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SECOND REGULAR SESSION
SENATE BILL NO. 1469
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BURGER.
6161S.01I KRISTINA MARTIN, Secretary
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 1
one new section, to be known as section 208.149, to read as 2
follows:3
208.149. 1. As used in this section, the following 1
terms mean: 2
(1) "Clinical pathology services", professional 3
medical services provided by a pathologist for the 4
examination, diagnosis, and interpretation of laboratory 5
tests performed on patient specimens to aid in the diagnosis 6
and treatment of disease. Clinical pathology services 7
include, but are not limited to, hematology, microbiology, 8
immunology, clinical chemistry, molecular pathology, and 9
other laboratory-based diagnostic procedures; 10
(2) "Hospital-based pathologist", a licensed physician 11
specializing in pathology who provides clinical pathology 12
services within a hospital setting; 13
(3) "Professional component of clinical pathology 14
services", the portion of clinical pathology services that 15
involves the pathologist's professional expertise in 16
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interpreting and supervising laboratory tests, excluding the 17
technical component of performing the laboratory tests. 18
2. The fee for the professional component of clinical 19
pathology services shall be paid by MO HealthNet for 20
professional services provided by a hospital-based 21
pathologist for inpatient clinical pathology services 22
rendered to patients covered by the MO HealthNet program. 23
3. The reimbursement amount for the professional 24
component of clinical pathology services shall be set at 25
thirty percent of the approved outpatient simplified fee 26
schedule based on Medicare's clinical laboratory fee 27
schedule for the corresponding clinical pathology services 28
payable by MO HealthNet. 29
4. (1) If the fee for the professional component of 30
clinical pathology services is paid for professional 31
services provided by a pathologist employed by the hospital 32
where the clinical pathology services are rendered to 33
covered MO HealthNet patients, the professional fee shall be 34
paid directly to the hospital. 35
(2) If the fee for the professional component of 36
clinical pathology services is paid for professional 37
services provided by a pathologist who is not employed by 38
the hospital where clinical pathology services are rendered 39
to covered MO HealthNet patients, the professional fee shall 40
be paid directly to the third party providing the services. 41
5. The department of social services shall promulgate 42
all necessary rules and regulations for the administration 43
of this section. Any rule or portion of a rule, as that 44
term is defined in section 536.010, that is created under 45
the authority delegated in this section shall become 46
effective only if it complies with and is subject to all of 47
the provisions of chapter 536 and, if applicable, section 48
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536.028. This section and chapter 536 are nonseverable and 49
if any of the powers vested with the general assembly 50
pursuant to chapter 536 to review, to delay the effective 51
date, or to disapprove and annul a rule are subsequently 52
held unconstitutional, then the grant of rulemaking 53
authority and any rule proposed or adopted after August 28, 54
2026, shall be invalid and void. 55
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