2023 Missouri Revised Statutes › Title XII - Public Health and Welfare › Chapter 191 - Health and Welfare › Section 191.875 - Citation--definitions--estimate of cost provided, when--statement--disclosure of costs without discounts.

Title XII PUBLIC HEALTH AND WELFARE
Chapter 191
Effective - 14 Oct 2016, see footnote
*191.875. Citation--definitions--estimate of cost provided, when--statement--disclosure of costs without discounts. —
1. This section shall be known as the "Health Care Cost Reduction and Transparency Act".
2. As used in this section, the following terms shall mean:
(1)
"Ambulatory surgical center"
, as such term is defined under section 197.200;
(2)
"Estimate of cost"
, an estimate based on the information entered and assumptions about typical utilization and costs for health care services. Such estimates of cost shall encompass only those services within the direct control of the health care provider and shall include the amount that will be charged to a patient for the health services if all charges are paid in full without a public or private third party paying for any portion of the charges;
(3)
"Health care provider"
, any ambulatory surgical center, assistant physician, chiropractor, clinical psychologist, dentist, hospital, imaging center, long-term care facility, nurse anesthetist, optometrist, pharmacist, physical therapist, physician, physician assistant, podiatrist, registered nurse, or other licensed health care facility or professional providing health care services in this state. "Health care provider" shall also include any provider located in a Kansas border county, as defined under section 135.1670, who participates in the MO HealthNet program;
(4)
"Hospital"
, as such term is defined under section 197.020;
(5)
"Imaging center"
, any facility at which diagnostic imaging services are provided including, but not limited to, magnetic resonance imaging;
(6)
"Medical treatment plan"
, a patient-specific plan of medical treatment for a particular illness, injury, or condition determined by such patient's health care provider, which includes the applicable current procedural terminology code or codes;
(7)
"Public or private third party"
, a state government, the federal government, employer, health carrier as such term is defined under section 376.1350, third-party administrator, or managed care organization.
3. Beginning July 1, 2017, upon written request by a patient, which shall include a medical treatment plan from the patient's health care provider, for an estimate of cost of a particular health care service or procedure, imaging procedure, or surgery procedure, a health care provider shall provide, in writing, the estimate of cost to the patient electronically, by mail, or in person within three business days after receiving the written request. Providing a patient a specific link to such estimates of cost and making such estimates of cost publicly available or posting such estimates of cost on a website of the health care provider shall constitute compliance with the provisions of this subsection.
4. Health care providers shall include with any estimate of cost the following: "Your estimated cost is based on the information entered and assumptions about typical utilization and costs. The actual amount billed to you may be different from the estimate of costs provided to you. Many factors affect the actual bill you will receive, and this estimate of costs does not account for all of them. Additionally, the estimate of costs is not a guarantee of insurance coverage. You will be billed at the health care provider's charge for any service provided to you that is not a covered benefit under your plan. Please check with your insurance company to receive an estimate of the amount you will owe under your plan or if you need help understanding your benefits for the service chosen.".
5. Beginning July 1, 2017, hospitals shall make available to the public the amount that would be charged without discounts for each of the one hundred most prevalent diagnosis-related groups as defined by the Medicare program, Title XVIII of the Social Security Act. The diagnosis-related groups shall be described in layperson's language suitable for use by reasonably informed patients. Disclosure of data under this subsection shall constitute compliance with subsection 3 of this section regarding any diagnosis-related group for which disclosure is required under this subsection.
6. It shall be a condition of participation in the MO HealthNet program for a health care provider located in a Kansas border county, as defined under section 135.1670, to comply with the provisions of this section.
7. No health care provider shall be required to report the information required by this section if the reporting of such information reasonably could lead to the identification of the person or persons receiving health care services or procedures in violation of the federal Health Insurance Portability and Accountability Act of 1996 or other federal law. This section shall not apply to emergency departments, which shall comply with requirements of the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. Section 1395dd.
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(L. 2016 S.B. 608)
*Effective 10-14-16, see § 21.250. S.B. 608 was vetoed July 5, 2016. The veto was overridden on September 14, 2016.