Bill > SB550

This bill amends Missouri insurance law to provide protections for individuals seeking mental health treatment in emergency situations. The legislation defines key terms related to health insurance, including "cost-sharing," which encompasses various out-of-pocket expenses like copayments and deductibles. When an enrollee is admitted to an emergency room for a behavioral or mental health condition and is transferred to a hospital outside their health plan's network, the bill mandates that health carriers cannot impose higher cost-sharing requirements than they would for in-network providers. Additionally, the health carrier must reimburse the out-of-network hospital at the same rate used by MO HealthNet, the state's Medicaid program. The bill also establishes a legal standard for network adequacy, stating that a health benefit plan's provider network for mental health services is considered inadequate if more than 15% of enrollees receive treatment outside the network, which could be grounds for legal action under consumer protection laws. This provision aims to ensure that patients have reasonable access to mental health care and are not financially penalized for seeking necessary treatment.

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https://www.senate.mo.gov/25info/BTS_Web/Bill.aspx?SessionType=R&BillID=1887432