SB897 • 2026

Enacts provisions relating to prior authorization of health care services

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Brown (26), Ben; House handler: N/A
Last action: 2026-03-03
Official status: Hearing Conducted S Insurance and Banking Committee
Effective date: 2026-08-28

Plain English Breakdown

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.

Enacts provisions relating to prior authorization of health care services

The following summaries of this bill are available: Print All Summaries Introduced Print SB 897 - This act provides that health care providers shall not be required to obtain prior authorization for a health care service unless the health carrier or utilization review entity determines that in the most recent evaluation period, as defined in the act, less than 90% of the prior authorization requests submitted by that provider for that health care service were approved or would have been approved.

What This Bill Does

The following summaries of this bill are available: Print All Summaries Introduced Print SB 897 - This act provides that health care providers shall not be required to obtain prior authorization for a health care service unless the health carrier or utilization review entity determines that in the most recent evaluation period, as defined in the act, less than 90% of the prior authorization requests submitted by that provider for that health care service were approved or would have been approved.
Additionally, health care providers shall not be required to obtain prior authorization for any health care services unless the health carrier or utilization review entity has approved or would have approved less than 90% of all prior authorization requests submitted by that provider for health care services.
Health carriers and utilization review entities shall notify providers within 25 days after a determination is made under the act, shall include in the notification certain information used in making the determination, shall establish an appeals process for the providers, and shall maintain an online prior authorization portal as described in the act.
No health carrier or utilization review entity shall deny or reduce payment to a health care provider for a health care service for which the provider has prior authorization, except as described in the act.

Limits and Unknowns

This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

Bill History

2026-03-03 Missouri House of Representatives and Missouri Senate
Hearing Conducted S Insurance and Banking Committee
2026-01-08 S126
Second Read and Referred S Insurance and Banking Committee
2026-01-07 S41
S First Read
2025-12-01 Missouri House of Representatives and Missouri Senate
Prefiled

Official Summary Text

The following summaries of this bill are available:

Print All Summaries

Introduced

Print

SB 897 - This act provides that health care providers shall not be required to obtain prior authorization for a health care service unless the health carrier or utilization review entity determines that in the most recent evaluation period, as defined in the act, less than 90% of the prior authorization requests submitted by that provider for that health care service were approved or would have been approved.

Additionally, health care providers shall not be required to obtain prior authorization for any health care services unless the health carrier or utilization review entity has approved or would have approved less than 90% of all prior authorization requests submitted by that provider for health care services.

Health carriers and utilization review entities shall notify providers within 25 days after a determination is made under the act, shall include in the notification certain information used in making the determination, shall establish an appeals process for the providers, and shall maintain an online prior authorization portal as described in the act.

No health carrier or utilization review entity shall deny or reduce payment to a health care provider for a health care service for which the provider has prior authorization, except as described in the act.

This act shall not apply to MO HealthNet services not provided through a managed care organization, or to providers who have not participated in a health benefit plan offered by the health carrier for at least one full evaluation period.

This act is identical to HB 1675 (2026), substantially similar to HB 618 (2025) and to provisions in HCS/SB 94 (2025), and is similar to SB 846 (2026), SB 841 (2026), HCS/HB 3010 (2026), SB 230 (2025), SB 983 (2024), HB 1976 (2024), SB 576 (2023), and HB 1045 (2023).
TAYLOR MIDDLETON

Current Bill Text

Read the full stored bill text

SECOND REGULAR SESSION
SENATE BILL NO. 897
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BROWN (26).
4611S.01I KRISTINA MARTIN, Secretary
AN ACT
To amend chapter 376, RSMo, by adding thereto five new sections relating to prior authorization
of 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 1
five new sections, to be known as sections 376.2100, 376.2102, 2
376.2104, 376.2106, and 376.2108, to read as follows:3
376.2100. 1. Except as otherwise provided in 1
subsection 1 of section 376.2108, as used in sections 2
376.2100 to 376.2108, terms shall have the same meanings as 3
are ascribed to them under section 376.1350. 4
2. As used in sections 376.2100 to 376.2108, the term 5
"evaluation period" shall mean the first six months of the 6
calendar year or the last six months of the calendar year. 7
376.2102. 1. A health carrier or utilization review 1
entity shall not require a health care provider to obtain 2
prior authorization for a health care service unless the 3
health carrier or utilization review entity makes a 4
determination that in the most recent evaluation period the 5
health carrier or utilization review entity has approved or 6
would have approved less than ninety percent of the prior 7
authorization requests submitted by that provider for that 8
health care service. 9
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2. A health carrier or utilization review entity shall 10
not require a health care provider to obtain prior 11
authorization for any health care services unless the health 12
carrier or utilization review entity makes a determination 13
that in the most recent evaluation period the health carrier 14
or utilization review entity has approved or would have 15
approved less than ninety percent of all prior authorization 16
requests submitted by that provider for health care services. 17
3. In making a determination under this section, the 18
health carrier or utilization review entity shall not count 19
any prior authorization requests denied by a health carrier 20
or utilization review entity and being appealed by the 21
health care provider but shall count as approved any prior 22
authorization request that was denied by a health carrier or 23
utilization review entity but that was subsequently 24
authorized. 25
376.2104. 1. The health carrier or utilization review 1
entity shall notify the health care provider no later than 2
twenty-five days after the conclusion of the relevant 3
evaluation period of any determination made under section 4
376.2102. The notification shall include the statistics, 5
data, and any supporting documentation for making the 6
determination for the relevant evaluation period. 7
2. The health carrier or utilization review entity 8
shall establish a process for health care providers to 9
appeal any determinations made under section 376.2102. 10
3. The health carrier or utilization review entity 11
shall maintain an online portal to allow health care 12
providers to access all prior authorization decisions, 13
including determinations made under section 376.2102. For 14
health care providers subject to prior authorizations, the 15
portal shall include the status of each prior authorization 16
SB 897 3
request, all notifications to the health care provider, the 17
dates the health care provider received such notifications, 18
and any other information relevant to the determination. 19
376.2106. No health carrier or utilization review 1
entity shall deny or reduce payment to a health care 2
provider for a health care service for which the provider 3
has a prior authorization unless the provider: 4
(1) Knowingly and materially misrepresented the health 5
care service in a request for payment submitted to the 6
health carrier or utilization review entity with the 7
specific intent to deceive and obtain an unlawful payment 8
from the carrier or entity; or 9
(2) Failed to substantially perform the health care 10
service. 11
376.2108. 1. The provisions of sections 376.2100 to 1
376.2108 shall not apply to MO HealthNet, except that a 2
Medicaid managed care organization as defined in section 3
208.431 shall be considered a health carrier for purposes of 4
sections 376.2100 to 376.2108. 5
2. The provisions of sections 376.2100 to 376.2108 6
shall not apply to health care providers who have not 7
participated in a health benefit plan offered by the health 8
carrier for at least one full evaluation period. 9
3. Nothing in sections 376.2100 to 376.2108 shall be 10
construed to: 11
(1) Authorize a health care provider to provide a 12
health care service outside the scope of his or her 13
applicable license; or 14
(2) Require a health carrier or utilization review 15
entity to pay for a health care service described in 16
subdivision (1) of this subsection. 17
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