HOUSE BILL NO. 1599 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE HRUZA.
3235H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To amend chapter 208, RSMo, by adding thereto one new section relating to MO HealthNet reimbursement for clinical pathology services.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 208, RSMo, is amended by adding thereto one new section, to be 2 known as section 208.149, to read as follows: 208.149. 1. As used in this section, the following terms mean: 2 (1) "Clinical pathology services", professional medical services provided by a 3 pathologist for the examination, diagnosis, and interpretation of laboratory tests 4 performed on patient specimens to aid in the diagnosis and treatment of disease. 5 Clinical pathology services include, but are not limited to, hematology, microbiology, 6 immunology, clinical chemistry, molecular pathology, and other laboratory-based 7 diagnostic procedures; 8 (2) "Hospital-based pathologist", a licensed physician specializing in pathology 9 who provides clinical pathology services within a hospital setting; 10 (3) "Professional component of clinical pathology services", the portion of 11 clinical pathology services that involves the pathologist's professional expertise in 12 interpreting and supervising laboratory tests, excluding the technical component of 13 performing the laboratory tests. 14 2. The fee for the professional component of clinical pathology services shall be 15 paid by MO HealthNet for professional services provided by a hospital-based 16 pathologist for inpatient clinical pathology services rendered to patients covered by 17 the MO HealthNet program.
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 1599 2
18 3. The reimbursement amount for the professional component of clinical 19 pathology services shall be set at thirty percent of the approved outpatient simplified fee 20 schedule based on Medicare's clinical laboratory fee schedule for the corresponding 21 clinical pathology services payable by MO HealthNet. 22 4. (1) If the fee for the professional component of clinical pathology services is 23 paid for professional services provided by a pathologist employed by the hospital where 24 the clinical pathology services are rendered to covered MO HealthNet patients, the 25 professional fee shall be paid directly to the hospital. 26 (2) If the fee for the professional component of clinical pathology services is paid 27 for professional services provided by a pathologist who is not employed by the hospital 28 where clinical pathology services are rendered to covered MO HealthNet patients, the 29 professional fee shall be paid directly to the third party providing the services. 30 5. The department of social services shall promulgate all necessary rules and 31 regulations for the administration of this section. Any rule or portion of a rule, as that 32 term is defined in section 536.010, that is created under the authority delegated in this 33 section shall become effective only if it complies with and is subject to all of the 34 provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 35 536 are nonseverable and if any of the powers vested with the general assembly 36 pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul 37 a rule are subsequently held unconstitutional, then the grant of rulemaking authority 38 and any rule proposed or adopted after August 28, 2025, shall be invalid and void. ✔
Statutes affected: