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A BILL TO BE ENTITLED
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AN ACT
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relating to the billing and reimbursement of anatomic pathology |
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services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Subtitle I, Title 2, Health and |
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Safety Code, is amended to read as follows: |
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SUBTITLE I. MEDICAL RECORDS AND BILLING |
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SECTION 2. Subtitle I, Title 2, Health and Safety Code, is |
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amended by adding Chapter 182 to read as follows: |
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CHAPTER 182. BILLING OF ANATOMIC PATHOLOGY SERVICES |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 182.001. DEFINITIONS. In this chapter: |
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(1) "Anatomic pathology services" means: |
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(A) histopathology or surgical pathology, which |
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is the gross and microscopic examination and histologic processing |
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of organ tissue performed by a physician or under the supervision of |
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a physician; |
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(B) cytopathology, which is the examination of |
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cells from the following: |
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(i) fluids; |
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(ii) aspirates; |
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(iii) washings; |
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(iv) brushings; or |
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(v) smears, including a Pap smear, |
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performed by a physician or under the supervision of a physician; |
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(C) hematology, which is the microscopic |
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evaluation of bone marrow aspirates and biopsies performed by a |
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physician, or under the supervision of a physician, and peripheral |
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blood smears when the attending or treating physician or |
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technologist requests that a blood smear be reviewed by a |
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pathologist; |
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(D) sub-cellular pathology and molecular |
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pathology; or |
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(E) a blood-banking service performed by a |
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pathologist. |
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(2) "Clinical laboratory" means a facility for the |
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biological, microbiological, serological, chemical, |
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immuno-hematological, hematological, biophysical, cytological, |
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pathological, or other examination of materials derived from the |
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human body to provide information for: |
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(A) the diagnosis, prevention, or treatment of a |
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disease or any impairment of the health of human beings; or |
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(B) the assessment of the health of human beings. |
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(3) "Licensed practitioner" means a health care |
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professional who is licensed in this state, including a physician, |
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dentist, advanced practice nurse, and physician assistant, and who |
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orders or performs anatomic pathology services within the scope of |
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the practitioner's practice. |
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(4) "Physician" includes a surgeon and an osteopath. |
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(5) "Referring laboratory," with respect to the |
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referral of anatomic pathology services, does not include a |
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laboratory of a physician's office or group practice that collects |
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a specimen and orders anatomic pathology services for a patient. |
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Sec. 182.002. RULES. The appropriate regulatory agency of |
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this state that issues a license or certificate to a licensed |
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practitioner may adopt the rules necessary to implement this |
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chapter. |
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[Sections 182.003-182.050 reserved for expansion] |
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SUBCHAPTER B. FEES OR CLAIMS FOR SERVICES |
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Sec. 182.051. LIMITATIONS ON BILLING SERVICES. (a) A |
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clinical laboratory or physician who provides anatomic pathology |
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services for a patient in this state may present or cause to be |
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presented a bill or demand for payment for the services provided by |
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the laboratory or physician only to: |
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(1) the patient directly; |
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(2) the responsible insurer or to another third-party |
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payor; |
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(3) a public health clinic or nonprofit health clinic |
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that ordered the services; |
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(4) the referring laboratory; |
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(5) a governmental agency or the agency's designated |
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agent, on behalf of the patient; or |
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(6) a hospital if the bill or demand for payment is |
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limited to the technical component of the services. |
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(b) In this section, "nonprofit health clinic" means a |
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clinic that is exempt from federal income tax under Section 501(a), |
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Internal Revenue Code of 1986, by being listed as an exempt |
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organization in Section 501(c)(3) or 501(c)(4) of that code and |
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that is organized and operated for the purpose of providing free or |
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reduced cost health care. |
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Sec. 182.052. BILLING FOR SERVICES NOT PERFORMED OR |
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SUPERVISED PROHIBITED. Except as provided by Section 182.053 and |
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subject to Section 182.051, a licensed practitioner may not |
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directly or indirectly charge, bill, or otherwise solicit payment |
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for anatomic pathology services unless the services were performed |
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personally by the licensed practitioner or under the licensed |
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practitioner's direct supervision in accordance with Section 353, |
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Public Health Service Act (42 U.S.C. Section 263a). |
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Sec. 182.053. REIMBURSEMENT; ASSIGNMENT OF BENEFITS. (a) |
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A patient, insurer, third-party payor, hospital, public health |
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clinic, or nonprofit health clinic may not be required to reimburse |
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a licensed practitioner or clinical laboratory for a charge, bill, |
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or demand for payment made or submitted in violation of this |
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chapter. |
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(b) Nothing in this chapter requires an assignment of |
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benefits for anatomic pathology services. |
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Sec. 182.054. BILLING OF REFERRING LABORATORY. This |
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chapter does not prohibit billing a referring laboratory for |
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anatomic pathology services in circumstances in which a specimen |
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must be sent to another specialist. |
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[Sections 182.055-182.100 reserved for expansion] |
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SUBCHAPTER C. ENFORCEMENT |
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Sec. 182.101. DISCIPLINARY ACTION. A licensed practitioner |
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who violates this chapter or a rule adopted under this chapter by |
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the appropriate regulatory agency of this state is subject to |
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disciplinary action by the agency under applicable law, including |
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revocation, suspension, or nonrenewal of the practitioner's |
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license. |
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SECTION 3. Section 161.061, Health and Safety Code, is |
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amended by adding Subsection (c) to read as follows: |
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(c) An agreement described by this section must comply with |
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Chapter 182, if applicable. |
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SECTION 4. Chapter 182, Health and Safety Code, as added by |
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this Act, applies only to anatomic pathology services performed on |
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or after the effective date of this Act. |
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SECTION 5. The appropriate regulatory agencies of this |
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state may adopt rules necessary to implement Chapter 182, Health |
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and Safety Code, as added by this Act. |
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SECTION 6. This Act takes effect September 1, 2007. |