NOTE: The governor signed this measure on 3/22/2012.
      
      
      HOUSE BILL 12-1221
      
      
      BY REPRESENTATIVE(S) Liston, Kerr J., Balmer, Miklosi, Summers,
      Swalm, Williams A., Labuda, Schafer S., Sonnenberg, Todd, Wilson,
      Szabo;
      also SENATOR(S) Tochtrop, Boyd, Morse, Aguilar, Carroll, Giron, Heath,
      Jahn, King S., Newell, Spence, White, Williams S.
      
      
      Concerning billing for anatomic pathology services.
      
      
      Be it enacted by the General Assembly of the State of Colorado:
      
           SECTION 1.  In Colorado Revised Statutes, add 10-16-138 as
      follows:
      
           10-16-138.  Pathology services - direct billing required. (1)  A
      clinical laboratory or physician that is located in this state or in
      another state, and that provides anatomic pathology services for
      patients in this state, shall present or cause to be presented a
      claim, bill, or demand for payment for these services only to:
      
           (a)  The patient;
      
           (b)  The responsible insurance carrier or other third-party
      payer;
      
           (c)  The hospital, public health clinic, or nonprofit health
      clinic ordering such services;
      
           (d)  The referring laboratory, excluding a laboratory of a
      physician's office or group practice that does not perform the
      professional component of the anatomic pathology service for
      which such claim, bill, or demand is presented; or
      
           (e)  A governmental agency or its specified public or private
      agent, agency, or organization on behalf of the recipient of the
      services.
      
           (2)  Except for a physician at a referring laboratory that
      has been billed pursuant to subsection (6) of this section, no
      licensed practitioner in the state may, directly or indirectly,
      charge, bill, or otherwise solicit payment for anatomic pathology
      services unless the services were rendered personally 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. sec. 263a.
      
           (3)  A patient, insurer, third-party payer, hospital, public
      health clinic, or nonprofit health clinic is not required to
      reimburse a licensed practitioner for charges or claims submitted
      in violation of this section.
      
           (4)  Nothing in this section:
      
           (a)  Mandates the assignment of benefits for anatomic
      pathology services; or
      
           (b)  Prohibits a group practice, as defined in 42 U.S.C. sec.
      1395nn (h) (4) (A) (i) to (iv), from billing for anatomic pathology
      services when a physician in the group  practice performs or
      supervises anatomic pathology services in a laboratory that is
      owned and operated by at least one member of the group practice.
      
           (5)  For purposes of this section, "anatomic pathology
      services" means:
      
           (a)  Histopathology or surgical pathology, meaning the
      gross and microscopic examination performed by a physician or
      under the supervision of a physician, including histologic
      processing;
      
           (b)  Cytopathology, meaning 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;
      
           (c)  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;
      
           (d)  Subcellular pathology or molecular pathology,
      meaning the assessment of a patient specimen for the detection,
      localization, measurement, or analysis of one or more protein or
      nucleic acid targets; and
      
           (e)  Blood-banking services performed by pathologists.
      
           (6)  This section does not prohibit billing of a referring
      laboratory for anatomic pathology services in instances where
      a sample or samples must be sent to another physician or
      laboratory for consultation or histologic processing. The term
      "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.
      
           (7)  A person who receives a bill for an anatomic pathology
      service made in knowing and willful violation of this section may
      maintain an action to recover the actual amount paid for the bill.
      
           SECTION 2.  Act subject to petition - effective date. This act
      takes effect January 1, 2013; except that, if a referendum petition is filed
      pursuant to section 1 (3) of article V of the state constitution against this act
      or an item, section, or part of this act within the ninety-day period after final
      adjournment of the general assembly, then the act, item, section, or part will
      not take effect unless approved by the people at the general election to be
      held in November 2012 and, in such case, will take effect on January 1,
      2013, or on the date of the official declaration of the vote thereon by the
      governor, whichever is later.
      
      
      
      
      ________________________________________________________
      Frank McNulty                      Brandon C. Shaffer
      SPEAKER OF THE HOUSE                     PRESIDENT OF
      OF REPRESENTATIVES                         THE SENATE
      
      
      
      
      
      
      ____________________________  ____________________________
      Marilyn Eddins                      Cindi L. Markwell
      CHIEF CLERK OF THE HOUSE                 SECRETARY OF
      OF REPRESENTATIVES                         THE SENATE
      
      
      
      
                  APPROVED________________________________________
      
      
      
      
      
                                    _________________________________________
                                    John W. Hickenlooper
                                    GOVERNOR OF THE STATE OF COLORADO