97-05: Implementation Dates for HB 335

* This bulletin was repealed by 08-05

To:           All Heath Maintenance Organizations, Managed Care Plans, and Utilization Review Agents

From:      Jay Angoff

Re:          Implementation Dates for HB 335

Date:       August 25, 1997

Earlier this year, the Missouri General Assembly passed, and Governor Carnahan signed into law HB 335, affecting Health Maintenance Organizations, managed care plans, and utilization review services, among other things. Listed below are effective dates for various provisions of HB 335, along with implementation notes which may be of interest. Citations to the bill and page numbers of the bill are included for your convenience.

The Department of Insurance (DOI) and the Department of Health are in the process of promulgating regulations pursuant to HB 335. Between the effective date of provisions of HB 335 and the effective date of regulations promulgated pursuant to HB335, health carriers are responsible for compliance with the statute without the benefit of regulations interpreting the statute. The DOI will evaluate compliance with HB 335 based on a carrier's good faith effort to conform to the requirements of the law.

Please note, not all provisions of the law are specifically enumerated below. This does not relieve a carrier's responsibility for complying with those provisions not specifically enumerated.


  • Coverage for FDA Approved Drugs Required: § 376.1350.11 p 46-7
    • Effective Date: Health Benefit Plans issued, amended, delivered, or renewed on or after 1/1/98.
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
  • Confirmation Numbers: § 376.1361.12 p 47
    • Effective Date: 8/28/97
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
  • Retraction of Authority Prohibited: § 376.1361.13 p 47
    • Effective Date: 8/28/97
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
  • Decision Notification Time Lines: § 376.1363 p 47-9
    • Effective Date: 8/28/97
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
  • Emergency Services Decisions: § 376.1367 p 49
    • Effective Date: For (1) & (2): Health benefit plans issued, continued, or renewed on or after 8/28/97. For (3) 8/28/97.
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
  • Certification of UR Compliance: § 376.1369 p 49
    • Effective Date: 8/28/97
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
  • UR Procedures in Handbook: § 376.1372 p 49-50
    • Effective Date: For health benefit plans issued, continued, or renewed on or after 8/28/97.
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
  • UR Toll Free Number on Membership Cards: § 376.1372.3 p 50
    • Effective Date: 8/28/97
    • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
    • Notes: Number must be on any membership cards printed after 8/28/97.
  • Mental Illness Benefits
    1. Definitions, Including Expanded Definition of "Licensed Professional", and Recognized Mental Illness": § 376.810 p 38-9
      • Effective Date: 8/28/97
    2. Minimum Coverage and Offer Standards: § 376.811.2 p 40
      • Effective Date: For health benefit plans issued, continued, or renewed on or after 8/28/97.
      • Parties Affected: Insurance Companies/Health Services Corporations/HMO's
    3. Grievance Procedures: § 376.1375 - 1389
      1. Written Register of Grievances: § 376.1375.1 p 50
        • Effective Date: 8/28/97
        • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
      2. Adequate Response to DOI W/I 20 Days: § 376.1375.3 p 50
        • Effective Date: 8/28/97
        • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
      3. Grievance Procedure/DOI Toll Free Number in Handbook: § 376.1378 p 50-1
        • Effective Date: For health benefit plans issued, continued, or renewed on or after 8/28/97.
        • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
        • Notes: Toll Free Number is: 800-726-7390
      4. Standards for First Level Grievance Review: § 376.1382.2 p 51
        • Effective Date: 8/28/97
        • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
      5. Standards for Second Level Grievance Review: § 376.1385 p 51-2
        • Effective Date: 8/28/97
        • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
      6. DOI Grievance Review/Independent Review Organization: § 376.1387 p 52
        • Effective Date: 8/28/97
        • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
      7. Standards for Expedited Review: § 376.1389 p 53
        • Effective Date: 8/28/97
        • Parties Affected: Health Carrier broadly defined: includes: indemnity companies, HMOs, nonprofit hospital and health services corporations and any other entity providing a plan of health insurance, as well as Utilization Review Agents
      8. POS Rider Without Separate License: Section 11 p 62
        • Effective Date: 8/28/97
        • Parties Affected: Licensed HMO's
      9. Peer Review Evaluations Exempt from Discovery: § 537.035 p 56-7
        • Effective Date: 8/28/97
        • Parties Affected: HMOs