Bill > SB1469

This bill establishes new provisions for MO HealthNet (Missouri's Medicaid program) reimbursement of clinical pathology services, defining key terms such as "clinical pathology services" as professional medical services provided by a pathologist for examining and diagnosing laboratory tests, and "hospital-based pathologist" as a licensed physician specializing in pathology who works within a hospital setting. The bill mandates that MO HealthNet will pay for the professional component of clinical pathology services for inpatient services, with the reimbursement set at 30% of the approved outpatient fee schedule based on Medicare's clinical laboratory fee schedule. The bill specifies that if the pathologist is employed by the hospital, the professional fee will be paid directly to the hospital, but if the pathologist is not employed by the hospital, the fee will be paid directly to the third-party service provider. Additionally, the bill requires the Department of Social Services to create necessary rules and regulations for implementing these provisions, with specific guidelines for rule-making processes and potential rule invalidation. The provisions are set to take effect after August 28, 2026.

Health and Social Services

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=36596