|
| | 98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014 SB1630 Introduced 2/13/2013, by Sen. William R. Haine SYNOPSIS AS INTRODUCED: |
| 210 ILCS 25/7-105 new | | 225 ILCS 60/70 new | |
|
Amends the Medical Practice Act of 1987 and the Illinois Clinical Laboratory and Blood Bank Act. Provides that a clinical laboratory or physician
that provides anatomic pathology services for patients in this State shall present or
cause to be presented a claim, bill, or demand for payment for these services only to specified people. Provides that the clinical laboratory or physician shall not
charge, bill, or otherwise solicit payment for anatomic pathology services unless
the services were rendered personally by the clinical laboratory or physician or under the
clinical laboratory's or physician's direct supervision. Defines "anatomic pathology services". Makes other changes. Effective December 31, 2013.
|
| |
| | A BILL FOR |
|
|
| | SB1630 | | LRB098 08625 MGM 38744 b |
|
|
1 | | AN ACT concerning regulation.
|
2 | | Be it enacted by the People of the State of Illinois,
|
3 | | represented in the General Assembly:
|
4 | | Section 5. The Illinois Clinical Laboratory and Blood Bank |
5 | | Act is amended by adding Section 7-105 as follows: |
6 | | (210 ILCS 25/7-105 new) |
7 | | Sec. 7-105. Direct billing of anatomic pathology services. |
8 | | (a) A clinical laboratory
that provides anatomic pathology |
9 | | services for patients in this State shall present or
cause to |
10 | | be presented a claim, bill, or demand for payment for these |
11 | | services only to: |
12 | | (1) the patient directly; |
13 | | (2) the responsible insurer or other third-party |
14 | | payor; |
15 | | (3) the hospital, public health clinic, or nonprofit |
16 | | health clinic ordering such
services; |
17 | | (4) the referring laboratory, excluding a laboratory |
18 | | of a physician's office or group
practice that does not |
19 | | perform the professional component of the anatomic
|
20 | | pathology service for which the claim, bill, or demand is |
21 | | presented; |
22 | | (5) governmental agencies, specified public or private |
23 | | agents of government agencies, or
organizations, working |
|
| | SB1630 | - 2 - | LRB098 08625 MGM 38744 b |
|
|
1 | | on behalf of the recipient of the services. |
2 | | (b) Clinical laboratories shall not, directly or |
3 | | indirectly,
charge, bill, or otherwise solicit payment for |
4 | | anatomic pathology services unless
the services were rendered |
5 | | by the clinical laboratory or by the laboratory's employee or |
6 | | agent in accordance with Section 353 of the
Public Health |
7 | | Service Act (42 U.S.C. 263a). |
8 | | (c) No patient, insurer, third-party payor, hospital, |
9 | | public health clinic, or nonprofit
health clinic shall be |
10 | | required to reimburse any clinical laboratory for charges or
|
11 | | claims submitted in violation of this Section. |
12 | | (d) Nothing in this Section shall be construed to mandate |
13 | | the assignment of benefits
for anatomic pathology services as |
14 | | defined in this Section. |
15 | | (e) For purposes of this Section, the term "anatomic |
16 | | pathology services" means: |
17 | | (1) histopathology or surgical pathology, meaning the |
18 | | gross and microscopic
examination performed by a physician |
19 | | or under the supervision of a physician,
including |
20 | | histologic processing; |
21 | | (2) cytopathology, meaning the microscopic examination |
22 | | of cells from the
following: (i) fluids, (ii) aspirates, |
23 | | (iii) washings, (iv) brushings, or (v) smears,
including |
24 | | the Pap test examination performed by a physician or under |
25 | | the
supervision of a physician; |
26 | | (3) hematology, meaning the microscopic evaluation of |
|
| | SB1630 | - 3 - | LRB098 08625 MGM 38744 b |
|
|
1 | | bone marrow aspirates
and biopsies performed by a |
2 | | physician, or under the supervision of a physician, and
|
3 | | peripheral blood smears when the attending or treating |
4 | | physician or technologist
requests that a blood smear be |
5 | | reviewed by a pathologist; |
