07 LC 37
0272
House
Bill 342
By:
Representatives Hembree of the
67th,
Knox of the
24th,
Casas of the
103rd,
Watson of the
91st,
and Jackson of the
161st
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia
Annotated, relating to general provisions relative to insurance, so as to
provide for direct billing of anatomic pathology services; to provide for
related matters; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Article
1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating
to general provisions relative to health, is amended by adding a new Code
section to read as follows:
"33-24-27.3.
(a)
As used in this Code section, the term 'anatomic pathology services'
means:
(1)
Histopathology or surgical pathology meaning the gross and microscopic
examination and histologic processing of organ tissue performed by a physician
or under the supervision of a physician;
(2)
Cytopathology meaning the examination of cells from fluids, aspirates, washings,
brushings, or smears, including the Pap test examination, performed by a
physician or under the supervision of a physician;
(3)
Hematology meaning 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 a pathologist;
(4)
Subcellular pathology and molecular pathology; and
(5)
Blood-banking services performed by pathologists.
(b)
A clinical laboratory or physician located in this state or in another state
providing anatomic pathology services for patients in this state shall present
or cause to be presented a claim, bill, or demand for payment for such services
only to one or more of the following:
(1)
The patient directly;
(2)
The responsible insurer or third-party payor;
(3)
The hospital, public health clinic, or nonprofit health clinic ordering such
services;
(4)
The referring laboratory, other than a laboratory of a physician´s office
or group practice; or
(5)
The governmental agencies or their specified public or private agent, agency, or
organization on behalf of the recipient of the services.
(c)
Except as provided under subsection (f) of this Code section, no licensed
practitioner in the state shall, directly or indirectly, charge, bill, or
otherwise solicit payment for anatomic pathology services unless such services
were rendered by the licensed practitioner or under the licensed
practitioner´s direct supervision in accordance with Section 353 of the
Public Health Service Act (42 U.S.C. Section 263a).
(d)
No patient, insurer, third-party payor, hospital, public health clinic, or
nonprofit health clinic shall be required to reimburse any licensed practitioner
for charges or claims submitted in violation of this Code section.
(e)
Nothing in this Code section shall be construed to mandate the assignment of
benefits for anatomic pathology services as defined in this Code
section.
(f)
The provisions of this Code section shall not prohibit billing of a referring
laboratory, other than a laboratory of a physician´s office or group
practice, for anatomic pathology services in instances where a sample or samples
must be sent to another specialist.
(g)
The respective state licensing boards having jurisdiction over any practitioner
who may request or provide anatomic pathology services may revoke, suspend, or
deny renewal of the license of any practitioner who violates the provisions of
this Code section."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.