Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Pathology Medicaid Payments topic
No spam. Unsubscribe anytime.
Public hearing on House Bill 1599 focuses on ensuring pathologists receive professional fees from Medicaid hospital payments
Summary
House Bill 1599, presented at a public hearing, would require clearer payment pathways so pathologists receive the professional component of Medicaid hospital reimbursements; multiple pathology witnesses said current practice leaves pathologists unpaid for services provided to Medicaid patients.
The Committee on Professional Registration and Licensing opened a public hearing on House Bill 1599, a bill the sponsor described as a regulatory clarification to ensure pathologists are paid the professional component of hospital Medicaid reimbursements.
At the hearing, proponents — including several practicing pathologists and representatives of pathology groups — said hospitals currently receive a single global payment for pathology services from Medicaid and often do not pass the professional portion on to the pathologist or pathology group. "The hospital uses it for whatever purposes they have, and none of that reaches the pathologist," said a testimony in favor of the bill. Witnesses characterized the disparity as long-standing and said it discourages pathology groups from covering smaller or rural hospitals.
Doctor Samuel Koren, vice president of the Missouri Society of Pathologists and president of Maud Pathology Group, said the issue has been a multi-year problem and that negotiations with Medicaid and the department had not resolved it. "At the end of the day, here I am sitting in front of you, very thankful to Representative Haruza for this introduction," he said, adding the bill provides a clear mechanism to be paid for professional services.
Other witnesses echoed those concerns. Michael Curry, a pathologist practicing in mid-Missouri, and Brian Odom, a St. Louis-area pathologist, said the group reimbursement situation has become unsustainable as Medicaid and hospital payment practices have changed and the supply of pathologists is shrinking. Curry said pathology groups often cannot identify how much of a bundled payment is attributable to Medicaid, Medicare or private pay and asked the committee to allow pathologists the right to bill directly or to require hospitals to pass through the professional component.
Committee members asked several technical questions. Members asked why the issue applies to pathology but not other specialties, whether employed pathologists face the same problem, and whether contracting language could solve the problem. Witnesses said employed pathologists are less affected because payment flows to their employer, but contracted groups that staff smaller hospitals face the greatest risk. Witnesses and the sponsor said they had worked with the Department of Social Services (DSS)/Medicaid and were told legislative action was the necessary remedy.
No committee vote on HB 1599 was recorded in the transcript; the item was in the public hearing stage and witnesses were directed to file witness forms for the record.
