Modifies provisions relating to health care

SECOND REGULAR SESSION
HOUSE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NOS. 1945 & 2570
103RD GENERAL ASSEMBL Y
4438H.03C JOSEPH ENGLER, Chief Clerk
AN ACT
T o 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Section A. Section 338.333, RSMo, is repealed and three new sections enacted in lieu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", pro fessional medical services pr ovided by a
3 licensed physician that involve the use of medical judgment, that contribute dir ectly to
4 the diagnosis, care, and trea tment of individual patients, and that ar e necessary for
5 every laboratory test run in a high-complexity laboratory envir onment;
6 (2) "Hospital-based pathologist", a licensed physician specializing in pathology
7 who provi des clinical pathology services for the laboratory within a hospital;
8 (3) "MO HealthNet", the Medicaid prog ram administered by the state of
9 Missouri in accordance with federal and state law;
10 (4) "Pro fessional component of clinical pathology services", the portion of each
11 clinical pathology service in a high-complexity laboratory envir onment that involves the
12 physician's use of medical judgment in interpret ing and supervising laboratory tests
13 and that excludes the technical component of the laboratory test.
14 2. The pr ofessional component of clinical pathology services pro vided by a
15 hospital-based pathologist shall be reco gnized as distinct physician services by the MO
16 HealthNet pr ogram.
17 3. The MO HealthNet prog ram shall r eimburse the pro fessional component of
18 clinical pathology services pr ovided to MO HealthNet participants.
EXPLANA TION — 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.
19 4. The re imbursement amount for the profes sional component of clinical
20 pathology services shall be set at no less than thirty per cent of the appr oved MO
21 HealthNet Independent Lab - T echnical Component fee schedule.
22 5. Payment for the profes sional component of clinical pathology services shall be
23 made directly to the licensed physician pr oviding the services or to the entity the
24 licensed physician has assigned the right to r eceive payment for the services pr ovided.
25 6. If a state plan amendment is determined by the department of social services
26 to be r equir ed, the department of social services shall timely submit such amendment.
27 If such amendment is not appr oved, the department shall make all r easonable efforts to
28 obtain federal appr oval, including res ubmission, modification, or pursuit of any
29 alternative lawful mechanism necessary to implement reim bursement consistent with
30 this section. Nothing in this subsection shall be construed to r elieve the department of
31 its obligation to implement rei mbursement to the fullest extent permitted under state
32 and federal authority .
33 7. The department of social services shall pro mulgate all necessary rules and
34 r egulations for the administration of this section. Any rule or portion of a rule, as that
35 term is defined in section 536.010, that is creat ed under the authority delegated in this
36 section shall become effective only if it complies with and is subject to all of the
37 pr ovisions of chapter 536 and, if applicable, section 536.028. This section and chapter
38 536 are nonseverable and if any of the powers vested with the general assembly
39 pursuant to chapter 536 to revi ew , to delay the effective date, or to disappr ove and annul
40 a rule are subsequently held unconstitutional, then the grant of rulemaking authority
41 and any rule prop osed 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 emer gency 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. T emporary 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
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15 such drug distributor , pharmacy distributor , drug outsourcer , or third-party logistics provider
16 meets the requirements of section 338.335.
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 ] pro viders , 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 r esident state, out-of-state wholesale drug distributors and third-party logistics
30 pr oviders with a curr ent and valid drug distributor accredi tation fr om the National
31 Association of Boards of Pharmacy or its successor may be eligible for licensur e as
32 pr ovided 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 pr esent with the patient, starting when the anesthesia practitioner begins to prep are the
4 patient for anesthesia services in the operating ro om 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 car e. The term "anesthesia time" includes, if counted by the anesthesia practitioner ,
8 blocks of time ar ound an interruption in anesthesia time, pr ovided the anesthesia
9 practitioner is furnishing continuous anesthesia care within the time periods aroun d the
10 interruption;
11 (2) "Anesthesia time units", time units re cognized with appr opriate time
12 intervals that do not exceed fifteen minutes in length for each interval and that, taken
13 together , r epresent 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;
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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 childr en's health insurance pro gram authorized under chapter 208, the Missouri
19 consolidated health car e plan established under chapter 103, and any other state-
20 sponsor ed health insurance pr ogram;
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 pr evailing medical coding and billing standards in the
26 pr ofessional medical billing community , such as the Curr ent Pr ocedural T erminology
27 code book published by the American Medical Association, the Medicare Claims
28 Pr ocessing Manual, or guidance fr om nationally recog nized anesthesia organizations;
29 and
30 (b) Calculated as the prod uct obtained by multiplying the following together:
31 a. The sum of the base units for the appr opriate medical code plus anesthesia
32 time units and modifying 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 gr oup.
36 2. No health carrier or health benefit plan shall establish, implement, or enforce
37 any policy , practice, or pro cedur e that imposes a time limit for the payment of
38 anesthesia services pr ovided during a medical or surgical proced ure.
39 3. No health carrier or health benefit plan shall establish, implement, or enforce
40 any policy , practice, or proc edure that res tricts or excludes all anesthesia time in
41 calculating the payment of anesthesia services.
42 4. Excepted benefit plans shall be subject to the requ irem ents of this section.
✔
HCS HBs 1945 & 2570 4