SB 1469 - This act requires that the fee for the professional component of clinical pathology services shall be paid by MO HealthNet for professional services provided by a hospital-based pathologist for inpatient clinical pathology services rendered to MO HealthNet patients. The reimbursement shall be set at thirty percent of the approved outpatient simplified fee schedule based on Medicare's clinical laboratory fee schedule, as described in the act. This act is identical to provisions in HB 1599 (2025), HCS/SB 94 (2025), and SCS/HCS/HB 943 (2025) and substantially similar to provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 2372 (2026) and SS/SCS/SB 841 (2026). SARAH HASKINS
This bill directs the Missouri Department of Social Services to submit a state plan amendment or seek federal waivers to allow MO HealthNet, the state's Medicaid program, to cover fertility treatments for eligible participants. The legislation specifically targets individuals enrolled in MO HealthNet who may need assisted reproductive services, requiring the department to formally request approval from the Centers for Medicare and Medicaid Services to expand coverage. By mandating this administrative process, the bill ensures that any new fertility treatment benefits comply with federal Medicaid regulations while enabling the state to pursue coverage options for reproductive health services. The measure does not establish new coverage on its own but creates a pathway for the department to seek the necessary federal authorization to include these treatments in the program.
HB 3168 requires Missouri health insurance plans to cover doula services starting January 1, 2027. It mandates coverage for pregnant women enrolled in MO HealthNet (Missouri's Medicaid program), including up to 16 support sessions (6 base sessions plus 10 additional if needed) during pregnancy and the first year postpartum. The bill defines "doula services" as nonmedical birth support, including prenatal education, labor assistance, and postpartum care, and requires the Department of Health to establish registration criteria for doulas to qualify for reimbursement. It exempts supplemental policies like accident-only or Medicare supplement plans from this requirement. The bill is currently in committee after its first reading in February 2026.
SB 1687 modifies Missouri's MO HealthNet program to clarify how the state recovers payments from third parties (like insurance companies or liable entities) when they are responsible for medical costs. It establishes MO HealthNet as the "payer of last resort," requiring third parties to reimburse the state for covered services paid by MO HealthNet, with claims due within three years of service. The bill specifies that insurers must process valid subrogation claims without denying them for late submission, missing documentation, or prior authorization issues (except for Medicare plans), and limits reimbursement to amounts the insurer would have paid if billed properly. This directly affects MO HealthNet participants, healthcare providers, and third-party insurers by streamlining recovery processes and setting clear timelines.
HB 3382 reestablishes a state health assistance program for employed individuals with disabilities who meet specific income and asset criteria, directly affecting working people with disabilities who previously lost Medicaid coverage due to earnings. The bill allows medical assistance for those earning up to 250% of the federal poverty level (FPL), with premiums based on income brackets (4-6% of income), while excluding certain assets like medical savings accounts and retirement funds from eligibility calculations. Key provisions include requiring proof of Medicare/Social Security tax withholding for earned income, prioritizing employer-sponsored insurance when cost-effective, and mandating annual reports to the legislature on program participation. The program expires on August 28, 2032, and aligns with federal Ticket to Work Act requirements.
HB 3422 requires health insurance plans sold in the state to cover annual kidney function screening tests starting August 28, 2026. This affects all health carriers offering plans in the state after that date, directly benefiting individuals at risk for chronic kidney disease by ensuring access to preventive screenings. The bill mandates coverage for specific tests including kidney function (glomerular filtration rate), basic metabolic panels, and urine tests for albumin/creatinine. It excludes certain supplemental policies like Medicare supplements, short-term plans, and long-term care coverage. The law aims to promote early detection of chronic kidney disease through mandated insurance coverage.
HB 3368 requires health insurers in the state to cover vasectomies for all policyholders starting January 1, 2027, without requiring medical necessity or imposing higher deductibles/co-pays than other services. It also creates a state program through the Department of Social Services to cover vasectomies for uninsured male residents who lack employer or public insurance, with eligibility based solely on residency and lack of coverage (no income checks). The state will fund this program via a dedicated "Vasectomy Fund," which may receive federal or private contributions and cannot revert unused funds to general revenue. These provisions apply to all health benefit plans issued in the state after 2026, excluding certain supplemental policies like short-term or Medicare supplements.
HB 2645 limits how pharmacy benefits managers (PBMs) can charge patients for prescription drugs. It prohibits PBMs from requiring patients to pay more at checkout than the cash price or their insurance copayment, and allows pharmacists to discuss cheaper drug alternatives without PBM restrictions. The bill also requires PBMs to disclose conflicts of interest to health plans and prohibits them from holding pharmacies responsible for unknown claim fees. It excludes Medicare Part D and self-funded employer health plans from these rules. The law applies to all other health benefit plans and pharmacy claims in the state.
SB 1571 modifies insurance coverage requirements for orthotic, prosthetic, and assistive devices. It directly affects individuals who rely on these medical devices, such as people with mobility impairments or chronic conditions. The bill changes existing provisions to clarify or adjust how health insurers must cover these specific items. This legislation is currently in committee review after its initial reading in January 2026.
HB 1658 requires most health insurance plans in the state to cover orthotic and prosthetic devices (like braces, supports, or artificial limbs) prescribed by a doctor. It mandates that coverage must match the benefit levels, copayments, and deductibles applied to basic health care services, with no separate annual or lifetime limits unless the plan has none for basic care. This applies to standard health plans but excludes supplemental policies like Medicare supplements, short-term plans, or accident-only coverage. The bill directly affects patients needing these devices and insurers offering health coverage in the state.
