Effective - 28 Aug 2021, 2 histories
191.1165. Medication-assisted treatment — formulary medications and requirements — disclosure of MAT services provided — incarcerated persons and diversion program participants, assessment for substance use disorders. — 1. Medication-assisted treatment (MAT) shall include pharmacologic therapies. A formulary used by a health insurer or managed by a pharmacy benefits manager, or medical benefit coverage in the case of medications dispensed through an opioid treatment program, shall include:
(1) Buprenorphine;
(2) Methadone;
(3) Naloxone;
(4) Naltrexone, including but not limited to extended-release injectable naltrexone; and
(5) Buprenorphine
aloxone combination.
2. All MAT medications required for compliance in this section shall be placed on the lowest cost-sharing tier of the formulary managed by the health insurer or the pharmacy benefits manager.
3. MAT medications provided for in this section shall not be subject to any of the following:
(1) Any annual or lifetime dollar limitations;
(2) Financial requirements and quantitative treatment limitations that do not comply with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), specifically 45 CFR 146.136(c)(3);
(3) Step therapy or other similar drug utilization strategy or policy when it conflicts or interferes with a prescribed or recommended course of treatment from a licensed health care professional; and
(4) Prior authorization for MAT medications as specified in this section.
4. MAT medications outlined in this section shall apply to all health insurance plans delivered in the state of Missouri.
5. Any entity that holds itself out as a treatment program or that applies for licensure by the state to provide clinical treatment services for substance use disorders shall be required to disclose the MAT services it provides, as well as which of its levels of care have been certified by an independent, national, or other organization that has competencies in the use of the applicable placement guidelines and level of care standards.
6. The MO HealthNet program shall cover the MAT medications and services provided for in this section and include those MAT medications in its preferred drug lists for the treatment of substance use disorders and prevention of overdose and death. The preferred drug list shall include all current and new formulations and medications that are approved by the U.S. Food and Drug Administration for the treatment of substance use disorders.
7. Subject to appropriations, the department of corrections and all other state entities responsible for the care of persons detained or incarcerated in jails or prisons shall be required to ensure all persons under their care are assessed for substance abuse disorders using standard diagnostic criteria by a social worker; licensed professional counselor; licensed psychologist; psychiatrist; or qualified addiction professional, as defined by the department of mental health, acting within the scope of practice for which the qualified addiction professional is credentialed. The department of corrections or state entity shall make available the MAT services covered in this section, consistent with a treatment plan developed by a physician, and shall not impose any arbitrary limitations on the type of medication or other treatment prescribed or the dose or duration of MAT recommended by the physician.
8. Drug courts or other diversion programs that provide for alternatives to jail or prison for persons with a substance use disorder shall be required to ensure all persons under their care are assessed for substance use disorders using standard diagnostic criteria by a licensed physician who actively treats patients with substance use disorders. The court or other diversion program shall make available the MAT services covered under this section, consistent with a treatment plan developed by the physician, and shall not impose any limitations on the type of medication or other treatment prescribed or the dose or duration of MAT recommended by the physician.
9. Requirements under this section shall not be subject to a covered person's prior success or failure of the services provided.
--------
(L. 2019 S.B. 514, A.L. 2021 S.B. 53 & 60)
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.