms mean:
2 (1) "Cost-sharing r equir ement", the same meaning as in section 376.1 183;
3 (2) "Health benefit plan", the same meaning as in section 376.1350;
4 (3) "Health carrier", the same meaning as in section 376.1350.
5 2. Each health carrier or health benefit plan that offers or issues health benefit
6 plans that ar e deliver ed, issued for delivery , continued, or r enewed in this state on or
7 after January 1, 2026, shall prov ide coverage and shall not impose any cost-sharing
8 r equir ement for:
9 (1) Evidence-based items or services that have in effect a rating of A or B in the
10 r ecommendations of the United States Pr eventive Services T ask For ce with res pect to
11 the individual involved;
12 (2) Immunizations that have in effect a recomm endation fr om the Advisory
13 Committee on Immunization Practices of the Centers for Disease Contr ol and
14 Pr evention with re spect to the individual involved; and
15 (3) Pr eventive car e and scre ening provi ded for in compr ehensive guidelines
16 supported by the federal Health Resour ces and Services Administration.
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.
17 3. T o the extent otherwise permissible under federal or state law , a health carrier
18 or health benefit plan that uses a network of pro viders may impose cost-sharing
19 r equir ements on the coverage described in subsection 2 of this section for items or
20 services deliver ed by an out-of-network pr ovider .
21 4. If an insur ed or enro llee is cover ed under a high deductible health plan, as
22 such term is defined in 26 U.S.C. Section 223(c)(2), a health carrier or health benefit
23 plan may apply the deductible r equir ement of the high deductible health plan to the
24 coverage r equir ed under subsection 2 of this section unless the dir ector of the
25 department of commer ce and insurance determines that the coverage is included in the
26 safe harbor prov isions for pr eventive care under 26 U.S.C. Section 223(c)(2)(c).
27 5. The provi sions of this section shall not be construed to proh ibit a health
28 carrier or health benefit plan fro m pr oviding coverage for services in addition to those
29 r ecommended by the United States Pr eventive Services T ask For ce or to deny coverage
30 for services that are not reco mmended by the United States Pr eventive Services T ask
31 For ce.
32 6. The dir ector of the department of commer ce and insurance shall enforc e the
33 pr ovisions of this section consistent with the re commendations and guidelines in effect
34 on December 31, 2025, set by the United States Pr eventive Services T ask For ce, the
35 Advisory Committee on Immunization Practices of the Centers for Disease Control and
36 Pr evention, or the federal Health Resour ces and Services Administration, and relat ed
37 federal rules or guidance.
38 7. The dir ector shall, by rule, adopt r egulations to requ ire health carriers and
39 health benefit plans to pr ovide coverage without cost-sharing req uire ments for any
40 pr eventive health care services recomm endations and guidelines issued after December
41 31, 2025, by the United States Pr eventive Services T ask For ce, the Advisory Committee
42 on Immunization Practices of the Centers for Disease Contr ol and Pr evention, or the
43 federal Health Resources and Services Administration, and r elated federal rules or
44 guidance.
45 8. (1) The department of commer ce and insurance shall cr eate an advisory
46 committee to be known as the "Health Insurance Pr eventive Health Car e Services
47 Advisory Committee". This committee shall be composed of five members, with thr ee
48 r epresent atives of health car e pr oviders and two rep rese ntatives of health carriers and
49 health benefit plans. All members of the committee shall be appointed by , and serve at
50 the pleasur e of, the director of the department. The committee members shall serve
51 without compensation and shall not be r eimbursed for their expenses.
52 (2) The committee shall meet at least once each year to make r ecommendations
53 to the department, the general assembly , and the governor rega rding any updates or
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54 modifications, as necessary , to the pr eventive health car e services described in
55 subsection 2 of this section. The committee shall pr ovide any recomm endations for
56 updates or modifications no later than November first each year to the department, the
57 general assembly , and the governor .
58 9. Any rule or portion of a rule, as that term is defined in section 536.010, that is
59 cr eated under the authority delegated in this section shall become effective only if it
60 complies with and is subject to all of the pr ovisions of chapter 536 and, if applicable,
61 section 536.028. This section and chapter 536 are nonseverable and if any of the powers
62 vested with the general assembly pursuant to chapter 536 to revi ew , to delay the
63 effective date, or to disappr ove and annul a rule are subsequently held unconstitutional,
64 then the grant of rulemaking authority and any rule pro posed or adopted after August
65 28, 2026, shall be invalid and void.
✔
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