Senate Study Bill 1131 SENATE FILE BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CO=CHAIRPERSON RAGAN) 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 1700SC 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 or clinic that ordered the services. 1 12 d. The referring clinical laboratory, other than the 1 13 laboratory of a physician's office or group practice, that 1 14 ordered the services. 1 15 e. A governmental agency or a specified public or private 1 16 agent, agency, or organization that is responsible for payment 1 17 of the services on behalf of the recipient of the services. 1 18 2. Except as provided under subsection 5, a clinical 1 19 laboratory or a physician providing anatomic pathology 1 20 services to patients in this state shall not, directly or 1 21 indirectly, charge, bill, or otherwise solicit payment for 1 22 such services unless the services were personally rendered by 1 23 a physician or under the direct supervision of a physician in 1 24 accordance with section 353 of the federal Public Health 1 25 Service Act, 42 U.S.C. } 263a. 1 26 3. A person to whom a claim, bill, or demand for payment 1 27 for anatomic pathology services is submitted is not required 1 28 to pay the claim, bill, or demand for payment if the claim, 1 29 bill, or demand for payment is submitted in violation of this 1 30 section. 1 31 4. This section shall not be construed to mandate the 1 32 assignment of benefits for anatomic pathology services as 1 33 defined in this section. 1 34 5. This section does not prohibit claims or charges 1 35 presented by a referring clinical laboratory, other than a 2 1 laboratory of a physician's office or group practice, to 2 2 another clinical laboratory when samples are transferred 2 3 between laboratories for the provision of anatomic pathology 2 4 services. 2 5 6. A violation of this section by a physician shall 2 6 subject the physician to the disciplinary provisions of 2 7 section 272C.3, subsection 2. 2 8 7. As used in this section: 2 9 a. "Anatomic pathology services" includes all of the 2 10 following: 2 11 (1) Histopathology or surgical pathology, meaning the 2 12 gross and microscopic examination and histologic processing of 2 13 organ tissue, performed by a physician or under the 2 14 supervision of a physician. 2 15 (2) Cytopathology, meaning the examination of cells from 2 16 fluids, aspirates, washings, brushings, or smears, including 2 17 the pap test examination, performed by a physician or under 2 18 the supervision of a physician. 2 19 (3) Hematology, meaning the microscopic evaluation of bone 2 20 marrow aspirates and biopsies performed by a physician or 2 21 under the supervision of a physician, and the examination of 2 22 peripheral blood smears, performed by a physician or under the 2 23 supervision of a physician, upon the request of an attending 2 24 or treating physician or technologist that a blood smear be 2 25 reviewed by a physician. 2 26 (4) Subcellular pathology and molecular pathology 2 27 services, performed by a physician or under the supervision of 2 28 a physician. 2 29 (5) Bloodbanking services, performed by a physician or 2 30 under the supervision of a physician. 2 31 b. "Physician" means any person licensed to practice 2 32 medicine and surgery, osteopathic medicine and surgery, or 2 33 osteopathy in this state or in another state. 2 34 EXPLANATION 2 35 This bill creates new Code section 147.105 relating to 3 1 bills submitted by a clinical laboratory or physician for the 3 2 provision of anatomic pathology services to a patient in this 3 3 state. The bill provides that a claim, bill, or demand for 3 4 payment for such services shall only be presented to certain 3 5 specified persons. 3 6 The bill also provides that a clinical laboratory or 3 7 physician shall not solicit payment for such services unless 3 8 the services were personally rendered by a physician or under 3 9 the supervision of a physician in accordance with federal law. 3 10 A person who receives a claim, bill, or demand for payment 3 11 that is made in violation of the new Code section is not 3 12 required to pay that claim, bill, or demand for payment. The 3 13 new Code section shall not be construed to mandate the 3 14 assignment of benefits for anatomic pathology services. The 3 15 bill does not prohibit claims or charges presented by one 3 16 clinical laboratory, other than a laboratory of a physician's 3 17 office or group practice, to another clinical laboratory when 3 18 samples are transferred between laboratories for the provision 3 19 of anatomic pathology services. The bill allows the board of 3 20 medical examiners to revoke, suspend, or deny renewal of 3 21 licensure to a physician licensed in this state who violates 3 22 the provisions of the bill. 3 23 The bill defines "anatomic pathology services". The bill 3 24 also defines "physician" as any person licensed to practice 3 25 medicine and surgery, osteopathic medicine and surgery, or 3 26 osteopathy in this state or in another state. 3 27 LSB 1700SC 81 3 28 av:nh/gg/14.1