Missouri House passes bill to streamline medical treatment approvals from insurance companies

The Missouri House of Representatives easily passed legislation this week that aims to reduce insurance bureaucracy that can delay medical treatment for patients.

The bill, HB618, will head to the Senate for consideration.

The bill targets what is called prior authorization. This is a step doctors have to take to convince insurance companies to cover certain treatments as part of an insurance company’s cost-control process.

Among other things, the bill states that providers with a 90% approval rate in previous requests won’t need prior authorization for most services. Hospitals won’t need prior authorization if they have a value-based care agreement; score at least three out of five on Medicare’s rating system; or have a 91% approval rate for prior authorization requests. Critical care hospitals are automatically exempt.

Exemptions can be revoked if approval rates drop, fraud occurs or unnecessary procedures increase.

“HB 618 will help Missourians improve their health care outcomes by increasing the amount of time providers are able to spend with patients, and reduce the time delays often experienced by patients waiting on an insurance company to preauthorize a service,” said John Voss, Cape Girardeau’s representative. “Our state is short of health care workers, and these providers often experience frustration and burn out from regulations and requirements placed upon them by insurance carriers. This bill will enable health care workers to help more patients while still providing oversight of both the health care and insurance industries.”

John VossSubmitted

The bill was supported by the Missouri State Medical Association, Missouri’s largest physician group.

“We look forward to continuing our work with lawmakers to ensure HB 618 becomes law,” said David Pohl, MSMA president in a news release from the organization. “This reform measure is vital to the future of healthcare in Missouri. This important bill will rein in the abuses of insurance companies through the over-utilization of control mechanisms created by their prior authorization processes. We are committed to advocating for policies that prioritize the health and wellbeing of Missouri patients.”

The bill was introduced by Rep. Melanie Stinnett, R-Springfield.. It passed through the house with a vote of 148-4.

“This bill is a step in the right direction for quality patient care,” Stinnett said in a news release. “By removing the barrier of prior authorization in some instances, we can ensure that patients are getting access to the healthcare they need when they need it.”

Melanie Stinnett, R-Springfield, speaks during the final day of the 2023 Missouri General Assembly session.Tim Bommel ~ House Communications, file

Consumer protections in the bill include a 90-day grace period for previously approved medications when patients switch insurance. Insurance companies must provide online portals for prior authorization requests; and if insurers fail to notify a provider on time, the service requested will be automatically approved.

Ten states tackled the issue of prior authorization in 2024, according to the American Medical Association. The AMA reports that 90% of 1,000 surveyed practicing physicians stated that prior authorization causes delays in care.

A similar bill was introduced in the Missouri Senate in 2023.