Full Text of HB3209 99th General Assembly
HB3209ham001 99TH GENERAL ASSEMBLY | Rep. Jay Hoffman Filed: 3/23/2015
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| 1 | | AMENDMENT TO HOUSE BILL 3209
| 2 | | AMENDMENT NO. ______. Amend House Bill 3209 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Medical Patient Rights Act is amended by | 5 | | changing Section 3.3 as follows: | 6 | | (410 ILCS 50/3.3) | 7 | | Sec. 3.3. Prohibition on the markup of anatomic pathology | 8 | | services. | 9 | | (a) A physician who orders, but who does not supervise or | 10 | | perform, an anatomic pathology service shall disclose in a bill | 11 | | for such service presented to the patient: | 12 | | (1) the name and address of the physician or laboratory
| 13 | | that provided the anatomic pathology service; and | 14 | | (2) the actual amount paid or to be paid for each | 15 | | anatomic pathology service provided to the patient by the | 16 | | physician or laboratory that performed the service. |
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| 1 | | (b) A physician subject to the requirement of subsection | 2 | | (a) of this Section when billing a patient, insurer, or | 3 | | third-party payer shall not markup, or directly or indirectly | 4 | | increase, the amount subject to disclosure under paragraph (2) | 5 | | of subsection (a) of this Section in any bill presented to a | 6 | | patient, insurer, or third-party payer. | 7 | | (c) This Section does not prohibit a referring physician | 8 | | from charging a specimen acquisition or processing charge if: | 9 | | (1) the charge is limited to actual costs incurred for | 10 | | specimen collection and transportation; and | 11 | | (2) the charge is separately coded or denoted as a | 12 | | service distinct from the performance of the anatomic | 13 | | pathology service, in conformance with the coding policies | 14 | | of the American Medical Association. | 15 | | (d) The only exemptions to the requirements of this Section | 16 | | do not apply are the following to an anatomic pathology service | 17 | | ordered or provided by : | 18 | | (1) facilities licensed under the Hospital Licensing | 19 | | Act or the University of Illinois Hospital Act or clinical | 20 | | laboratories owned, operated by, or operated within | 21 | | facilities licensed under the Hospital Licensing Act or the | 22 | | University of Illinois Hospital Act; | 23 | | (2) any public health clinic or nonprofit health | 24 | | clinic; or | 25 | | (3) any government agency, or their specified public or | 26 | | private agents ; or . |
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| 1 | | (4) an anatomic pathology laboratory certified or | 2 | | accredited under Section 263a of the Public Health Service | 3 | | Act, 42 U.S.C. 263a, when owned and operated by a physician | 4 | | or physician group practice who orders such services, | 5 | | provided that: | 6 | | (A) the referral and billing for the anatomic | 7 | | pathology service would otherwise be permitted under | 8 | | paragraph (2) of subsection (b) of 42 U.S.C. 13955nn as | 9 | | an in-office ancillary service; | 10 | | (B) the professional component of the anatomic | 11 | | pathology service is provided at the laboratory | 12 | | exclusively for patients of the physician or group | 13 | | practice who owns and operates the laboratory; and | 14 | | (C) the physician performing the anatomic | 15 | | pathology services is in an employee, group practice, | 16 | | or contractual arrangement in compliance with Section | 17 | | 20 of the Health Care Worker Self-Referral Act and | 18 | | subsections (a) and (b) of Section 22.2 of the Medical | 19 | | Practice Act of 1987. | 20 | | (e) No patient, insurer, or other third-party payer, shall | 21 | | be required to reimburse any licensed health care professional | 22 | | for charges or claims submitted in violation of this Section. | 23 | | (f) A person who receives a bill for an anatomic pathology | 24 | | service made in knowing and willful violation of this Section | 25 | | may maintain an action to recover the actual amount paid for | 26 | | the bill. |
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| 1 | | (g) The Department of Insurance shall enforce the | 2 | | provisions of this Section for any bill submitted to a payer in | 3 | | violation of this Section. | 4 | | (h) For the purposes of this Section : , "anatomic | 5 | | "Anatomic" pathology services" means: | 6 | | (1) histopathology or surgical pathology, meaning the | 7 | | gross and microscopic examination performed by a physician | 8 | | or under the supervision of a physician, including | 9 | | histologic processing; | 10 | | (2) cytopathology, meaning the microscopic examination | 11 | | of cells from (A) fluids, (B) aspirates, (C) washings, (D) | 12 | | brushings, or (E) smears, including the Pap smear test | 13 | | examination performed by a physician or under the | 14 | | supervision of a physician; | 15 | | (3) hematology, meaning the microscopic evaluation of | 16 | | bone marrow aspirates and biopsies performed by a | 17 | | physician, or under the supervision of a physician, and | 18 | | peripheral blood smears when the attending or treating | 19 | | physician or technologist requests that a blood smear be | 20 | | reviewed by a pathologist; | 21 | | (4) sub-cellular pathology or molecular pathology, | 22 | | meaning the assessment of a patient specimen for the | 23 | | detection, localization, measurement, or analysis of one | 24 | | or more protein or nucleic acid targets; and | 25 | | (5) blood-banking services performed by pathologists.
| 26 | | "Professional component of the anatomic pathology service" |
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| 1 | | means the entire anatomic pathology service other than | 2 | | histologic processing. | 3 | | (Source: P.A. 98-1127, eff. 1-1-15.)".
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