Missouri Revised Statutes
Chapter 376
Life, Health and Accident Insurance
←376.1215
Section 376.1218.1
376.1219→
August 28, 2015
Insurance coverage for children enrolled in the Part C early intervention system (First Steps).
376.1218. 1. Any health carrier or health benefit plan that offers or
issues health benefit plans, other than Medicaid health benefit plans, which
are delivered, issued for delivery, continued, or renewed in this state on or
after January 1, 2006, shall provide coverage for early intervention services
described in this section that are delivered by early intervention
specialists who are health care professionals licensed by the state of
Missouri and acting within the scope of their professions for children from
birth to age three identified by the Part C early intervention system as
eligible for services under Part C of the Individuals with Disabilities
Education Act, 20 U.S.C. Section 1431, et seq. Such coverage shall be
limited to three thousand dollars for each covered child per policy per
calendar year, with a maximum of nine thousand dollars per child.
2. As used in this section, "health carrier" and "health benefit plan"
shall have the same meaning as such terms are defined in section 376.1350.
3. In the event that any health benefit plan is found not to be required
to provide coverage under subsection 1 of this section because of preemption
by a federal law, including but not limited to the act commonly known as
ERISA contained in Title 29 of the United States Code, or in the event that
subsection 1 of this section is found to be unconstitutional, then the lead
agency shall be responsible for payment and provision of any benefit provided
under this section.
4. For purposes of this section, "early intervention services" means
medically necessary speech and language therapy, occupational therapy,
physical therapy, and assistive technology devices for children from birth to
age three who are identified by the Part C early intervention system as
eligible for services under Part C of the Individuals with Disabilities
Education Act, 20 U.S.C. Section 1431, et seq. Early intervention services
shall include services under an active individualized family service plan that
enhance functional ability without effecting a cure. An individualized
family service plan is a written plan for providing early intervention
services to an eligible child and the child's family that is adopted in
accordance with 20 U.S.C. Section 1436. The Part C early intervention system,
on behalf of its contracted regional Part C early intervention system centers
and providers, shall be considered the rendering provider of services for
purposes of this section.
5. No payment made for specified early intervention services shall be
applied by the health carrier or health benefit plan against any maximum
lifetime aggregate specified in the policy or health benefit plan if the
carrier opts to satisfy its obligations under this section under subdivision
(2) of subsection 7 of this section. A health benefit plan shall be billed
at the applicable Medicaid rate at the time the covered benefit is delivered,
and the health benefit plan shall pay the Part C early intervention system at
such rate for benefits covered by this section. Services under the Part C
early intervention system shall be delivered as prescribed by the
individualized family service plan and an electronic claim filed in
accordance with the carrier's or plan's standard format. Beginning January
1, 2007, such claims' payments shall be made in accordance with the
provisions of sections 376.383 and 376.384.
6. The health care service required by this section shall not be subject
to any greater deductible, co-payment, or coinsurance than other similar
health care services provided by the health benefit plan.
7. (1) Subject to the provisions of this section, payments made during a
calendar year by a health carrier or group of carriers affiliated by or under
common ownership or control to the Part C early intervention system for
services provided to children covered by the Part C early intervention system
shall not exceed one-half of one percent of the direct written premium for
health benefit plans as reported to the department of insurance, financial
institutions and professional registration on the health carrier's most
recently filed annual financial statement.
(2) In lieu of reimbursing claims under this section, a carrier or group
of carriers affiliated by or under common ownership or control may, on behalf
of all of the carrier's or carriers' health benefit plan or plans providing
coverage under this section, directly pay the Part C early intervention system
by January thirty-first of the calendar year an amount equal to one-half of
one percent of the direct written premium for health benefit plans as
reported to the department of insurance, financial institutions and
professional registration on the health carrier's most recently filed annual
financial statement, or five hundred thousand dollars, whichever is less, and
such payment shall constitute full and complete satisfaction of the health
benefit plan's obligation for the calendar year. Nothing in this subsection
shall require a health carrier or health benefit plan providing coverage under
this section to amend or modify any provision of an existing policy or plan
relating to the payment or reimbursement of claims by the health carrier or
health benefit plan.
8. This section shall not apply to a supplemental insurance policy,
including a life care contract, specified disease policy, hospital policy
providing a fixed daily benefit only, Medicare supplement policy,
hospitalization-surgical care policy, policy that is individually
underwritten or provides such coverage for specific individuals and members of
their families, long-term care policy, or short-term major medical policies
of six months or less duration.
9. Except for health carriers or health benefit plans making payments
under subdivision (2) of subsection 7 of this section, the department of
insurance, financial institutions and professional registration shall collect
data related to the number of children receiving private insurance coverage
under this section and the total amount of moneys paid on behalf of such
children by private health carriers or health benefit plans. The department
shall report to the general assembly regarding the department's findings no
later than January 30, 2007, and annually thereafter.
