HOUSE BILL NO. 1945 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE HRUZA.
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.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 338.333, RSMo, is repealed and three new sections enacted in lieu 2 thereof, to be known as sections 208.149, 338.333, and 376.1245, to read as follows: 208.149. 1.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 1945 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, 2026, shall be invalid and void. 338.333. 1. Except as otherwise provided by the board of pharmacy by rule in the 2 event of an emergency or to alleviate a supply shortage, no person or distribution outlet shall 3 act as a wholesale drug distributor, pharmacy distributor, drug outsourcer, or third-party 4 logistics provider without first obtaining license to do so from the Missouri board of 5 pharmacy and paying the required fee. The board may grant temporary licenses when the 6 wholesale drug distributor, pharmacy distributor, drug outsourcer, or third-party logistics 7 provider first applies for a license to operate within the state. Temporary licenses shall 8 remain valid until such time as the board shall find that the applicant meets or fails to meet the 9 requirements for regular licensure. No license shall be issued or renewed for a wholesale 10 drug distributor, pharmacy distributor, drug outsourcer, or third-party logistics provider to 11 operate unless the same shall be operated in a manner prescribed by law and according to the 12 rules and regulations promulgated by the board of pharmacy with respect thereto. Separate 13 licenses shall be required for each distribution site owned or operated by a wholesale drug 14 distributor, pharmacy distributor, drug outsourcer, or third-party logistics provider, unless 15 such drug distributor, pharmacy distributor, drug outsourcer, or third-party logistics provider 16 meets the requirements of section 338.335. HB 1945 3
17 2. An agent or employee of any licensed or registered wholesale drug distributor, 18 pharmacy distributor, drug outsourcer, or third-party logistics provider need not seek 19 licensure under this section and may lawfully possess pharmaceutical drugs, if the agent or 20 employee is acting in the usual course of his or her business or employment. 21 3. The board may permit out-of-state wholesale drug distributors, drug outsourcers, 22 third-party logistics [provider] providers, or out-of-state pharmacy distributors to be licensed 23 as required by sections 338.210 to 338.370 on the basis of reciprocity to the extent that the 24 entity both: 25 (1) Possesses a valid license granted by another state pursuant to legal standards 26 comparable to those which must be met by a wholesale drug distributor, pharmacy distributor, 27 drug [outsourcers] outsourcer, or third-party logistics provider of this state as prerequisites 28 for obtaining a license under the laws of this state. If a state license is not issued by their 29 resident state, out-of-state wholesale drug distributors and third-party logistics 30 providers with a current and valid drug distributor accreditation from the National 31 Association of Boards of Pharmacy or its successor may be eligible for licensure as 32 provided by the board by rule; and 33 (2) Distributes into Missouri from a state which would extend reciprocal treatment 34 under its own laws to a wholesale drug distributor, pharmacy distributor, drug outsourcers, or 35 third-party logistics provider of this state. 376.1245. 1. As used in this section, the following terms mean: 2 (1) "Anesthesia time", the period during which an anesthesia practitioner is 3 present with the patient, starting when the anesthesia practitioner begins to prepare the 4 patient for anesthesia services in the operating room or an equivalent area and ending 5 when the anesthesia practitioner is no longer furnishing anesthesia services to the 6 patient because the patient may be placed safely under postoperative or postanesthesia 7 care. The term "anesthesia time" includes, if counted by the anesthesia practitioner, 8 blocks of time around an interruption in anesthesia time provided the anesthesia 9 practitioner is furnishing continuous anesthesia care within the time periods around the 10 interruption; 11 (2) "Anesthesia time units", time units recognized with appropriate time 12 intervals that do not exceed fifteen minutes in length for each interval and that, taken 13 together, represent the total anesthesia time for a particular anesthesia service; 14 (3) "Excepted benefit plan", the same meaning given to the term in section 15 376.998; 16 (4) "Health benefit plan", the same meaning given to the term in section 17 376.1350. The term "health benefit plan" shall also include MO HealthNet, the 18 children's health insurance program authorized under chapter 208, the Missouri HB 1945 4
19 consolidated health care plan established under chapter 103, and any other state- 20 sponsored health insurance program; 21 (5) "Health carrier", the same meaning given to the term in section 376.1350. 22 The term "health carrier" shall also include the MO HealthNet division and any 23 Medicaid managed care organization as defined in section 208.431; 24 (6) "Payment of anesthesia services", an amount paid for anesthesia services: 25 (a) Determined by using prevailing medical coding and billing standards in the 26 professional medical billing community, such as the Current Procedural Terminology 27 code book published by the American Medical Association, the Medicare Claims 28 Processing Manual, or guidance from nationally recognized anesthesia organizations; 29 and 30 (b) Calculated as the product obtained by multiplying the following together: 31 a. The sum of the base units for the appropriate medical code plus anesthesia 32 time units; and 33 b. An anesthesia conversion factor that is defined in the individual contract 34 between the health carrier or health benefit plan and the anesthesia practitioner or 35 group. 36 2. No health carrier or health benefit plan shall establish, implement, or enforce 37 any policy, practice, or procedure that imposes a time limit for the payment of 38 anesthesia services provided during a medical or surgical procedure. 39 3. No health carrier or health benefit plan shall establish, implement, or enforce 40 any policy, practice, or procedure that restricts or excludes all anesthesia time in 41 calculating the payment of anesthesia services. 42 4. Excepted benefit plans shall be subject to the requirements of this section. ✔
Statutes affected: