Bill > HB1071

This bill amends Missouri insurance law to provide protections for patients seeking mental health and behavioral health treatments, particularly in emergency situations. Specifically, if a patient is admitted to an emergency room with a mental health condition and is transferred to a hospital outside their health plan's network, the insurance carrier cannot impose higher cost-sharing requirements than they would for an in-network provider. Additionally, the carrier must reimburse the out-of-network hospital at the same rate as MO HealthNet (the state's Medicaid program). The bill also establishes a legal standard for network adequacy, creating a rebuttable presumption that a health plan's mental health provider network is inadequate if more than 15% of enrollees with behavioral or mental health conditions are treated outside the network. This would constitute an unlawful practice under existing consumer protection laws, potentially allowing for legal action against the health carrier. The bill defines cost-sharing broadly to include co-payments, coinsurance, deductibles, and other out-of-pocket expenses related to mental health treatment.

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https://house.mo.gov/Bill.aspx?bill=HB1071&year=2025&code=R