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Private Insurance Data Requirements in Missouri

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        Private health insurance companies and health plans are subject to a number of requirements in the state of Missouri.  In particular, health maintenance organizations (HMOs) must provide financial, structural, and grievance information to its enrollees.1  HMOs must also provide enrollees with a written disclosure statement that outlines the specific terms of coverage.2  This requirement extends to all health insurers in the state of Missouri.3  All information held by an HMO is confidential, and may only be disclosed under limited circumstances.  The law also requires HMOs to have separate provisions regarding the confidentiality of mental health records.4  HMOs must also maintain a register of all grievances filed against the organization.5

        In order to better meet the needs of all citizens of Missouri, the state has authorized the development of community based HMOs.  Community based HMOs must meet certain state specified requirements, and demonstrate its involvement in performance improvement as well as public accountability of cost, quality and access to health care for the particular community.6

 

Footnotes

  • 1. V.A.M.S. 354.440
  • 2. V.A.M.S. 354.442
  • 3. V.A.M.S. 376.446
  • 4. V.A.M.S. 354.515
  • 5. V.A.M.S. 376.1375
  • 6. 20 CSR 400-7.300

 

Private Insurance Data Requirements in Missouri

Subtopic Statute/Regulation Description
Private Insurance Data Requirements Confidentiality of Information Regarding Treatment or Diagnosis Held by a Health Maintenance Organization - Mo. Rev. Stat. § 354.515 All enrollee information regarding treatment or diagnosis held by a health maintenance organization (HMO) must be kept confidential.  This...
Availability of cost-sharing amount information, applicability to supplemental insurance policies-cost impact analysis of proposed health care benefit mandates - Mo. Rev. Stat. §376.446 Health insurers must allow individuals to gain access to cost-sharing information, such as copays, deductibles, and premium.  At a minimum, this...
Disclosure Requirements for Providers in Health Maintenance Organizations - Mo. Rev. Stat. §354.441 No health maintenance organization (HMO) or other entity may restrict a provider from disclosing to a member or enrollee any relevant information...
Establishment and Maintenance of a Registry of Grievances by Health Insurers - Mo. Rev. Stat. §376.1375 A health insurer must maintain a register of all grievances filed, and must include the total number of grievances filed, type, nature and end result...
Evidence Required to Prove Criteria for Designation as Community-Based Health Maintenance Organization - Mo. Code Regs. Ann. tit. 20, § 400-7.300 Health maintenance organizations (HMOs) that want to be designated as community based HMOs, must meet certain criteria laid out by regulations....
Information to be Available to Enrollees in Health Maintenance Organizations - Mo. Rev. Stat. §354.440 All health maintenance organizations (HMO) must make the following information available to its enrollees: Financial information;...
Monitoring Health Maintenance Organizations Definitions - Mo. Code Regs. Ann. tit. 19, § 10-5.010 All health maintenance organization run health plans must submit patient satisfaction surveys to the Department of Health and Senior Services. ...
Provision of Any Records or Information on a Medicaid Beneficiary by the Department of Social Services - Mo. Rev. Stat. §208.217 The Department of Social Services may enter into a contract with an insurance company or health maintenance organization, where the entity may...
Reporting Requirements for Claim Information - Mo. Rev. Stat. §376.435 A health insurer providing a group health benefit plan to an employer must provide the employer with the total amount of claims paid under the plan...
Requirements for Provision of Data by Health Maintenance Organizations - Mo. Rev. Stat. §192.068 All health maintenance organizations (HMOs) are required to provide data on quality of care, access to care, member satisfaction, and health status...
Requirements for the Provision of a Disclosure Statement by Health Maintenance Organizations - Mo. Rev. Stat. §354.442 All health maintenance organizations (HMOs) are required to provide enrollees with a written disclosure statement outlining the specific terms of...
Click on the individual state law in the table above to see our summary of the individual law.


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