Joe Smith: Health Care Reform begins with a Common-Sense Approach

Bill to Aid Children and Families with Autism in Missouri

Autism is a terrible disease that affects children and families across Missouri and across our nation.  Unfortunately, the treatment for this disorder generally comes out of the pockets of the parents – many of which cannot always afford proper treatment for their child.   Republicans in the House of Representatives have worked passionately for the past year to craft a solution to the growing epidemic of Autism Spectrum Disorders and the lack of insurance-covered treatment for these individuals.  Even insurance companies voiced support for a bill that would require insurance coverage for this treatment.

Over the summer, the Speaker of the House, Ron Richard, assigned an Interim Committee on Autism Spectrum Disorders chaired by Representative Dwight Scharnhorst.  The Speaker tasked this committee to meet and work on a bi-partisan piece of legislation that gathered consensus between families with autism, autism advocate groups and insurance companies.

The work done by the committee was then passed to the Special Standing Committee on Health Insurance when session started.  Chaired by Representative Kevin Wilson, this committee met constantly, working to further reach an agreement that would require insurance companies to cover the treatment of children with autism.

That work materialized into a bill [HB1311] passed through the House this session and includes the following:

1. This bill balances both sides of the issue:  the costs that a requirement for insurance coverage incurs to businesses along with the growing need for coverage for children with autism.
2. Insurance companies would be required to cover children up to 18 years of age and cover up to $36,000 in costs for treatment.
3. The bill also cracks down to protect families in regard to who treats their children.  In order to treat children with autism, providers must be licensed and registered by the state of Missouri.
4. To protect businesses, small businesses in particular, a business should report a problem if the insurance requirement for autism treatment is causing them to drop in revenue.  If reported and deemed legitimate, these businesses will be granted the option of "dropping out" on the insurance requirement.

The passage of this bill was a great achievement in the House of Representatives.  The ability to aid children and families suffering from autism is something we are proud of and will continue work on.  It is because of Speaker Ron Richard, Representatives Scharnhorst and Wilson and the work of our members on both sides of the isle that this bill was passed.

House Ensures Prompt Payment from Insurance Companies to Health Providers

Health care reform is one of the most talked about issues in the country.  There are several differing views on what steps need to be taken to improve health care including making it more affordable, more accessible and more transparent.  Because of the controversy surrounding the issue, very little has been done on a national level to improve the system.  In the Missouri House of Representatives, however, the wheels are turning and we are accomplishing the common-sense steps necessary to advance health care reform.

Many health care providers in Missouri, which include hospitals, physicians, and so forth, have experienced financial difficulties because of the failure of health insurance companies to make payments for health care services in a reasonable time frame.  The House saw this as a problem that needed to be remedied.

This session House members passed House Bill 1498 with overwhelming bi-partisan support.  The bill sponsored by Representative Tim Jones, R—Eureka, requires health insurance companies to pay provider claims in a timely manner.

1. Through this legislation, a health insurance company would no longer have the ability to delay payments to providers by suspending a claim through loopholes and special exceptions.  Instead, the health insurance company would be allowed 45 days to process and pay or deny the provider's claim.
2. If the health insurance company needs additional information or has any questions regarding the claim, they must do so inside the 45-day window.   Days in which the health insurance company is waiting for a response from the provider for that information would not count towards the 45-day window, however.
3. If the health insurance company does not pay the provider within the specific timeframe, that company would incur a penalty.
   
4. If the provider's claim is denied, health insurance companies will be required to provide a specific reason for the denial.

Through HB1498, we are giving health care providers an opportunity to remain financially stable in their practice and give them the ability to rely on the prompt payment of their claims.  This legislation has gained wide-spread support throughout the state and on both sides of the isle.