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Read. Follow. Verify.Missouri House Bill 1675 Exempts Providers with 90% Approval Rates from Prior Authorization Requirements
Last action · May 15, 2026: Referred: Emerging Issues(H)Sponsors: Brian Seitz and 4 others
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What This Bill Would Do
Health carriers and utilization review entities are prohibited from requiring for health care services from providers who achieved a 90% or higher approval rate during the most recent . The bill mandates online portals for tracking decisions, establishes appeals processes, and restricts carriers from denying payments unless intentional misrepresentation or failure to perform occurred.
Medical practices and health carriers must alter administrative workflows and evaluation tracking to comply with new thresholds for exemptions, directly impacting billing practices and approval oversight.
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
health care providers
Health care providers are exempt from prior authorization requirements if they achieve a ninety percent or higher approval rate during an evaluation period.
health carriers
Health carriers must track approval rates, issue determinations within twenty-five days, maintain online portals, and establish appeal processes.
Medicaid managed care organizations
Medicaid managed care organizations are classified as health carriers and subjected to the prior authorization exemption rules.
Key Facts
- Health carriers or utilization review entities cannot require prior authorization for a specific health care service if they approved or would have approved less than ninety percent of prior authorization requests for that service from that provider in the most recent evaluation period.
- Carriers cannot require prior authorization for any health care services if their overall approval rate for that provider was less than ninety percent in the most recent evaluation period.
- Appealed denials do not count as denied requests, and previously denied requests that were subsequently authorized count as approved.
- Carriers must notify health care providers of determination results no later than twenty-five days after the evaluation period concludes, including supporting statistics and data.
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- Carriers must establish an appeal process for determinations and maintain an online portal allowing providers to access prior authorization decisions and statuses.
- Carriers cannot deny or reduce payment for a serviced prior authorization unless the provider knowingly and materially misrepresented the service with intent to deceive or failed to substantially perform.
- The provisions do not apply to MO HealthNet, except that Medicaid managed care organizations are considered health carriers.
- Providers who have not participated in a health benefit plan offered by the health carrier for at least one full evaluation period are exempt from these rules.
Frequently Asked Questions
Which health care providers qualify for an exemption from prior authorization?
What tools must health carriers provide to health care providers under this bill?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
4 actions- May 15, 2026HouseCommitteeReferred: Emerging Issues(H)
- Jan 8, 2026HouseFloorRead Second Time (H)
- Jan 7, 2026HouseIntroducedRead First Time (H)
- Dec 1, 2025HouseIntroducedPrefiled (H)
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Connected Entities
Sources
house.mo.gov
Analysis Score
0–100- Significance75How much this matters to a regular citizen
- Controversy50Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz35Current news / social attention level
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