THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY DeLUCA, MUNDY, BARBIN, D. COSTA, BELFANTI, CALTAGIRONE, DAY, FRANKEL, GEORGE, HARKINS, JOSEPHS, KOTIK, MATZIE, M. O'BRIEN, PASHINSKI, SIPTROTH, SOLOBAY, THOMAS, WHITE AND YOUNGBLOOD, MAY 19, 2010

REFERRED TO COMMITTEE ON INSURANCE, MAY 19, 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,

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

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 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 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.