HB 1945 — Modifies provisions relating to health care

SECOND REGULAR SESSION HOUSE COMMITTEE SUBSTITUTE FOR HOUSE BILL NO.NOS.

1945 & 2570 103RD GENERAL ASSEMBLY INTRODUCED4438H.03C BYJOSEPH REPRESENTATIVEENGLER, HRUZA.Chief Clerk AN ACT To repeal section 338.333, RSMo, and to enact in lieu thereof three new sections relating to health care.

4438H.01I JOSEPH ENGLER, Chief Clerk AN ACT To repeal section 338.333, RSMo, and to enact in lieu thereof three new sections relating to health care.

(1) "Clinical pathology services", professional medical services provided by a pathologistlicensed forphysician that involve the examination,use of medical judgment, that contribute directly to the diagnosis, care, and interpretationtreatment of laboratoryindividual testspatients, performedand onthat patientare specimensnecessary tofor aidevery inlaboratory thetest diagnosisrun andin treatmenta ofhigh-complexity disease.laboratory environment;

Clinical(2) pathology"Hospital-based servicespathologist", include,a butlicensed arephysician notspecializing limitedin to,pathology hematology,who microbiology,provides immunology, clinical chemistry,pathology molecularservices pathology,for andthe otherlaboratory laboratory-basedwithin diagnostica procedures;hospital;

(2)(3) "Hospital-based"MO pathologist",HealthNet", athe licensedMedicaid physicianprogram specializingadministered inby pathologythe whostate providesof clinicalMissouri pathologyin servicesaccordance withinwith afederal hospitaland setting;state law;

(3)(4) "Professional component of clinical pathology services", the portion of each clinical pathology servicesservice in a high-complexity laboratory environment that involves the pathologist'sphysician's professionaluse expertiseof medical judgment in interpreting and supervising laboratory tests,tests excludingand that excludes the technical component of performing the laboratory tests.test.

The fee for the professional component of clinical pathology services shall be paid by MO HealthNet for professional services provided by a hospital-based pathologist forshall inpatientbe clinicalrecognized pathologyas servicesdistinct renderedphysician toservices patients covered by the MO HealthNet program.

3.

The MO HealthNet program shall reimburse the professional component of clinical pathology services provided to MO HealthNet participants.

HBHCS HBs 1945 & 2570 2 3.4.

The reimbursement amount for the professional component of clinical pathology services shall be set at no less than thirty percent of the approved outpatientMO simplifiedHealthNet feeIndependent scheduleLab based- onTechnical Medicare'sComponent clinical laboratory fee scheduleschedule. for the corresponding clinical pathology services payable by MO HealthNet.

4.

(1) If the fee for the professional component of clinical pathology services is paid for professional services provided by a pathologist employed by the hospital where the clinical pathology services are rendered to covered MO HealthNet patients, the professional fee shall be paid directly to the hospital.

(2) If the fee for the professional component of clinical pathology services is paid for professional services provided by a pathologist who is not employed by the hospital where clinical pathology services are rendered to covered MO HealthNet patients, the professional fee shall be paid directly to the third party providing the services.

Payment for the professional component of clinical pathology services shall be made directly to the licensed physician providing the services or to the entity the licensed physician has assigned the right to receive payment for the services provided.

6.

If a state plan amendment is determined by the department of social services to be required, the department of social services shall timely submit such amendment.

If such amendment is not approved, the department shall make all reasonable efforts to obtain federal approval, including resubmission, modification, or pursuit of any alternative lawful mechanism necessary to implement reimbursement consistent with this section.

Nothing in this subsection shall be construed to relieve the department of its obligation to implement reimbursement to the fullest extent permitted under state and federal authority.

7.

Separate licenses shall be required for each distribution site owned or operated by a wholesale drug distributor, pharmacy distributor, drug outsourcer, or third-party logistics provider, unless HCS HBs 1945 & 2570 3 such drug distributor, pharmacy distributor, drug outsourcer, or third-party logistics provider meets the requirements of section 338.335.

HB 1945 3 2.

The term "anesthesia time" includes, if counted by the anesthesia practitioner, blocks of time around an interruption in anesthesia timetime, provided the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption;

HCS HBs 1945 & 2570 4 (4) "Health benefit plan", the same meaning given to the term in section 376.1350.

The term "health benefit plan" shall also include MO HealthNet, the children's health insurance program authorized under chapter 208, the Missouri HB 1945 4 consolidated health care plan established under chapter 103, and any other state- sponsored health insurance program;

The sum of the base units for the appropriate medical code plus anesthesia time units and modifying units;