Effective - 28 Aug 2019
191.1164. Citation of law — definitions. — 1. Sections 191.1164 to 191.1168 shall be known and may be cited as the "Ensuring Access to High Quality Care for the Treatment of Substance Use Disorders Act".
2. As used in sections 191.1164 to 191.1168, the following terms shall mean:
(1) "Behavioral therapy", an individual, family, or group therapy designed to help patients engage in the treatment process, modify their attitudes and behaviors related to substance use, and increase healthy life skills;
(2) "Department of insurance", the department that has jurisdiction regulating health insurers;
(3) "Financial requirements", deductibles, co-payments, coinsurance, or out-of-pocket maximums;
(4) "Health care professional", a physician or other health care practitioner licensed, accredited, or certified by the state of Missouri to perform specified health services;
(5) "Health insurance plan", an individual or group plan that provides, or pays the cost of, health care items or services;
(6) "Health insurer", any person or entity that issues, offers, delivers, or administers a health insurance plan;
(7) "Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)", the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 found at 42 U.S.C. Section 300gg-26 and its implementing and related regulations found at 45 CFR 146.136, 45 CFR 147.160, and 45 CFR 156.115;
(8) "Nonquantitative treatment limitation" or "NQTL", any limitation on the scope or duration of treatment that is not expressed numerically;
(9) "Pharmacologic therapy", a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance use disorder;
(10) "Pharmacy benefits manager", an entity that contracts with pharmacies on behalf of health carriers or any health plan sponsored by the state or a political subdivision of the state;
(11) "Prior authorization", the process by which the health insurer or the pharmacy benefits manager determines the medical necessity of otherwise covered health care services prior to the rendering of such health care services. Prior authorization also includes any health insurer's or utilization review entity's requirement that a subscriber or health care provider notify the health insurer or utilization review entity prior to receiving or providing a health care service;
(12) "Quantitative treatment limitation" or "QTL", numerical limits on the scope or duration of treatment, which include annual, episode, and lifetime day and visit limits;
(13) "Step therapy", a protocol or program that establishes the specific sequence in which prescription drugs for a medical condition that are medically appropriate for a particular patient are authorized by a health insurer or prescription drug management company;
(14) "Urgent health care service", a health care service with respect to which the application of the time period for making a nonexpedited prior authorization, in the opinion of a physician with knowledge of the enrollee's medical condition:
(a) Could seriously jeopardize the life or health of the subscriber or the ability of the enrollee to regain maximum function; or
(b) Could subject the enrollee to severe pain that cannot be adequately managed without the care or treatment that is the subject of the utilization review.
3. For the purpose of this section, "urgent health care service" shall include services provided for the treatment of substance use disorders.
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(L. 2019 S.B. 514)
Structure Missouri Revised Statutes
Title XII - Public Health and Welfare
Chapter 191 - Health and Welfare
Section 191.005 - Information exchange between departments, rulemaking authority.
Section 191.025 - Health care compact.
Section 191.127 - Land may be leased for farming or grazing — procedure.
Section 191.150 - Purchase of food limited to use of institution inmates.
Section 191.160 - Board and living quarters for employees of institutions.
Section 191.170 - Mistreatment of inmates — penalty.
Section 191.180 - Furnishing unfit food to institution — penalty.
Section 191.190 - Accessory to mistreatment of inmates or furnishing of unwholesome food — penalty.
Section 191.210 - Attendance of patient by private physician.
Section 191.211 - Funding of certain programs.
Section 191.213 - Additional funding sources for certain programs.
Section 191.228 - Physician and pharmacist not subject to discipline for cooperation.
Section 191.300 - Definitions.
Section 191.315 - Genetics program to be established by department — rules authorized — procedure.
Section 191.335 - Hemophilia program established — state assistance, when.
Section 191.362 - Appropriately trained employees to have completed course in dialysis techniques.
Section 191.365 - Sickle cell anemia — purposes of program — financial assistance, when.
Section 191.375 - Cystic fibrosis, program for care and treatment — financial assistance, when.
Section 191.380 - Cystic fibrosis, duties of department.
