Bill Text: MO HB982 | 2011 | Regular Session | Introduced
Bill Title: Restricts the authority of radiology benefit managers to deny diagnostic testing ordered and recommended by a licensed physician
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2011-04-12 - Referred: Health Care Policy (H) [HB982 Detail]
Download: Missouri-2011-HB982-Introduced.html
FIRST REGULAR SESSION
96TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES JONES (117) (Sponsor), TORPEY, SCHIEBER AND WHITE (Co-sponsors).
2081L.01I D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To amend chapters 334 and 376, RSMo, by adding thereto two new sections relating to radiology benefit managers.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapters 334 and 376, RSMo, are amended by adding thereto two new sections, to be known as sections 334.225 and 376.408, to read as follows:
334.225. Any person who countermands the treatment order or recommendation of a treating physician by any means or manner that is intended to influence the patient to refuse a recommended service or to elect to receive a different service than the service ordered or recommended by the treating physician shall be deemed to be practicing medicine in this state.
376.408. 1. The general assembly finds and declares that:
(1) Health carriers and health benefit plans are engaging the services of individuals and organizations to act as radiology benefit managers;
(2) Radiology benefit managers are making decisions about the appropriateness of medical services recommended for a patient by a treating physician and are directing alternative treatments or testing without the benefit of any direct contact between the patient and the radiology benefit manager;
(3) The actions of radiology benefit managers in denying authorization for medical services that have been recommended by a treating physician or in directing alternative treatments or testing are having a direct and adverse impact on the health of Missouri citizens; and
(4) Decisions to deny authorization for medical services recommended by treating physicians or to direct alternative treatments or testing are being made by individuals who are not licensed to practice medicine in the state of Missouri, and who are operating in this state without any regulation or oversight by an agency of this state.
2. As used in this section, the following terms shall mean:
(1) "Diagnostic radiology testing", includes the following diagnostic tests: X-ray, computerized tomography, magnetic resonance imaging, positron emission tomography, fluoroscopy, ultrasound, and nuclear imaging studies, including cardiac nuclear imaging;
(2) "Health carrier", the same meaning as such term is defined in section 376.1350;
(3) "Health benefit plan", the same meaning as such term is defined in section 376.1350;
(4) "Radiology benefits manager", a person, business or other entity, and any wholly or partially owned subsidiary of such entity, that administers diagnostic radiology and imaging benefits in any health benefit plan or policy of insurance that provides coverage for diagnostic radiology testing;
(5) "Treating physician", a physician licensed under chapter 334 who orders or recommends to a patient a diagnostic radiology test that is based upon an in-person medical examination of the patient for whom the test is ordered or recommended.
3. If a health carrier or health benefit plan provides coverage for diagnostic radiology testing and if a treating physician presents an order or recommendation for a diagnostic radiology test to a radiology benefits manager for authorization, a decision to deny authorization of the treating physician's order or recommendation shall only be made by a physician licensed in this state and subject to the regulation of the state board for the healing arts. Along with any decision to deny an authorization for diagnostic radiology testing, the treating physician and the patient shall be furnished with the full name, mailing address, telephone number, and employer of the radiology benefits manager physician who is making the denial decision. In every case in which authorization to perform a diagnostic radiology test is given by a health carrier or health benefit plan or by a radiology benefits manager which is contracted to provide utilization review services for the health carrier or health benefit plan, such authorization shall be conclusive to satisfy any requirement of medical necessity in a health benefit plan or a health carrier's plan, policy, or schedule of benefits, and the provider's subsequently filed claim for payment for such services shall not be denied but shall be timely paid, unless there was fraud on the part of the provider in procuring the authorization.
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