Assigned to HEALTH                                                                                                 AS PASSED BY THE SENATE

ARIZONA STATE SENATE

Forty-seventh Legislature, Second Regular Session

AMENDED

FACT SHEET FOR H.B. 2426

health professionals; lab costs; billing

Purpose

            Prohibits a laboratory from billing any entity other than specified parties for a rendered service and stipulates that a health professional who requests a laboratory to bill directly for a requested service any entity other than certain specified parties commits an act of unprofessional conduct.

Background

            Current law defines professionals as a member of one of 23 health professions, including dentists, nurses, osteopathic and allopathic physicians, pharmacists, psychologists and physician assistants. 

            Direct billing is when the health professional who performed a given service bills the patient or patient’s insurer directly.  Client billing is when the health professional who requested the service bills the patient or patient’s insurer for a service performed by another health professional.

            Several states across the country have statutorily required direct billing, including California and Montana. 

            There is no anticipated fiscal impact to the state General Fund associated with this legislation.

Provisions

1. Classifies as unprofessional conduct when a health professional requests a laboratory that provides requested anatomic pathology services occurring in this state or elsewhere to bill any person or entity other than any of the following:

a) the patient.

b) the responsible insurer or other third-party payor.

c) the health care institution.

d) a referring laboratory excluding the laboratory of the requesting health professional.

e) a governmental agency or the agency’s public or private agent, agency or organization acting on behalf of the recipient of the services.

2. Prohibits a laboratory that provides anatomic pathology services from billing any person or entity other than those previously listed.

3. Stipulates that “anatomic pathology services” include cytology services, molecular pathology services, hematopathology, histopathology, surgical pathology and blood banking services.

4. Excludes the collection, packaging and transportation of the specimen from the outlined “anatomic pathology services.”

5. Becomes effective on the general effective date.

Amendments Adopted by Committee

1. Stipulates what tests include.

2. Expands the classification of unprofessional conduct from health professionals who direct a laboratory to bill the health professional directly to health professionals who instruct a laboratory to bill any other entity other than those outlined.

Amendments Adopted by Committee of the Whole

1. Expands the list of entities a health professional may request a laboratory to bill to include a governmental agency or the agency’s public or private agent, agency or organization acting on behalf of the recipient of the services.

2. Outlines what “anatomic pathology services” includes.

3. Prohibits a laboratory from billing any entity other than those mentioned.

House Action Senate Action

FII                   2/13/06     DP     8-0-0-1                     HEALTH        3/13/06     DPA     6-0-1-0

3^rd Read           3/2/06                 56-0-4-0                   3^rd Read           3/28/06                  28-1-0-0-1

Prepared by Senate Research

March 31, 2006

BKL/AH/jas