HCS HB 1990 -- HEALTH CARE SERVICES

SPONSOR:  Wilson (130)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
Health Insurance by a vote of 8 to 1.

This substitute changes the laws regarding health care services.

ANATOMIC PATHOLOGY SERVICES

A licensed health care professional is prohibited from charging,
billing, or soliciting payment for anatomic pathology services,
unless the services are rendered personally by the licensed
health care professional or under his or her direct supervision.
No patient, insurer, third-party payor, hospital, public health
clinic, or nonprofit health clinic will be required to reimburse
any licensed health care professional for charges or claims
submitted in violation of this provision.  Nothing will prohibit
the billing of a referring laboratory for services when samples
must be sent to another specialist.  The state licensing board
having jurisdiction over the licensed health care professional
who requests or provides these services may revoke, suspend, or
deny the license of anyone who violates these provisions.

HEALTH CARRIER NOTIFICATION REQUIREMENTS

All health carriers are required to notify their enrollees in
writing or electronically or by phone when a health care provider
changes from an in-network provider to an out-of-network
provider.  Carriers must notify enrollees at least 30 days prior
to the effective date of the status change and must have a
written procedure that ensures continuity of care for enrollees
when network status changes occur including notification and
transfers to other in-network providers.  If a provider changes
their network status, the carrier must provide enrollees with
continuation of care for up to 90 days when medically necessary
and medically prudent.  If continuation of care is needed or if
the carrier fails to notify an enrollee 30 days prior to any
network status change, the enrollee can continue to receive
services at in-network costs from the provider who changed to
out-of-network status and the enrollee will not be liable for any
charges in excess of in-network rates and costs.  If the
in-network provider who changed network status is authorized to
provide continuation of care to an enrollee, the carrier must
reimburse the provider at in-network rates.

FISCAL NOTE:  No impact on General Revenue Fund in FY 2009,
FY 2010, and FY 2011.  Estimated Cost on Other State Funds of
Unknown but Less than $100,000 in FY 2009, FY 2010, and FY 2011.

PROPONENTS:  Supporters say that Medicaid and Medicare doctors
cannot charge a brokerage fee for anatomic pathology services but
private physicians can.  The bill requires private physicians to
follow the same standards of the Centers for Medicaid and
Medicare Services.  Disallowing a brokerage fee will protect
patients from markups in charges for pathology services, and the
statement for services will go directly to the patient and not to
the treating physician.  Thirteen states have already passed
similar provisions.

Testifying for the bill were Representative Wilson (130); and
Robert Breckenridge.

OPPONENTS:  Those who oppose the bill say that the bill is
unnecessary and is a reckless approach to rectify a situation
that only some physicians identify as a problem which could be
resolved in the medical community.  There is no evidence of
unethical behavior.  The bill will put an end to the one-stop
shop for patients because they will get separate bills from the
physician and the pathology provider.  The bill will create a
monopoly for larger pathology labs and interfere with the free
market.  Capping the ways physicians can make money will result
in fewer individuals entering the field of medicine.

Testifying against the bill were Missouri Academy of Family
Physicians; Missouri Association of Osteopathic Physicians and
Surgeons; and American Academy of Dermatology Association.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:11 pm