Senate File 269 - Introduced
SENATE FILE
BY COMMITTEE ON HUMAN
RESOURCES
(SUCCESSOR TO SSB 1131)
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act concerning billing for anatomic pathology services and
2 making licensing sanctions applicable.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 1700SV 81
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PAG LIN
1 1 Section 1. NEW SECTION. 147.105 ANATOMIC PATHOLOGY
1 2 SERVICES == BILLING.
1 3 1. A physician or a clinical laboratory located in this
1 4 state or in another state that provides anatomic pathology
1 5 services to a patient in this state shall present or cause to
1 6 be presented a claim, bill, or demand for payment for such
1 7 services only to the following persons:
1 8 a. The patient who is the recipient of the services.
1 9 b. The insurer or other third=party payor responsible for
1 10 payment of the services.
1 11 c. The hospital that ordered the services.
1 12 d. The public health clinic or nonprofit clinic that
1 13 ordered the services.
1 14 e. The referring clinical laboratory, other than the
1 15 laboratory of a physician's office or group practice, that
1 16 ordered the services.
1 17 f. A governmental agency or a specified public or private
1 18 agent, agency, or organization that is responsible for payment
1 19 of the services on behalf of the recipient of the services.
1 20 2. Except as provided under subsections 5 and 6, a
1 21 clinical laboratory or a physician providing anatomic
1 22 pathology services to patients in this state shall not,
1 23 directly or indirectly, charge, bill, or otherwise solicit
1 24 payment for such services unless the services were personally
1 25 rendered by a physician or under the direct supervision of a
1 26 physician in accordance with section 353 of the federal Public
1 27 Health Service Act, 42 U.S.C. } 263a.
1 28 3. A person to whom a claim, bill, or demand for payment
1 29 for anatomic pathology services is submitted is not required
1 30 to pay the claim, bill, or demand for payment if the claim,
1 31 bill, or demand for payment is submitted in violation of this
1 32 section.
1 33 4. This section shall not be construed to mandate the
1 34 assignment of benefits for anatomic pathology services as
1 35 defined in this section.
2 1 5. This section does not prohibit claims or charges
2 2 presented by a referring clinical laboratory, other than a
2 3 laboratory of a physician's office or group practice, to
2 4 another clinical laboratory when samples are transferred
2 5 between laboratories for the provision of anatomic pathology
2 6 services.
2 7 6. This section does not prohibit claims or charges for
2 8 anatomic pathology services presented on behalf of a public
2 9 health clinic or nonprofit clinic that ordered the services
2 10 provided that the clinic is identified on the claim or charge
2 11 presented.
2 12 7. A violation of this section by a physician shall
2 13 subject the physician to the disciplinary provisions of
2 14 section 272C.3, subsection 2.
2 15 8. As used in this section:
2 16 a. "Anatomic pathology services" includes all of the
2 17 following:
2 18 (1) Histopathology or surgical pathology, meaning the
2 19 gross and microscopic examination and histologic processing of
2 20 organ tissue, performed by a physician or under the
2 21 supervision of a physician.
2 22 (2) Cytopathology, meaning the examination of cells from
2 23 fluids, aspirates, washings, brushings, or smears, including
2 24 the pap test examination, performed by a physician or under
2 25 the supervision of a physician.
2 26 (3) Hematology, meaning the microscopic evaluation of bone
2 27 marrow aspirates and biopsies performed by a physician or
2 28 under the supervision of a physician, and the examination of
2 29 peripheral blood smears, performed by a physician or under the
2 30 supervision of a physician, upon the request of an attending
2 31 or treating physician or technologist that a blood smear be
2 32 reviewed by a physician.
2 33 (4) Subcellular pathology and molecular pathology
2 34 services, performed by a physician or under the supervision of
2 35 a physician.
3 1 (5) Bloodbanking services, performed by a physician or
3 2 under the supervision of a physician.
3 3 b. "Physician" means any person licensed to practice
3 4 medicine and surgery, osteopathic medicine and surgery, or
3 5 osteopathy in this state or in another state.
3 6 EXPLANATION
3 7 This bill creates new Code section 147.105 relating to
3 8 bills submitted by a clinical laboratory or physician for the
3 9 provision of anatomic pathology services to a patient in this
3 10 state. The bill provides that a claim, bill, or demand for
3 11 payment for such services shall only be presented to certain
3 12 specified persons.
3 13 The bill also provides that a clinical laboratory or
3 14 physician shall not solicit payment for such services unless
3 15 the services were personally rendered by a physician or under
3 16 the supervision of a physician in accordance with federal law.
3 17 A person who receives a claim, bill, or demand for payment
3 18 that is made in violation of the new Code section is not
3 19 required to pay that claim, bill, or demand for payment. The
3 20 new Code section shall not be construed to mandate the
3 21 assignment of benefits for anatomic pathology services. The
3 22 bill does not prohibit claims or charges presented by one
3 23 clinical laboratory, other than a laboratory of a physician's
3 24 office or group practice, to another clinical laboratory when
3 25 samples are transferred between laboratories for the provision
3 26 of anatomic pathology services. The bill also does not
3 27 prohibit claims or charges presented on behalf of a public
3 28 health clinic or nonprofit clinic that ordered the services
3 29 provided that the clinic is identified on the claim or charge
3 30 presented. The bill allows the board of medical examiners to
3 31 revoke, suspend, or deny renewal of licensure to a physician
3 32 licensed in this state who violates the provisions of the
3 33 bill.
3 34 The bill defines "anatomic pathology services". The bill
3 35 also defines "physician" as any person licensed to practice
4 1 medicine and surgery, osteopathic medicine and surgery, or
4 2 osteopathy in this state or in another state.
4 3 LSB 1700SV 81
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