Missouri § 208.149 - Professional component of clinical pathology services recognized as distinct physician service — definitions — reimbursement — rules.

§ 208.149. Professional component of clinical pathology services recognized as distinct physician service — definitions — reimbursement — rules.

1.  As used in this section, the following terms mean:

(1)  "Clinical pathology services", professional medical services provided by a licensed physician that involve the use of medical judgment, that contribute directly to the diagnosis, care, and treatment of individual patients, and that are necessary for every laboratory test run in a high-complexity laboratory environment;

(2)  "Hospital-based pathologist", a licensed physician specializing in pathology who provides clinical pathology services for the laboratory within a hospital;

(3)  "MO HealthNet", the Medicaid program administered by the state of Missouri in accordance with federal and state law;

(4)  "Professional component of clinical pathology services", the portion of each clinical pathology service in a high-complexity laboratory environment that involves the physician's use of medical judgment in interpreting and supervising laboratory tests and that excludes the technical component of the laboratory test.

2.  The professional component of clinical pathology services provided by a hospital-based pathologist shall be recognized as distinct physician services by the MO HealthNet program.

3.  The MO HealthNet program shall reimburse the professional component of clinical pathology services provided to MO HealthNet participants.

4.  The reimbursement amount for the professional component of clinical pathology services shall be set at no less than thirty percent of the approved MO HealthNet Independent Lab - Technical Component fee schedule.

5.  Payment for the professional component of clinical pathology services shall be made directly to the licensed physician providing the services or to the entity the licensed physician has assigned the right to receive payment for the services provided.

6.  If a state plan amendment is determined by the department of social services to be required, the department of social services shall timely submit such amendment.  If such amendment is not approved, the department shall make all reasonable efforts to obtain federal approval, including resubmission, modification, or pursuit of any alternative lawful mechanism necessary to implement reimbursement consistent with this section.  Nothing in this subsection shall be construed to relieve the department of its obligation to implement reimbursement to the fullest extent permitted under state and federal authority.

7.  The department of social services shall promulgate all necessary rules and regulations for the administration of this section.  Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028.  This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2026, shall be invalid and void.

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(L. 2026 H.B. 2372)

---- end of effective  28 Aug 2026 ----

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