376.1245.  Anesthesia time limits for payment of services prohibited — definitions — inapplicability — construction. — 1.  As used in this section, the following terms mean:

  (1)  "Anesthesia time", the period during which an anesthesiologist, an anesthesiologist assistant, as defined in section 334.400, or a certified registered nurse anesthetist, as defined in section 385.016, is present with the patient, starting when the anesthesiologist, anesthesiologist assistant, or certified registered nurse anesthetist begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ending when the anesthesiologist, anesthesiologist assistant, or certified registered nurse anesthetist is no longer furnishing anesthesia services to the patient because the patient may be placed safely under postoperative or postanesthesia care;

  (2)  "Anesthesia time units", time units recognized with appropriate time intervals that do not exceed fifteen minutes in length for each interval and that, taken together, represent the total anesthesia time for a particular anesthesia service;

  (3)  "Excepted benefit plan", a policy or certificate of insurance extending coverage under short-term major medical policies;

  (4)  "Health benefit plan", the same meaning given to the term in section 376.1350.  The term health benefit plan shall also include MO HealthNet, the children's health insurance program authorized under chapter 208, the Missouri consolidated health care plan established under chapter 103, and any other state-sponsored health insurance program;

  (5)  "Health carrier", the same meaning given to the term in section 376.1350.  The term health carrier shall also include the MO HealthNet division and any Medicaid managed care organization, as defined in section 208.431;

  (6)  "Payment of anesthesia services", an amount paid for anesthesia services as determined in a contract between a health carrier, health benefit plan, or utilization review entity and an anesthesiologist, an anesthesiologist assistant, a certified registered nurse anesthetist, or a health care provider.  Such contract shall identify the payment methodology agreed to by the parties, which may include a methodology based on a medical billing code, base units for the applicable medical billing code, anesthesia time units, modifying units, and an anesthesia conversion factor, or any other payment methodology agreed to by the health carrier and the contracted provider.

  2.  No health carrier or health benefit plan shall establish, implement, or enforce any policy, practice, or procedure that imposes a time limit for the payment of anesthesia services provided during a medical or surgical procedure.

  3.  No health carrier or health benefit plan shall establish, implement, or enforce any policy, practice, or procedure that restricts or excludes all anesthesia time in calculating the payment of anesthesia services.

  4.  Excepted benefit plans shall be subject to the requirements of this section.

  5.  The provisions of this section shall not apply to anesthesia services provided in connection with dental procedures or services performed pursuant to a license issued under chapter 332, including, but not limited to, oral and maxillofacial surgery performed under such license.

  6.  Nothing in this section shall be construed in a way to:

  (1)  Authorize a health care provider to provide a health care service outside of the scope of the provider's applicable license.  No health carrier or health benefit plan shall be required to pay for anesthesia services administered by a person not licensed or otherwise qualified to administer such services;

  (2)  Interfere with a health carrier, health benefit plan, or utilization review entity requiring compliance by an anesthesiologist, an anesthesiologist assistant, a certified registered nurse anesthetist, a health care provider, or a group with any program authorized under sections 376.1350 to 376.1389; or

  (3)  Affect, alter, or impair the terms of any contract between a health carrier or health benefit plan and an anesthesiologist, an anesthesiologist assistant, a certified registered nurse anesthetist, a health care provider, or a group that was executed before January 1, 2027.  This section shall only apply to contracts entered into, renewed, or materially amended on or after January 1, 2027.