DHT assumes this will require their medical plan to cover the cost of medically necessary health care services that are incurred as a result of treatment being provided to a member for purposes of clinical trial. Oversight assumes a minimal fiscal impact on the Criminal Records System Fund and the Air Pollution Control Fund, and will range costs for DHT and MSHP depending on the decision to increase the state shares to offset an increase in rates. HCP notes these drugs are typically expensive, resulting in additional costs to the plan. In addition, HCP states that this proposal allows HMOs to be sued. HCP assumes this would increase premiums so that HMOs will be able to cover any potential liability.
Oversight assumes a four percent annual increase in medical costs.
Oversight also assumes these cost estimates are based on HCP's current contract, as a change in contracts could result in additional costs in future years. This proposal addresses four areas of the federal Patient's Bill of Rights which Missouri has not previously enacted. It also requires health carriers to permit enrollees with life-threatening or serious illnesses to participate in approved clinical trials, provided there is meaningful potential for significant clinical benefit. The proposal prohibits health maintenance organizations from entering into any compensation agreement with a provider that would induce the provider to limit medical care. It also creates a state cause of action for enrollees who are improperly denied care by their health maintenance organizations.