10. Notwithstanding the provisions of section 23.253 to the contrary,
the provisions of this section shall not sunset.
(L. 2005 S.B. 500, A.L. 2007 S.B. 112)
2005
2005
376.1218. 1. Any health carrier or health benefit plan that offers
or issues health benefit plans, other than Medicaid health benefit plans,
which are delivered, issued for delivery, continued, or renewed in this
state on or after January 1, 2006, shall provide coverage for early
intervention services described in this section that are delivered by early
intervention specialists who are health care professionals licensed by the
state of Missouri and acting within the scope of their professions for
children from birth to age three identified by the Part C early
intervention system as eligible for services under Part C of the
Individuals with Disabilities Education Act, 20 U.S.C. Section 1431, et
seq. Such coverage shall be limited to three thousand dollars for each
covered child per policy per calendar year, with a maximum of nine thousand
dollars per child.
2. As used in this section, "health carrier" and "health benefit
plan" shall have the same meaning as such terms are defined in section
376.1350.
3. In the event that any health benefit plan is found not to be
required to provide coverage under subsection 1 of this section because of
preemption by a federal law, including but not limited to the act commonly
known as ERISA contained in Title 29 of the United States Code, or in the
event that subsection 1 of this section is found to be unconstitutional,
then the lead agency shall be responsible for payment and provision of any
benefit provided under this section.
4. For purposes of this section, "early intervention services" means
medically necessary speech and language therapy, occupational therapy,
physical therapy, and assistive technology devices for children from birth
to age three who are identified by the Part C early intervention system as
eligible for services under Part C of the Individuals with Disabilities
Education Act, 20 U.S.C. Section 1431, et seq. Early intervention services
shall include services under an active individualized family service plan
that enhance functional ability without effecting a cure. An
individualized family service plan is a written plan for providing early
intervention services to an eligible child and the child's family that is
adopted in accordance with 20 U.S.C. Section 1436. The Part C early
intervention system, on behalf of its contracted regional Part C early
intervention system centers and providers, shall be considered the
rendering provider of services for purposes of this section.
5. No payment made for specified early intervention services shall be
applied by the health carrier or health benefit plan against any maximum
lifetime aggregate specified in the policy or health benefit plan if the
carrier opts to satisfy its obligations under this section under
subdivision (2) of subsection 7 of this section. A health benefit plan
shall be billed at the applicable Medicaid rate at the time the covered
benefit is delivered, and the health benefit plan shall pay the Part C
early intervention system at such rate for benefits covered by this
section. Services under the Part C early intervention system shall be
delivered as prescribed by the individualized family service plan and an
electronic claim filed in accordance with the carrier's or plan's standard
format. Beginning January 1, 2007, such claims' payments shall be made in
accordance with the provisions of sections 376.383 and 376.384.
6. The health care service required by this section shall not be
subject to any greater deductible, co-payment, or coinsurance than other
similar health care services provided by the health benefit plan.
7. (1) Subject to the provisions of this section, payments made
during a calendar year by a health carrier or group of carriers affiliated
by or under common ownership or control to the Part C early intervention
system for services provided to children covered by the Part C early
intervention system shall not exceed one-half of one percent of the direct
written premium for health benefit plans as reported to the department of
insurance on the health carrier's most recently filed annual financial
statement.
(2) In lieu of reimbursing claims under this section, a carrier or
group of carriers affiliated by or under common ownership or control may,
on behalf of all of the carrier's or carriers' health benefit plan or plans
providing coverage under this section, directly pay the Part C early
intervention system by January thirty-first of the calendar year an amount
equal to one-half of one percent of the direct written premium for health
benefit plans as reported to the department of insurance on the health
carrier's most recently filed annual financial statement, or five hundred
thousand dollars, whichever is less, and such payment shall constitute full
and complete satisfaction of the health benefit plan's obligation for the
calendar year.
Nothing in this subsection shall require a health carrier or health benefit
plan providing coverage under this section to amend or modify any provision
of an existing policy or plan relating to the payment or reimbursement of
claims by the health carrier or health benefit plan.
8. This section shall not apply to a supplemental insurance policy,
including a life care contract, specified disease policy, hospital policy
providing a fixed daily benefit only, Medicare supplement policy,
hospitalization-surgical care policy, policy that is individually
underwritten or provides such coverage for specific individuals and members
of their families, long-term care policy, or short-term major medical
policies of six months or less duration.
9. Except for health carriers or health benefit plans making payments
under subdivision (2) of subsection 7 of this section, the department of
insurance shall collect data related to the number of children receiving
private insurance coverage under this section and the total amount of
moneys paid on behalf of such children by private health carriers or health
benefit plans. The department shall report to the general assembly
regarding the department's findings no later than January 30, 2007, and
annually thereafter.
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