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Legislature Overrides Missed Appointment Fees Bill

During the September 14 Veto Session, the Legislature overrode Governor Nixon's veto of Senate Bill 608. Among other provisions, this bill allows providers to charge Medicaid patients fees for missed appointments. The fees would range from $5 to $20 depending on the number of appointments missed. Providers would be able to refuse to schedule further appointments with the patient until they paid the fee.

MARHC has heard from clinics asking whether or not RHCs will be allowed to charge these fees. As the bill is written, it appears to apply to all providers, including RHCs. However, this provision is still a long way from taking effect, and CMS may not allow Missouri to implement it.

Before the section on missed appointment fees can take effect, the Department of Social Services (DSS) must apply for a waiver from CMS. CMS has 90 days to respond to a state's waiver application. Based on CMS' responses to similar requests from other states, they are not expected to approve this waiver. If it is approved, DSS will issue rules to provide guidance on the specifics of the law. This process is likely to take about six to nine months.

MARHC will provide additional updates as the state moves forward with the waiver process. If you have additional questions about SB 608 or other legislation, please contact MARHC at

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