Section 191.500 - Definitions.
Section 191.510 - Contracts for loans to include terms.
Section 191.515 - Requirements for application.
Section 191.520 - Maximum amount of loans — source of funds.
Section 191.525 - Number of loans available — to whom — length of loans.
Section 191.530 - Interest on loans — repayment terms — temporary deferral.
Section 191.535 - Termination of course of study, effect.
Section 191.540 - Repayment schedules — breach of contract.
Section 191.545 - Recovery — actions for.
Section 191.550 - Approval of contracts.
Section 191.603 - Definitions.
Section 191.605 - Department to designate as areas of need — factors to be considered.
Section 191.607 - Qualifications for eligibility established by department.
Section 191.609 - Contract for repayment of loans, contents.
Section 191.615 - Application for federal funds — insufficient funds, effect.
Section 191.630 - Definitions.
Section 191.650 - Definitions.
Section 191.653 - HIV testing performed by whom, how — consultation with subject required, when.
Section 191.665 - Discrimination prohibited, exceptions.
Section 191.680 - Maintaining a nuisance, abatement to be ordered, when.
Section 191.683 - Reports to general assembly by department of health and senior services.
Section 191.692 - Premarital HIV testing, rulemaking authorized, when.
Section 191.695 - Rulemaking authority, department of health and senior services — procedure.
Section 191.710 - MO HealthNet program and SCHIPS to focus on premature infant health care.
Section 191.711 - Education publications to be prepared, contents — distribution.
Section 191.748 - Shaken baby syndrome video, required viewing, when.
Section 191.755 - Department to post resources on website, content.
Section 191.756 - Grants awarded by board of health and senior services — eligibility criteria.
Section 191.758 - Information to be made available by physician to pregnant women, when.
Section 191.765 - Definitions.
Section 191.769 - Areas not considered public places.
Section 191.771 - Person in control of public places or public meetings, duties.
Section 191.773 - Violators, guilty of infraction.
Section 191.800 - Definitions.
Section 191.803 - Boards of education to establish breakfast program — rules — waiver, procedure.
Section 191.805 - Hardship grant program, distribution of, rules.
Section 191.815 - Administrative rules, procedure.
Section 191.828 - Evaluations, effect of initiatives.
Section 191.839 - Education programs for persons with no or inadequate health insurance.
Section 191.843 - Authorizes grants for regional research consortia in a distressed community.
Section 191.900 - Definitions.
Section 191.907 - Original source of information to receive a portion of any recovery.
Section 191.908 - Whistleblower protections — violations, penalty.
Section 191.914 - False report or claim, penalty.
Section 191.915 - Breast-feeding information provided, when, by whom.
Section 191.931 - Early intervention services available — report, content.
Section 191.937 - Rulemaking authority, procedure.
Section 191.990 - Diabetes goals and benchmarks — report, contents.
Section 191.1050 - Definitions.
Section 191.1056 - Fund created, use of moneys.
Section 191.1075 - Definitions.
Section 191.1080 - Council created, purpose, members, terms, duties — report — expiration date.
Section 191.1085 - Program established, purpose — website information — rulemaking authority.
Section 191.1100 - Citation of law — definitions.
Section 191.1102 - Additional licensure not required, when — inapplicability.
Section 191.1104 - Display of license or certificate, how satisfied.
Section 191.1140 - Treatment of chronic, common, and complex diseases, program authorized, purpose.
Section 191.1145 - Definitions — telehealth services authorized, when.
Section 191.1146 - Physician-patient relationship required, how established.
Section 191.1150 - Citation of law — definitions — designation of caregiver, when — requirements.
Section 191.1164 - Citation of law — definitions.
Section 191.1167 - Contracts, policies, or procedures in violation of act deemed null and void.
Section 191.1168 - Severability clause.
Section 191.1601 - Citation of law.
Section 191.1603 - Definitions.
Section 191.1604 - Long-term dignity savings account, use, requirements.
Section 191.1606 - Reporting, forms — rulemaking authority.
Section 191.1607 - Financial institutions, requirements — no responsibility or liability, when.