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 
3everything after the enacting clause with the following:

 
4    "Section 5. The Medical Patient Rights Act is amended  by 
5changing Section 3.3 as follows:
 
6    (410 ILCS 50/3.3)
7    Sec. 3.3. Prohibition on the markup of anatomic pathology 
8services.
9    (a) A physician who orders, but who does not supervise or 
10perform, an anatomic pathology service shall disclose in a bill 
11for 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 
3third-party payer shall not markup, or directly or indirectly 
4increase, the amount subject to disclosure under paragraph (2) 
5of subsection (a) of this Section in any bill presented to a 
6patient, insurer, or third-party payer.
7    (c)  This Section does not prohibit a referring physician 
8from 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 
16do not apply are the following to an anatomic pathology service 
17ordered 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 
21be required to reimburse any   licensed health care professional 
22for charges or claims submitted in violation of this Section.
23    (f) A person who receives a bill for an anatomic pathology 
24service made in knowing and willful violation of this Section 
25may maintain an action to recover the actual amount paid for 
26the bill.
 
 
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1    (g) The Department of Insurance shall enforce the 
2provisions of this Section for any bill submitted to a payer in 
3violation 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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1means the entire anatomic pathology service other than 
2histologic processing. 
3(Source: P.A. 98-1127, eff. 1-1-15.)".