Bill > HB1944

This bill creates two new sections in Missouri law addressing health insurance claims settlement practices, focusing specifically on anesthesia services and claim downcoding. For anesthesia services, the bill establishes detailed definitions for terms like "anesthesia time" and "anesthesia time units" and prohibits health carriers and health benefit plans from imposing time limits on payment for anesthesia services or excluding anesthesia time from payment calculations. Regarding claim downcoding (the unilateral reduction of a medical service code by an insurer), the bill mandates that downcoding can only be performed by a licensed physician in the same specialty as the treating physician, who must conduct a documented clinical review. The bill requires health carriers to provide clear notifications when downcoding occurs, including specific reasons for the change, original and revised service codes, and payment amounts. Additionally, the bill establishes an appeal process for physicians, allowing them to challenge downcoding decisions within 180 days and prohibits discriminatory downcoding practices against physicians treating patients with complex or chronic conditions. The legislation empowers the state's insurance director to take enforcement actions, including issuing administrative orders, maintaining civil actions, and potentially imposing penalties on health carriers who violate these provisions. The bill applies to various health insurance programs, including MO HealthNet, children's health insurance, and state-sponsored health insurance programs.

https://house.mo.gov/Bill.aspx?bill=HB1944&year=2026&code=R