New Requirements for Health Care Providers Under Missouri’s Health Care Cost and Transparency Act

On May 25, 2016, Missouri Senate Bill 608 was passed by the Missouri House and Senate.  The Bill adds new requirements to the provision known as the “Health Care Cost and Transparency Act.” Beginning July 1, 2017, the new law requires all licensed health care providers, facilities, and imaging centers to provide an estimate on the cost of a particular health care service or procedure within three business days of a written request from the patient, along with a medical treatment plan from the patient’s health care provider. The estimate must only include those services within the direct control of the health care provider and the amount that will be charged to a patient if all of the charges are paid in full by the patient, without a public or private third-party paying for any portion of the charge. Further, these provisions do not apply to charges for hospital emergency departments.

If health care providers provide publicly available links to the estimated costs or post such costs on a publicly available website, they are not required to provide cost estimates to patients upon written request.

Beginning also July 1, 2017, hospitals will be required to make publicly available the amount that would be charged, without discounts, for each of the 100 most prevalent diagnosis-related groups, as defined by Medicare.

On July 5, 2016, Governor Jay Nixon vetoed Missouri Senate Bill 608. In his veto letter, Governor Nixon offered reasons that are unrelated to the “Health Care Cost and Transparency Act” provision of the Bill.  Specifically, he opposed the provision of the Bill that would impose fees on MO HealthNet participants for missing appointments or failing to provide twenty-four hour cancellation notice. The Bill would also prohibit a MO HealthNet participant from scheduling another appointment until the fee is paid. Governor Nixon argued that this would needlessly punish our state’s most vulnerable citizens, calling the fees “cruel and punitive.”

He used the opportunity to criticize the legislature for refusing to expand Medicaid edibility over the past four years, costing Missouri billions of dollars in federal funding. He argued that Medicaid needs to be strengthened in Missouri, noting that currently, in order for an individual to qualify for Medicaid in Missouri, a single parent with two children can make no more than $3,600 per year. “Strengthening Medicaid would provide health coverage to an additional 300,000 working Missourians, create thousands of jobs in high-paying health care fields, and generate millions of dollars in revenues for other priorities.”

However, on September 14, 2016, the Missouri House of Representatives joined the Missouri Senate in overriding Governor Nixon’s veto with a vote of 110-45.  Therefore, Missouri Senate Bill 608 will become law.  It will be interesting to see its implementation. In 2014, Massachusetts passed a similar price transparency law requiring hospitals, physicians, clinics, and insurance companies to give patients the price of medical services prospectively. The results of a study by Pioneer Institute were discouraging.  The study found that many health care providers lacked systems or procedures for price inquiries.  In the cases where price estimates were actually obtained, it took an average of two-to-four business days and numerous calls. Furthermore, the study found wide variation in price estimates.

Click here to read Missouri Senate Bill 608

Click here to read the Pioneer Institute’s Survey

Posted by Attorney Katherine M. Flett. Flett is a member of the litigation team focusing on assisting clients with matters relating to business, civil and commercial litigation.