BILL NUMBER: SB 1369 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 7, 2006
AMENDED IN ASSEMBLY JUNE 19, 2006
AMENDED IN SENATE MAY 26, 2006
AMENDED IN SENATE APRIL 17, 2006
AMENDED IN SENATE MARCH 27, 2006
INTRODUCED BY Senator Maldonado
FEBRUARY 21, 2006
An act to amend Sections 655.6 and 1288 of the Business and
Professions Code, relating to clinical laboratories.
LEGISLATIVE COUNSEL'S DIGEST
SB 1369, as amended, Maldonado Clinical laboratories: anatomic
pathology services.
Existing law provides that it is unlawful for certain health care
professionals to charge, bill, or otherwise solicit payment from any
patient, client, customer, or third-party 3rd
party payer for cytologic services relating to the examination
of gynecologic slides if those services were not actually rendered
by the person or under his or her direct supervision. Existing law
also requires clinical laboratories performing cytologic examinations
of gynecologic slides to directly bill either the patient or the
responsible third-party 3rd party payer
for the cytology services rendered by the laboratory, except as
specified. A violation of these provisions is a crime.
This bill would instead make it unlawful for those health care
professionals to charge, bill, or otherwise solicit payment from any
patient, client, customer, or third-party 3rd
party payer for professional assessment and
interpretation of anatomic pathology services , as
defined, on samples specimens
originating in California, as defined, if those
services were not actually rendered by the person or under his or her
direct supervision. The bill would also require clinical
laboratories providing professional assessment and
interpretation of anatomic pathology services to directly
bill either the patient, the responsible third-party
3rd party payer, or the requesting hospital or
clinic for those services, except as specified.
Existing law allows clinical laboratories to accept assignments to
perform tests only from licensed health care providers.
This bill would require licensed persons ordering tests
to provide include accurate billing
information or the means to get that information if a third
party is to be billed to enable the laboratory to bill
the patient or responsible 3rd party payer, when the
laboratory is required to directl y bill for its services
.
Because a violation of these provisions would be a crime, this
bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 655.6 of the Business and Professions Code is
amended to read:
655.6. (a) It is unlawful for any person licensed under this
division or under any initiative act referred to in this division to
charge, bill, or otherwise solicit payment from any patient, client,
customer, or third-party payer for professional assessment
and interpretation of anatomic pathology services if
that professional assessment and interpretation of
those services was were not actually
rendered by that person or under his or her direct supervision.
(b) (1) Clinical laboratories providing professional
assessment and interpretation of anatomic pathology
services on specimens originating in California shall directly bill
(i) the patient, (ii) the insurer or third-party payer responsible
for payment of the services, or (iii) the hospital ,
public health clinic, or nonprofit health clinic that ordered the
professional assessment and interpretation of
anatomic pathology services rendered by those laboratories. Clinical
laboratories shall not bill the physician and surgeon who requests
professional assessment and interpretation of
anatomic pathology services, but may bill the physician and surgeon
who requests only technical preparation of slides. A clinical
laboratory shall first bill the patient's health care service plan or
insurer, when it knows or should know that the patient is an
enrollee of a health care service plan or an insured under a health
insurance policy, for amounts in excess of any applicable copayments,
deductibles, or coinsurance. However, if the patient's health care
service plan or health insurer has denied payment of all or part of
the claim or failed to pay the claim, the clinical lab may bill the
patient or a responsible third-party payer.
(2) Notwithstanding subdivision (a), it is not unlawful for a
clinical laboratory to bill for anatomic pathology services that were
performed by an affiliated clinical laboratory. An "affiliated
clinical laboratory" means a clinical laboratory that is wholly owned
by, is the parent company of, or is under common ownership with, the
clinical laboratory billing for the anatomic pathology services. For
these purposes, "wholly owned" means 100 percent ownership directly
or through one or more subsidiaries, and "common ownership" means 100
percent ownership by a common parent company.
(3) Notwithstanding subdivision (a), this section does not
prohibit the billing of a referring laboratory for anatomic pathology
services when a sample must be sent to another specialist, except
that for the purposes of this paragraph "referring laboratory" does
not include a laboratory of a physician's office or group practice
that does not perform the professional component of the anatomic
pathology service involved.
(c) For the purposes of this section, any person or entity who is
responsible to pay for anatomic pathology services provided to that
patient shall be considered a responsible third-party payer.
(d) This section shall not apply to any of the following:
(1) Any person who, or clinical laboratory that, contracts
directly with a health care service plan licensed pursuant to Section
1349 of the Health and Safety Code, if services are to be provided
to members of the plan on a prepaid basis.
(2) Any person who, or clinic that, provides anatomic pathology
services without charge to the patient, or on a sliding scale payment
basis if the patient's charge for services is determined by the
patient's ability to pay.
(3) Health care programs operated by public entities, including,
but not limited to, colleges and universities.
(4) Health care programs operated by private educational
institutions to serve the health care needs of their students.
(5) Any person who, or clinic that, contracts with an employer to
provide medical services to employees of the employer if the anatomic
pathology services are provided under the contract.
(e) For purposes of this section, the term "anatomic pathology
services" means any of the following:
(1) Histopathology or surgical pathology, meaning the gross and
microscopic examination of organ tissue performed by a physician and
surgeon or under the supervision of a physician and surgeon.
(2) Cytopathology, meaning the examination of cells, from fluids,
aspirates, washings, brushings, or smears, including the Pap test
examination performed by a physician and surgeon or under the
supervision of a physician and surgeon.
(3) Hematology, meaning the microscopic evaluation of bone marrow
aspirates and biopsies performed by a physician and surgeon, or under
the supervision of a physician and surgeon, and peripheral blood
smears when the attending or treating physician and surgeon or
technologist requests that a blood smear be reviewed by a
pathologist.
(4) Subcellular pathology and molecular pathology.
SEC. 2. Section 1288 of the Business and Professions Code is
amended to read:
1288. (a) Any person conducting or operating a clinical
laboratory may accept assignments for tests only from and make
reports only to persons licensed under the provisions of law relating
to the healing arts or their representatives. This section does not
prohibit the acceptance of evaluation specimens for proficiency
testing or referral of specimens or such assignment from one clinical
laboratory to another clinical laboratory, either licensed or exempt
under this chapter, providing the report indicates clearly the
laboratory performing the test. A report of results issuing from a
clinical laboratory shall show clearly the name and address of the
laboratory and the name of the director.
(b) The licensed persons ordering tests from clinical
laboratories pursuant to this section shall include complete and
accurate billing information with the test assignments or requests to
enable the laboratories to bill the patients or responsible
third-party payers whenever any provisions of this chapter or of this
code require the performing clinical laboratories to bill the
patients or third-party payers directly for any services rendered by
those laboratories.
(b) The licensed person ordering tests from a clinical laboratory
pursuant to this section shall include complete and accurate billing
information with the test assignment or request to enable the
laboratory to bill the patient or responsible third-party payer
whenever any provisions of this chapter or of this code require the
performing clinical laboratory to bill the patient or third-party
payer directly for any services rendered by the laboratory.
SEC. 3. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.