Politics & policy

Insight into federal and state health care legislation & CMS regulation

Missouri Clarifies Provisions of New HMO Choice Rules

Missouri's insurance department has spelled out exactly what HMOs in the state have to do to comply with employee choice provisions of regulations passed last year. Insurance Director Jay Angoff sent a bulletin to the more than 30 state-licensed HMOs specifying the choices they must offer to members of plans covering 50 or more workers.

Angoff said HMOs could comply with the law in any of three ways: If they don't require HMO members to see a primary care gatekeeper physician before going to a specialist; offer a fee-for-service plan as an alternative to an HMO gatekeeper plan; or offer a modified HMO that allows unrestricted access to specialists as an alternative to an HMO gatekeeper plan. The directive applies to plans that were issued or renewed after Aug. 28, 1997, when the law took effect.

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