Bill > HB1675

This bill creates new provisions for prior authorization of health care services, focusing on reducing administrative burdens for health care providers. Specifically, health carriers (insurance companies) or utilization review entities (organizations that review the medical necessity of health care services) will be prohibited from requiring prior authorization for a health care service if they have approved at least 90% of prior authorization requests from a specific provider during the previous six-month evaluation period. The bill mandates that health carriers notify providers within 25 days after an evaluation period about any prior authorization requirements, establish an appeals process, and maintain an online portal with detailed information about prior authorization decisions. Additionally, the bill prevents health carriers from denying payment for a service that has received prior authorization, unless the provider knowingly misrepresented the service or failed to substantially perform it. The provisions do not apply to MO HealthNet (Missouri's Medicaid program) except for Medicaid managed care organizations, and they also do not apply to providers who have not participated in a health benefit plan for at least one full evaluation period. The bill aims to streamline the prior authorization process and reduce administrative barriers for health care providers.

https://house.mo.gov/Bill.aspx?bill=HB1675&year=2026&code=R