Requires parity between out-of-pocket expenses charged for occupational therapist services and similar services provided by primary care physicians
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FIRST REGULAR SESSION
HOUSE BILL NO. 548
98TH GENERAL ASSEMBLY
D. ADAM CRUMBLISS, Chief Clerk
INTRODUCED BY REPRESENTATIVE ROWDEN.
To repeal section 376.1235, RSMo, and to enact in lieu thereof one new section relating to
insurance coverage for occupational therapy services.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 376.1235, RSMo, is repealed and one new section enacted in lieu thereof, to be known as section 376.1235, to read as follows:
376.1235. 1. No health carrier or health benefit plan, as defined in section 376.1350, shall impose a co-payment or coinsurance percentage charged to the insured for services rendered for each date of service by a physical therapist licensed under chapter 334 or occupational therapist licensed under chapter 324, for services that require a prescription, that is greater than the co-payment or coinsurance percentage charged to the insured for the services of a primary care physician licensed under chapter 334 for an office visit. 2. A health carrier or health benefit plan shall clearly state the availability of physical therapy and occupational therapy coverage under its plan and all related limitations, conditions, and exclusions. 3. Beginning September 1,  2015, the oversight division of the joint committee on legislative research shall perform an actuarial analysis of the cost impact to health carriers, insureds with a health benefit plan, and other private and public payers if the provisions of this section regarding occupational therapy coverage were enacted. By December 31,  2015, the director of the oversight division of the joint committee on legislative research shall submit a report of the actuarial findings prescribed by this section to the speaker, the president pro tem, and the chairpersons of both the house of representatives and senate standing committees having jurisdiction over health insurance matters. If the fiscal note cost estimation is less than the cost of an actuarial analysis, the actuarial analysis requirement shall be waived.
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language.