Sub.
H.B. 493
127th General Assembly
(As Passed by the House)
Reps. Daniels, Ujvagi, Flowers, Goodwin, Collier, Zehringer, Strahorn, J. Otterman, R. Hagan, Budish, Chandler, Combs, Domenick, Evans, Gerberry, Harwood, Letson, Szollosi
BILL SUMMARY
· Prohibits a clinical laboratory or physician from presenting, or causing to be presented, a claim, bill, or demand for payment for anatomic pathology services to any person other than the following: the patient or other person responsible for the patient's bills, the patient's insurer or other third-party payor, a hospital or clinic that orders the services, a referring clinical laboratory, or a governmental agency or person acting on behalf of such an agency.
· Prohibits a physician from charging, billing, or otherwise soliciting payment, directly or indirectly, for anatomic pathology services unless the services are personally rendered by the physician or rendered under the on-site supervision of the physician.
· Specifies that the bill's prohibitions are not to be construed to (1) mandate the assignment of benefits for anatomic pathology services, (2) prohibit a clinical laboratory that provides anatomic pathology services from billing a referring clinical laboratory for services in instances in which the referring laboratory must send one or more samples to a specialist for analysis, consultation, or histologic processing, or (3) prohibit a physician who performs the professional component of an anatomic pathology service on a patient specimen from billing for the technical component of the service when that component is performed by a clinical laboratory.
· Authorizes the State Medical Board to take disciplinary action against a physician who violates the bill.
CONTENT AND OPERATION
The bill establishes restrictions regarding billing for anatomic pathology services. "Anatomic pathology services" is defined as all of the following:
(1) Histopathology or surgical pathology--the gross and microscopic examination and histologic processing[1] of organ tissue performed by a physician or under the supervision of a physician (R.C. 3701.86(F)).
(2) Cytopathology--the microscopic examination of cells from fluids, aspirates, washings, brushings, or smears, including a Papanicolau smear (PAP smear or test) (R.C. 3701.86(D)).
(3) Hematology--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 (R.C. 3701.86(E)).
(4) Subcellular or molecular pathology--the assessment of a patient specimen for the detection, localization, measurement, or analysis of one or more protein or nucleic acid targets performed or interpreted by or under supervision of a pathologist (R.C. 3701.86(K)).
(5) Blood banking services performed by pathologists.
(R.C. 3701.861 and 4731.721)
The bill prohibits a clinical laboratory[2] or physician, including a podiatrist,[3] from presenting, or causing to be presented, a claim, bill, or demand for payment for anatomic pathology services to any person other than the following:
(1) The patient who receives the services or another individual, such as a parent, spouse, or guardian, who is responsible for the patient's bills;
(2) A responsible insurer[4] or other third-party payor of a patient who receives the services;
(3) A hospital, public health clinic, or not-for-profit health clinic ordering the services;
(4) A referring clinical laboratory;[5]
(5) A governmental agency or any person acting on behalf of a governmental agency.
The bill specifies that this prohibition does not prohibit a clinical laboratory that provides anatomic pathology services from billing a referring clinical laboratory for anatomic pathology services in instances in which the referring clinical laboratory must send one or more samples to a specialist for analysis, consultation, or histologic processing.[6]
(R.C. 4731.722)
The bill prohibits a physician from charging, billing, or otherwise soliciting payment, directly or indirectly, for anatomic pathology services unless the services are personally rendered by the physician or rendered under the on-site supervision of a physician. The bill specifies that this prohibition does not, however, prohibit a physician who performs the professional component[7] of an anatomic pathology service on a patient specimen from billing for the technical component of the service[8] when that component is performed by a clinical laboratory.
(R.C. 3701.86, 3701.862, 4731.72, and 4731.723)
The bill specifies
that its prohibitions regarding anatomic pathology services are not to be
construed to mandate the assignment of benefits for anatomic pathology
services. "Assignment of benefits" is defined as the transfer of health
care coverage reimbursement benefits or other rights under an insurance policy,
subscription contract, or health care plan by an insured, subscriber, or plan
enrollee to a health care provider, hospital, or other health care facility.
(R.C. 4731.22(B)(38))
Current law authorizes the State Medical Board, by an affirmative vote of not fewer than six members, to take disciplinary action against a physician for any of a number of reasons specified in statute. The Board may limit, revoke, or suspend a physician's certificate to practice, refuse to register a physician, refuse to reinstate a physician's certificate, or reprimand or place a physician on probation.
The bill authorizes
the State Medical Board to take disciplinary action against a physician who violates
either of the bill's prohibitions regarding billing for anatomic pathology
services.
HISTORY
|
ACTION |
DATE |
|
|
|
|
Introduced |
03-05-08 |
|
Reported, H. Health |
05-22-08 |
|
Passed House (92-3) |
05-29-08 |
h0493-ph-127.doc/kl
[1] The bill defines
"histologic processing" as fixation, processing, embedding,
microtomy, and other special staining, including histochemical or
immunohistochemical staining and in situ hybridization of clinical human
tissues or cells, for pathological examination (R.C. 3701.86(F)).
[2] The bill defines a
"clinical laboratory" as a facility for the biological,
microbiological, serological, chemical, immunohematological, hematological,
biophysical, cytological, pathological, or other examination of substances
derived from the human body for the purpose of providing information for the
diagnosis, prevention, or treatment of any disease, or in the assessment or
impairment of the health of human beings (R.C. 3701.86(C)).
[3] The bill defines "physician" as an
individual authorized by the State Medical Board to practice medicine and
surgery, osteopathic medicine and surgery, or podiatric medicine and surgery
(R.C. 3701.86(I)).
[4] The bill defines an
"insurer" as a person authorized to engage in the business of
insurance in Ohio, a health insuring corporation, or an entity that is
self-insured and provides benefits to its employees or members (R.C. 3701.86(H)).
[5] The bill defines a
"referring clinical laboratory" as a clinical laboratory that refers
a patient specimen to another clinical laboratory for an anatomic pathology
service, but excludes a laboratory in an office of one or more physicians that
refers a specimen and does not perform the professional component of the
anatomic pathology service (R.C. 3701.86(J)).
[6] The
effect of this provision is unclear, particularly since the bill includes a
separate provision expressly authorizing a clinical laboratory to bill a
referring laboratory. An amendment may
be necessary to clarify the provision's intended purpose.
[7] The bill specifies
that the professional component of an anatomic pathology service means the
entire anatomic pathology service other than histologic processing (R.C.
4731.722(A)(1)).
[8] The bill specifies
that the technical component of an anatomic pathology service includes only
histologic processing (R.C. 4731.722(A)(2)).