Highlight on Missouri: Recent legislation on health care and coverage

The Missouri legislature enacted two new laws related to health care and coverage during its 2015 session. S.B. 145 requires health benefit plans to cover the diagnosis and treatment of eating disorders. S.B. 239 limits actions against health care providers for personal injuries arising out of the treatment or failure to treat a patient in cases involving personal injury or death.

Coverage of eating disorders

S.B. 145 , signed by Governor Jay Nixon (D) on June 19, 2015, and effective August 28, 2015, adds a new section 376.845 to the Revised Statutes of Missouri (RSMo). The law defines “eating disorder” broadly to include avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, pica, rumination disorder, binge eating disorder, “and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual  of Mental Disorders published by the American Psychiatric Association” when diagnosed by a physician, psychiatrist, psychologist, clinical social worker, licensed marital and family therapist, or professional counselor (the health professional) licensed in the state where he or she practices and practicing within the scope of the license. The definition of “health benefit plan” is consistent with the other state statutes governing health insurance.

The law requires that all health benefit plans that cover Missouri residents that are issued for delivery, delivered, renewed, continued, on or after January 1, 2017, must cover the diagnosis and treatment of eating disorders as a mental health condition. The requirement is limited to medically necessary treatment provided by a licensed health professional in accordance with a treatment plan. The treatment plan must include the type, frequency, duration, and goals of treatment.

Care management and determinations of medical necessity must consider the overall medical and mental health needs of the patient. They may not be based solely on weight and must take into consideration the most recent Practice Guidelines for Treatment of Patients with Eating Disorders adopted by the American Psychiatric Association and other current standards generally recognized as authoritative in the medical community.

Limited damage awards against health care providers

Governor Nixon signed S.B. 239 on May 7, 2015; it becomes effective August 28, 2015. The law sets limits on noneconomic damages in actions against health care providers for personal injuries or death arising from “the rendering of or failure to render health care services.” It continues to use the preexisting definition of health care providers, which includes hospitals, ambulatory surgical centers, health maintenance organizations, long-term care facilities, as well as physicians, nurses, physicians in training, and other health care professionals.

The major change made by this law is to set limits on noneconomic damages using three levels of severity. For personal injuries that do not qualify as catastrophic, the ceiling on damage awards is $400,000 regardless of the number of defendants. The term “catastrophic personal injuries” includes:

  • paraplegia or quadriplegia, that is, the permanent loss of functional use of two or four limbs, respectively;
  • loss of two or more limbs;
  • an injury to the brain that causes permanent cognitive impairment that results in the permanent inability to make independent decisions or to perform one or more activities of daily living, specifically, eating, dressing, bathing, toileting, transferring, or walking;
  • irreversible failure of one or more organ systems; or
  • vision loss that leaves the individual with visual acuity after correction no better than 20/200 or with a visual field that permits no greater than a 20 degree angle at the widest diameter.

The legislature retained the preexisting definition of noneconomic damages, i.e., nonpecuniary harm, including pain and suffering, mental anguish, physical impairment, disfigurement, inconvenience, loss of enjoyment of life, and loss of consortium. The damage cap in actions involving death or catastrophic personal injury is $700,000 regardless of the number of defendants. The amount of the cap will increase by 1.7 percent in January each year. The director of the state Department of Insurance will calculate the increase and submit it to the Secretary of State for publication in the Missouri Register each year.