Bill Text: PA HB2521 | 2009-2010 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Providing for anatomic pathology service disclosure.

Sponsorship: Moderate Partisan Bill (Democrat 19-4)

Status: (Passed) 2010-11-23 - Act No. 121 [HB2521 Detail]

Download: Pennsylvania-2009-HB2521-Amended.html

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PRIOR PRINTER'S NO. 3753 PRINTER'S NO. 4075
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2521 Session of2010
INTRODUCED BY DeLUCA, MUNDY, BARBIN, D. COSTA, BELFANTI, CALTAGIRONE, DAY, FRANKEL, GEORGE, HARKINS, JOSEPHS, KOTIK, MATZIE, M. O'BRIEN, PASHINSKI, SIPTROTH, SOLOBAY, THOMAS, WHITE, YOUNGBLOOD, MICOZZIE, QUINN AND KILLION, MAY 19, 2010
AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES, JULY 1, 2010
AN ACT
Providing for anatomic pathology service disclosure.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Anatomic
Pathology Service Disclosure Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Anatomic pathology service." The term shall include:
(1) histopathology or surgical pathology, which means
the gross and microscopic examination of organ tissue
performed by a physician or under the supervision of a
physician, including histologic processing;
(2) cytopathology, which means the microscopic
examination of cells from the following:
(i) fluids;
(ii) aspirates;
(iii) washings;
(iv) brushings; or
(v) smears, including the Pap test examination
performed by a physician or under the supervision of a
physician;
(3) hematology, which means 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 the pathologist;
(4) subcellular pathology and molecular pathology; or
(5) blood-banking services performed by pathologists.
The term does not include the initial collection or packaging of
the specimen for transport.
"Designated health service." The following goods or <--
services:
(1) clinical laboratory services;
(2) physical therapy, occupational therapy or speech
language pathology;
(3) chiropractic;
(4) radiation oncology;
(5) psychometric services; or
(6) home health services.
"Health care provider." A person, corporation, facility or
institution licensed or otherwise authorized by the Commonwealth
to provide health care services, including, but not limited to,
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a physician, coordinated care organization, hospital, health
care facility, dentist, nurse, optometrist, podiatrist, physical
therapist, psychologist, chiropractor or pharmacist and an
officer, employee or agent of the person acting in the course
and scope of employment or agency related to health care
services.
"Referral." <--
(1) The term shall include:
(i) The request by a health care provider for, or
ordering of, or the certifying or recertifying of the
need for any designated health service, including a
request for a consultation with another health care
provider and any test or procedure ordered by or to be
performed by, or under the supervision of, that other
health care provider, but not including any designated
health service personally performed or provided by the
referring provider. A designated health service is not
personally performed or provided by the referring health
care provider if it is performed or provided by any other
person, including, but not limited to, the referring
health care provider's employees, independent contractors
or group practice members.
(ii) A request by a health care provider that
includes the provision of any designated health service,
the establishment of a plan of care by a health care
provider that includes the provision of such a designated
health service or the certifying or recertifying of the
need for such a designated health service, but not
including any designated health service personally
performed or provided by the referring health care
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provider. A designated health service is not personally
performed or provided by the referring health care
provider if it is performed or provided by any other
person, including, but not limited to, the referring
health care provider's employees, independent contractors
or group practice members.
(2) The term shall not include a request by a
pathologist for clinical diagnostic laboratory tests and
pathological examination services by a radiologist for
diagnostic radiology services and by a radiation oncologist
for radiation therapy or ancillary services necessary for,
and integral to, the provision of radiation therapy, if:
(i) the request results from a consultation
initiated by another health care provider, whether the
request for a consultation was made to a particular
health care provider or to an entity with which the
health care provider is affiliated; and
(ii) the tests or services are furnished by or under
the supervision of the pathologist, radiologist or
radiation oncologist or under the supervision of a
pathologist, radiologist or radiation oncologist,
respectively, in the same group practice as the
pathologist, radiologist or radiation oncologist.
(3) A referral may be in any form, including, but not
limited to, written, oral or electronic.
Section 3. Disclosure requirement.
A health care provider or any physician group practice who <--
orders but who does not supervise or perform a component of an
anatomic pathology service shall disclose in a bill for the
service presented to a patient, insurer or other third-party
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payor:
(1) The name and address of the health care provider or
laboratory that provided the anatomic pathology service.
(2) The amount paid or to be paid for each anatomic
pathology service provided to the patient by the health care
provider or laboratory that performed the service.
Section 4. Penalties.
(a) Limitation on billing.--No claim for payment may be <--
presented by an entity to any individual, third-party payer or
other entity for a designated health service furnished pursuant
to a violation of this act.
(b) Denial of payment.--
(1) Except as provided in paragraph (2), no payment may
be made by a payer for a designated health service that is
furnished pursuant to a violation of this act.
(2) Payment may be made to an entity that submits a
claim for a designated health service if the entity did not
have actual knowledge of, and did not act in reckless
disregard or deliberate ignorance of, the identity of the
provider who made the referral of the designated health
service to the entity.
(c) Violation.--A violation of this act by a health care
provider shall constitute grounds for disciplinary action to be
taken by the applicable board under an applicable licensing
statute.
Section 20. Effective date.
This act shall take effect in 60 days.
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