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2014 MPTA FALL CONFERENCE – October 18, ’14
University of Missouri, Columbia

Notice: The Fair Copay bill went into effect on August 28, 2013. Click here to view this new law.

Note that existing contracts are not affected (unless the insurance company chooses to make the change immediately) however, the contract WILL BE AFFECTED AT THE RENEWAL.  Click the link below to read information from MPTA’s attorney regarding the implementation process.

Note these other exceptions to the Fair Copay bill:
1.  Does NOT APPLY to self-insured plans  (Do you know how self-insured plans differ from commercial plans?  If not, click this link to find out more:  Self Insured vs commercially insured
2.  does NOT APPLY to nationally based Medicare replacement policies

Do the co-pay anti-discrimination provisions of Senate Bill No. 159 apply to a qualified health plan (QHP) issued through the Affordable Care Act exchange in Missouri?

Yes. The Affordable Care Act (ACA) does not relieve insurers from implementing the co-pay/coinsurance anti-discrimination requirements of Senate Bill No. 159. Missouri may still regulate the content of insurance policies issued in Missouri, including QHPs, so long as that regulation does not prevent application of the ACA. The anti-discrimination provision of Senate Bill No. 159 is not contrary to anything in the ACA, including ACA provisions on cost-sharing for QHPs, and does not prevent its application.

What if the provisions of a QHP apply a discriminatory co-pay or coinsurance for physical therapy services?

Handle the matter in the same way you would other refusals of insurers or health plans to meet the obligations of Senate Bill No. 159. In addition to an insured/patient directly filing a complaint with the Missouri Department of Insurance, it can seek the assistance of an ACA navigator in filing the complaint.

Implementation of SB 159 – the Fair Copay Bill

Notice of the new law that went out from the Dept. of Insurance:


Please pay close attention to insurance plans (contract) and if it (the plan) has been signed up for or renegotiated after August 28, 2013.  If it was put into effect after August 28, 2013  then the PT Provider needs to make sure when verifying/checking insurance benefits that the insurance company is not charging the specialist co-pay rate for PT patients but are charging the patient the PCP (Primary Care Physician/Provider) rate.

If a company says that they still owe at the Specialist co-pay rate then the PT Provider may need to follow-up with the representative for that insurance company.  You may use this letter as a template Fair Copay – Template letter to Insurance Company

If you have questions, please e-mail your question to ckemna@bardgett.net
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About the MPTA

The American Physical Therapy Association is a national, professional organization representing more than 70,000 members. Its goal is to foster advancements in physical therapy practice, research and education.

To become a member, you must be accepted to or enrolled in a physical therapist or physical therapist assistant program that is accredited or is seeking or has been granted candidacy status by the Commission on Accreditation in Physical Therapy Education (see qualifications on application), or have graduated from an accredited PT or PTA program.

Benefits of Belonging:

Legislative representation of your profession at both the national and local levels. Information regarding physical therapy research and practice issues. A 40% discount off nonmember rates on all APTA products, publications, and services. Access to cutting-edge information through Physical Therapy (monthly), PT–Magazine of Physical Therapy (monthly), and PT Bulletin (weekly). All at no additional cost to members: a $130 value!
Unlimited opportunities to advance your professional skills through section membership, specialist certification, seminars, conferences, and a local network of colleagues. Insurance and financial benefits, including: VISA & MasterCard, professional liability insurance, disability insurance, and more!

For more information on APTA membership, call 1-800-999-APTA, ext. 3124. Or call TDD for members who are hearing impaired, at 703/683-6748.