House committee advances bill barring insurers from cutting off anesthesia-time payments, adopts substitute 15-0
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Summary
A House committee voted unanimously to advance a committee substitute combining House Bill 25,70 and related language that would prevent insurers from declining to pay for anesthesia time when a surgery runs long; the panel adopted an amendment and substitute after testimony from medical groups and objections from insurers about definitions and billing rules.
A House committee voted to advance a committee substitute that would bar health insurers from refusing to cover anesthesia time if a surgical procedure runs longer than expected.
"So this bill basically says that any insurance company cannot do that," Representative David Tyson Smith, sponsor, told the committee as he summarized the measure and its history. Smith said a prior version of the measure had passed committee last year and that insurance carrier Anthem briefly proposed a policy limiting payment for extended procedures before backing off.
Supporters included physicians and specialty societies. "I suspect the insurance companies are still embarrassed to testify against this and you will not see them in opposition today," said Jorgen Schleitmeyer of the Missouri Society of Anesthesiologists. Jacob Scott, a registered lobbyist for several physician groups, said carriers had moved toward time-limiting payments and the state should prevent that practice.
The Missouri Association of Nurse Anesthetists also urged swift action. "We can figure out if there is common ground here," Chris Ropi said, adding the coalition believed the three practical concerns — dental billing, payment amount and scope-of-practice definitions — could be resolved without delaying the bill.
The insurance industry witness said the bill as written raised legal and contractual questions. "The definition of anesthesia practitioner is not clear," Hampton Williams said, arguing that one sentence appears inconsistent with another and could lead to payment disputes. Williams said the bill should avoid prescribing specific payment formulas that parties currently negotiate in contracts and suggested explicitly addressing dental flat-rate billing as an exception.
Committee members pressed for clarification. Representative Peruzza said the bill is focused on medical procedures and aims to use accepted CPT/time-based standards for anesthesia billing, while acknowledging adjustments could be made to protect dental procedures and avoid scope-of-practice changes. "We really are not talking about dental services here," Peruzza said, and sponsors indicated they would work with stakeholders on precise wording.
During executive session the committee adopted a House committee amendment that rolls the bills together and added language clarifying modifiers used in anesthesia billing. Sponsors also noted a separate provision in the substitute addressing clinical pathology payments may require the department to seek a Medicaid waiver to implement.
The committee then voted on the committee substitute. "By a vote of 15 ayes and 0 nos, you voted House Committee substitute for House Bill 19-45 and 25-70 do pass," the chair announced. The committee adjourned without further action.
The substitute advances the combined anesthesia and related payment provisions for further consideration; sponsors said they expect technical language changes and possible floor amendments to address insurer and dental-billing concerns.