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
  5 av/gg/14

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
  4  4 av:nh/gg/14