Missouri insurance laws

What it would do: Requires health benefit plans delivered, issued, continued or renewed in Missouri on or after January 1, 2026, that provide maternity benefits to cover home blood pressure monitoring devices and related services for pregnant and postpartum women.

What it would do: Adds Lyme disease to Missouri's list of reportable communicable diseases, creates a Lyme Research and Eradication Fund for research grants, protects health care providers from license discipline for prescribing extended antibiotic therapy for Lyme disease, and requires health insurers to cover Lyme disease diagnostics and treatment including extended antibiotics starting January 1, 2027.

What it would do: Repeals numerous expired, terminated, sunset, and obsolete Missouri statutes and reenacts fifty-eight of them with existing penalty provisions intact.

What it would do: Requires health carriers and pharmacy benefits managers to include amounts paid for medications without generic substitutes when calculating an enrollee's out-of-pocket maximum and cost-sharing requirements, and prohibits varying these requirements based on cost-sharing assistance program availability for such medications.

What it would do: Establishes audit standards for pharmacy benefits managers including notice requirements, audit scope limits, appeal processes, and prohibitions on certain recoupment practices. Requires PBMs to update maximum allowable cost lists every seven days, ensure critical access care pharmacies receive at least actual cost reimbursement, and remit 100% of rebates to health plans beginning January 1, 2027.

What it would do: Repeals and replaces provisions governing permanent total disability benefits, administrative law judge appointments and discipline, and administrative hearing commission jurisdiction over workers' compensation matters.

What it would do: Prohibits health carriers and health benefit plans, including MO HealthNet and state children's health insurance program, from covering human organ transplants or posttransplant care if the transplant is performed in China or the organ was procured by sale or donation originating in China.

What it would do: Establishes audit standards for pharmacy benefits managers and entities auditing pharmacies, including notice requirements, limits on audit frequency and scope, and prohibitions on certain recoupment practices. Also regulates pharmacy benefits manager contracts regarding maximum allowable cost pricing, copayments, and disclosure of conflicts of interest and affiliate relationships.

What it would do: Requires MO HealthNet to reimburse hospital-based pathologists for the professional component of clinical pathology services at thirty percent of Medicare's approved outpatient fee schedule, and prohibits health carriers from imposing time limits or excluding anesthesia time when calculating anesthesia service payments.

What it would do: Requires MO HealthNet and health insurance plans to cover orthotic, prosthetic, and assistive devices, supplies, and services prescribed by physicians, including repair and replacement without lifetime restrictions, and mandates access to at least two in-network providers.

What it would do: Establishes a Missouri Disaster Mediation Act creating a nonbinding alternative dispute resolution program for residential property insurance claims arising from disasters, and creates the Missouri Stronger Homes Program providing grants up to fifteen thousand dollars to retrofit homes to resist tornado, windstorm, and hail damage.

What it would do: Modifies the definition of 'eligible employee' to include those working at least 30 hours per week and modifies 'small employer' to mean employers with at least one but no more than fifty eligible employees, down from the previous threshold of at least two employees.

What it would do: Establishes requirements for settlement demands in personal injury cases to be considered reasonable opportunities to settle, including that demands must be in writing, sent by certified mail, remain open at least ninety days, and include specified material terms and documentation.

What it would do: Prohibits providers from offering or entering into provider network contracts containing anti-steering, anti-tiering, gag, or most-favored-nation clauses, and voids such clauses if included. Requires health benefit plan issuers to act as fiduciaries when steering enrollees to specific providers or modifying tiered networks.

What it would do: Allows the director to share confidential insurer information with guaranty associations to prepare for potential insolvencies, amends guaranty association board composition, and suspends plan of operation requirements if medical malpractice insurance is available in the voluntary market.

What it would do: Allows a joint underwriting association's board to suspend operations if medical malpractice insurance is reasonably available in the voluntary market and two or fewer individual physicians are insured annually for at least two consecutive years.

What it would do: Modifies workers' compensation provisions including permanent total disability benefits, occupational disease benefits for toxic exposure and mesothelioma, attorney fee arrangements, and tax and surcharge rates for insurers and self-insurers.

What it would do: Establishes requirements for health carrier prior authorization processes, including timeframes for determinations, notification procedures, API implementation by January 1, 2027, and exemptions for providers with ninety percent approval rates. Requires reporting of prior authorization statistics and continuation of approvals during plan transitions.

What it would do: Requires health benefit plans in Missouri to cover self-administered hormonal contraceptives with supplies lasting up to 90 days (or 180 days for generics) through December 31, 2026, then up to one year thereafter, without higher deductibles or co-payments than other similar services.

What it would do: Modifies workers' compensation definitions and requirements, including narrowing what constitutes compensable injuries and accidents, restricting occupational disease coverage to specific conditions, establishing the prevailing factor standard for causation, and allowing employers to dismiss claims within 180 days on specified grounds.

What it would do: Modifies homeowner's insurance provisions including roof age requirements, replacement cost coverage rules, and post-loss benefit assignments. Creates disaster mediation and stronger homes programs with premium discounts for wind/hail-resistant retrofits.

What it would do: Modifies compensation rules for veterans benefits services by prohibiting referral fees, limiting contingent fees to five times monthly benefit increases, requiring written agreements, and mandating specific disclosures to veterans. Also establishes various National Guard programs and medals for military service.

What it would do: Requires health benefit plans and health insurance issuers to not discriminate against health care providers based on licensure in reimbursement or participation, and mandates equal reimbursement rates for the same service within a provider's scope of practice, except for physicians licensed under chapter 334.

What it would do: Prohibits health benefit plans from denying coverage of nonopioid pain medications prescribed by licensed health care professionals, requiring opioid trial first, or imposing higher cost-sharing for nonopioids than opioids, effective January 1, 2027.