Read the full stored bill text
EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1490
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR GREGORY (21).
5887S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 376.427 and 376.1575, RSMo, and to enact in lieu thereof two new sections
relating to athletic trainers.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 376.427 and 376.1575, RSMo, are 1
repealed and two new sections enacted in lieu thereof, to be 2
known as sections 376.427 and 376.1575, to read as follows:3
376.427. 1. As used in this section, the following 1
terms mean: 2
(1) "Health benefit plan", as such term is defined in 3
section 376.1350. The term health benefit plan shall also 4
include a prepaid dental plan, as defined in section 354.700; 5
(2) "Health care services", medical, surgical, dental, 6
podiatric, pharmaceutical, chiropractic, licensed ambulance 7
service, and optometric services; 8
(3) "Health carrier" or "carrier", as such term is 9
defined in section 376.1350. The term health carrier or 10
carrier shall also include a prepaid dental plan 11
corporation, as defined in section 354.700; 12
(4) "Insured", any person entitled to benefits under a 13
contract of accident and sickness insurance, or medical- 14
payment insurance issued as a supplement to liability 15
insurance but not including any other coverages contained in 16
SB 1490 2
a liability or a workers' compensation policy, issued by an 17
insurer; 18
(5) "Insurer", any person, reciprocal exchange, 19
interinsurer, fraternal benefit society, health services 20
corporation, self-insured group arrangement to the extent 21
not prohibited by federal law, prepaid dental plan 22
corporation as defined in section 354.700, or any other 23
legal entity engaged in the business of insurance; 24
(6) "Provider", a physician, hospital, dentist, 25
podiatrist, chiropractor, athletic trainer, pharmacy, 26
licensed ambulance service, or optometrist, licensed by this 27
state. 28
2. Upon receipt of an assignment of benefits made by 29
the insured to a provider, the insurer shall issue the 30
instrument of payment for a claim for payment for health 31
care services in the name of the provider. All claims shall 32
be paid within thirty days of the receipt by the insurer of 33
all documents reasonably needed to determine the claim. 34
3. Nothing in this section shall preclude an insurer 35
from voluntarily issuing an instrument of payment in the 36
single name of the provider. 37
4. Except as provided in subsection 5 of this section, 38
this section shall not require any insurer, health services 39
corporation, prepaid dental plan as defined in section 40
354.700, health maintenance corporation or preferred 41
provider organization which directly contracts with certain 42
members of a class of providers for the delivery of health 43
care services to issue payment as provided pursuant to this 44
section to those members of the class which do not have a 45
contract with the insurer. 46
5. When a patient's health benefit plan does not 47
include or require payment to out-of-network providers for 48
SB 1490 3
all or most covered services, which would otherwise be 49
covered if the patient received such services from a 50
provider in the health benefit plan's network, including but 51
not limited to health maintenance organization plans, as 52
such term is defined in section 354.400, or a health benefit 53
plan offered by a carrier consistent with subdivision (19) 54
of section 376.426, payment for all services shall be made 55
directly to the providers when the health carrier has 56
authorized such services to be received from a provider 57
outside the health benefit plan's network. 58
6. Payments made to providers under this section shall 59
be subject to the provisions of section 376.383. Entities 60
that are not currently subject to the provisions of section 61
376.383 shall have a delayed effective date of January 1, 62
2026 to be subject to such provisions. 63
376.1575. As used in sections 376.1575 to [376.1580] 1
376.1578, the following terms shall mean: 2
(1) "Completed application", a practitioner's 3
application to a health carrier that seeks the health 4
carrier's authorization for the practitioner to provide 5
patient care services as a member of the health carrier's 6
network and does not omit any information which is clearly 7
required by the application form and the accompanying 8
instructions; 9
(2) "Credentialing", a health carrier's process of 10
assessing and validating the qualifications of a 11
practitioner to provide patient care services and act as a 12
member of the health carrier's provider network; 13
(3) "Health carrier", the same meaning as such term is 14
defined in section 376.1350. The term health carrier shall 15
also include any entity described in subdivision (4) of 16
section 354.700; 17
SB 1490 4
(4) "Practitioner": 18
(a) A physician [or], physician assistant, or athletic 19
trainer eligible to provide treatment services under chapter 20
334; 21
(b) A pharmacist eligible to provide services under 22
chapter 338; 23
(c) A dentist eligible to provide services under 24
chapter 332; 25
(d) A chiropractor eligible to provide services under 26
chapter 331; 27
(e) An optometrist eligible to provide services under 28
chapter 336; 29
(f) A podiatrist eligible to provide services under 30
chapter 330; 31
(g) A psychologist or licensed clinical social worker 32
eligible to provide services under chapter 337; or 33
(h) An advanced practice nurse eligible to provide 34
services under chapter 335. 35
✓