Read the full stored bill text
SECOND REGULAR SESSION
SENATE BILL NO. 1644
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR HUDSON.
6945S.01I KRISTINA MARTIN, Secretary
AN ACT
To amend chapter 376, RSMo, by adding thereto one new section relating to conduct affecting
health care provider networks.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto 1
one new section, to be known as section 376.1068, to read as 2
follows:3
376.1068. 1. As used in this section, the following 1
terms mean: 2
(1) "Anti-steering clause", a provision in a provider 3
network contract that restricts the ability of a general 4
contracting entity to encourage an enrollee to obtain a 5
health care service from a competitor of the provider, 6
including offering incentives to encourage enrollees to use 7
specific providers; 8
(2) "Anti-tiering clause", a provision in a provider 9
network contract that: 10
(a) Restricts the ability of a general contracting 11
entity to introduce or modify a tiered network plan or 12
assign providers into tiers; or 13
(b) Requires a general contracting entity to place all 14
members of a provider in the same tier of a tiered network 15
plan; 16
SB 1644 2
(3) "Covered individual", an individual who is covered 17
under a health benefit plan; 18
(4) "Enrollee", the same meaning given to the term in 19
section 376.1350; 20
(5) "Facility", the same meaning given to the term in 21
section 376.1350; 22
(6) "Gag clause", a provision in a provider network 23
contract that restricts the ability of a general contracting 24
entity or provider to disclose: 25
(a) Price or quality information, including the 26
allowed amount, negotiated rates or discounts, fees for 27
services, or other claim-related financial obligations 28
included in the contract, to a governmental entity as 29
authorized by law or its contractors or agents, an enrollee, 30
a treating provider of an enrollee, a plan sponsor, or 31
potential eligible enrollees and plan sponsors; or 32
(b) Out-of-pocket costs to an enrollee; 33
(7) "General contracting entity", a person who enters 34
into a direct contract with a provider for the delivery of 35
health care services to covered individuals regardless of 36
whether the person, in the ordinary course of business, 37
establishes a provider network for access by another party. 38
The term "general contracting entity" shall not include a 39
health care provider or facility unless the provider or 40
facility is entering into the contract in the provider's or 41
facility's role as a health benefit plan; 42
(8) "Health benefit plan", the same meaning given to 43
the term in section 376.1350; 44
(9) "Health care service", the same meaning given to 45
the term in section 376.1350; 46
(10) "Most-favored-nation clause", a provision in a 47
provider network contract that: 48
SB 1644 3
(a) Prohibits or grants an option to prohibit: 49
a. A provider from contracting with another general 50
contracting entity to provide health care services at a 51
lower rate; or 52
b. A general contracting entity from contracting with 53
another provider to provide health care services at a higher 54
rate; 55
(b) Requires or grants an option to require: 56
a. A provider to accept a lower rate for health care 57
services if the provider agrees with another general 58
contracting entity to accept a lower rate for the services; 59
or 60
b. A general contracting entity to pay a higher rate 61
for health care services if the entity agrees with another 62
provider to pay a higher rate for the services; 63
(c) Requires or grants an option to require 64
termination or renegotiation of an existing provider network 65
contract if: 66
a. A provider agrees with another general contracting 67
entity to accept a lower rate for providing health care 68
services; or 69
b. A general contracting entity agrees with a provider 70
to pay a higher rate for health care services; or 71
(d) Requires: 72
a. A provider to disclose the provider's contractual 73
reimbursement rates with other general contracting entities; 74
or 75
b. A general contracting entity to disclose the 76
general contracting entity's contractual reimbursement rates 77
with other providers; 78
(11) "Provider", the same meaning given to the term in 79
section 376.1350; 80
SB 1644 4
(12) "Provider network contract", a contract between a 81
general contracting entity and a provider for the delivery 82
of, and payment for, health care services to a covered 83
individual. 84
2. A provider shall not: 85
(1) Offer to a general contracting entity a written 86
provider network contract that includes an anti-steering, 87
anti-tiering, gag, or most-favored-nation clause; 88
(2) Enter into a provider network contract that 89
includes an anti-steering, anti-tiering, gag, or most- 90
favored-nation clause; or 91
(3) Amend or renew an existing provider network 92
contract previously entered into with a general contracting 93
entity so that the contract as amended or renewed adds or 94
retains an anti-steering, anti-tiering, gag, or most-favored- 95
nation clause. 96
3. Any provision in a provider network contract that 97
is an anti-steering, anti-tiering, gag, or most-favored- 98
nation clause is void and unenforceable. The remaining 99
provisions in the provider network contract shall remain in 100
effect and are enforceable. 101
4. A health benefit plan issuer that encourages an 102
enrollee to obtain a health care service from a particular 103
provider, including offering incentives to encourage 104
enrollees to use specific providers, or that introduces or 105
modifies a tiered network plan or assigns providers into 106
tiers has a good faith duty to the enrollee or policyholder 107
to engage in that conduct for the benefit of the enrollee or 108
policyholder. 109
✓