FIRST REGULAR SESSION
94TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES HUBBARD (Sponsor) AND PAGE (Co-sponsor).
Read 1st time March 16, 2007 and copies ordered printed.
D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To amend chapter 191, RSMo, by adding thereto one new section relating to direct billing of anatomic pathology services.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 191, RSMo, is amended by adding thereto one new section, to be known as section 191.890, to read as follows:
191.890. 1. A clinical laboratory or physician located in this state or another state that is providing anatomic pathology services for patients in this state shall present or cause to be presented a claim, bill, or demand for such services only to the following:
(1) The patient directly;
(2) The responsible insurer or other third-party payor;
(3) The hospital, public health clinic, or nonprofit health clinic ordering such services;
(4) The referring laboratory, other than a laboratory of a physician's office or group practice that does not perform the professional component of the anatomic pathology service;
(5) Governmental agencies and/or their specific public or private agent, agency, or organization on behalf of the recipient of the services.
2. Except as provided under subsection 6 of this section, no licensed practitioner in this state shall, directly or indirectly, charge, bill, or otherwise solicit payment for anatomic pathology services unless such services were rendered personally by the licensed practitioner or under the licensed practitioner's direct supervision in accordance with Section 353 of the Public Health Service Act, 42 U.S.C. Section 263a.
3. No patient, insurer, third-party payor, hospital, public health clinic, or nonprofit health clinic shall be required to reimburse any licensed practitioner for charges or claims submitted in violation of this section.
4. Nothing in this section shall be construed to mandate the assignment of benefits for anatomic pathology services.
5. For purposes of this section, "anatomic pathology services" means:
(1) Histopathology or surgical pathology. "Histopathology or surgical pathology" means the gross and microscopic examination and histologic processing of organ tissue performed by a physician or under the supervision of a physician;
(2) Cytopathology. "Cytopathology" means the examination of cells from fluids, aspirates, washings, brushings, or smears, including Pap test examination performed by a physician or under the supervision of a physician;
(3) Hematology. "Hematology" means the microscopic evaluation of bone marrow aspirates and biopsies performed by a physician or under the supervision of a physician, and peripheral blood smears when the attending or treating physician, or technologist requests that a blood smear be reviewed by a pathologist;
(4) Sub-cellular pathology and molecular pathology; and
(5) Blood-banking services performed by pathologists.
6. This section shall not be construed to prohibit billing of a referring laboratory for anatomic pathology services in instances where a sample or samples must be sent to another specialist; except that, for purposes of this subsection, referring laboratory does not include a laboratory of a physician's office or group practice that does not perform the professional component of the anatomic pathology service involved.
7. Nothing in this section shall be construed to prohibit a referring physician from sending a patient's specimen to any laboratory providing anatomic pathology services.
8. The respective state licensing boards having jurisdiction over any practitioner who may request or provide anatomic pathology services may revoke, suspend, or deny renewal of the license of any practitioner who violates the provisions of this section.
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