Creates provisions relating to insurance coverage of preventative health care services

SECOND REGULAR SESSION
HOUSE BILL NO. 3452
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE BUSH.
7404H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 376, RSMo, by adding thereto one new section relating to insurance
coverage of preventative 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 pro vide 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 U.S. Pr eventative Services T ask For ce with res pect to the
11 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 eventative care and scr eening pr ovided for in compreh ensive guidelines
16 supported by the Health Resources 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 requ ired 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 eventative 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 U.S. Pr eventative Services T ask For ce or to deny coverage for
30 services that are not reco mmended by the T ask For ce.
31 6. The dir ector of the department of commer ce and insurance shall enforc e the
32 pr ovisions of this section consistent with the re commendations and guidelines in effect
33 on December 31, 2025, set by the U.S. Pr eventative Services T ask For ce, the Advisory
34 Committee on Immunization Practices of the Centers for Disease Contr ol and
35 Pr evention, or the Health Resources and Services Administration, and re lated federal
36 rules or guidance.
37 7. The dir ector shall, by rule, adopt r egulations to requ ire health carriers and
38 health benefit plans to pr ovide coverage without cost-sharing r equir ement for any
39 pr eventative health care services r ecommendations and guidelines issued after
4 0 December 31, 2025, by the U.S. Pr eventative Services T ask For ce, the Advisory
41 Committee on Immunization Practices of the Centers for Disease Contr ol and
42 Pr evention, or the Health Resourc es and Services Administration, and r elating
43 federal rules or guidance.
44 8. (1) The department of commer ce and insurance shall cr eate an advisory
45 committee to be known as the "Health Insurance Pr eventative Health Car e Services
46 Advisory Committee". This committee shall be comprised of five members, with thr ee
47 r epresent atives of health car e pr oviders and two rep rese ntatives of health carriers and
48 health benefit plans. All members of the committee shall be appointed by , and serve at
49 the pleasur e of, the director of the department. The committee members shall serve
50 without compensation and shall not be r eimbursed for their expenses.
51 (2) The committee shall meet at least once a year to make r ecommendations to
52 the department, the general assembly , and the governor re garding any updates or
53 modifications, as necessary , to the preven tative health care services described in
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54 subsection 2 of this section. The committee shall pr ovide any recomm endations for
55 updates or modifications no later than November first each year to the department, the
56 general assembly , and the governor .
57 9. Any rule or portion of a rule, as that term is defined in section 536.010, that is
58 cr eated under the authority delegated in this section shall become effective only if it
59 complies with and is subject to all of the pr ovisions of chapter 536 and, if applicable,
60 section 536.028. This section and chapter 536 are nonseverable and if any of the powers
61 vested with the general assembly pursuant to chapter 536 to revi ew , to delay the
62 effective date, or to disappr ove and annul a rule are subsequently held unconstitutional,
63 then the grant of rulemaking authority and any rule pro posed or adopted after August
64 28, 2026, shall be invalid and void.
✔
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