6 | | (4) sub-cellular pathology or molecular pathology, |
7 | | meaning the assessment of a
patient specimen for the |
8 | | detection, localization, measurement, or analysis of one |
9 | | or
more protein or nucleic acid targets; and |
10 | | (5) blood-banking services performed by pathologists. |
11 | | (f) The provisions of this Section do not prohibit billing |
12 | | of a referring laboratory for
anatomic pathology services in |
13 | | instances where a sample or samples must be sent
to another |
14 | | laboratory for consultation or histologic processing. For |
15 | | purposes of this subsection (f), the term "referring |
16 | | laboratory" does not
include a laboratory of a physician's |
17 | | office or group practice that does not perform
the professional |
18 | | component of the anatomic pathology service involved. |
19 | | (g) The Department may revoke, suspend, or
deny renewal of |
20 | | the license of any clinical laboratory who violates the |
21 | | provisions of this
Section. |
22 | | (h) A person who receives a bill for an anatomic pathology |
23 | | service made in
knowing and willful violation of this Section |
24 | | may maintain an action to recover the
actual amount paid for |
25 | | the bill. |
|
| | SB1630 | - 4 - | LRB098 08625 MGM 38744 b |
|
|
1 | | Section 10. The Medical Practice Act of 1987 is amended by |
2 | | adding Section 70 as follows: |
3 | | (225 ILCS 60/70 new) |
4 | | Sec. 70. Direct billing of anatomic pathology services. |
5 | | (a) A physician that provides anatomic pathology services |
6 | | for patients in this State shall present or
cause to be |
7 | | presented a claim, bill, or demand for payment for these |
8 | | services only to: |
9 | | (1) the patient directly; |
10 | | (2) the responsible insurer or other third-party |
11 | | payor; |
12 | | (3) the hospital, public health clinic, or nonprofit |
13 | | health clinic ordering such
services; |
14 | | (4) the referring laboratory, excluding a laboratory |
15 | | of a physician's office or group
practice that does not |
16 | | perform the professional component of the anatomic
|
17 | | pathology service for which the claim, bill, or demand is |
18 | | presented; |
19 | | (5) governmental agencies, specified public or private |
20 | | agents of government agencies, or
organizations, working |
21 | | on behalf of the recipient of the services. |
22 | | (b) Except for a physician at a referring laboratory that |
23 | | has been billed pursuant to
subsection (f), physicians shall |
24 | | not, directly or indirectly,
charge, bill, or otherwise solicit |
25 | | payment for anatomic pathology services unless
the services |
|
| | SB1630 | - 5 - | LRB098 08625 MGM 38744 b |
|
|
1 | | were rendered personally by the physician or under the
|
2 | | physician's direct supervision in accordance with Section 353 |
3 | | of the
Public Health Service Act (42 U.S.C. 263a). |
4 | | (c) No patient, insurer, third-party payor, hospital, |
5 | | public health clinic, or nonprofit
health clinic shall be |
6 | | required to reimburse any physician for charges or
claims |
7 | | submitted in violation of this Section. |
8 | | (d) Nothing in this Section shall be construed to mandate |
9 | | the assignment of benefits
for anatomic pathology services as |
10 | | defined in this Section. |
11 | | (e) For purposes of this Section, the term "anatomic |
12 | | pathology services" means: |
13 | | (1) histopathology or surgical pathology, meaning the |
14 | | gross and microscopic
examination performed by a physician |
15 | | or under the supervision of a physician,
including |
16 | | histologic processing; |
17 | | (2) cytopathology, meaning the microscopic examination |
18 | | of cells from the
following: (i) fluids, (ii) aspirates, |
19 | | (iii) washings, (iv) brushings, or (v) smears,
including |
20 | | the Pap test examination performed by a physician or under |
21 | | the
supervision of a physician; |
22 | | (3) hematology, meaning the microscopic evaluation of |
23 | | bone marrow aspirates
and biopsies performed by a |
24 | | physician, or under the supervision of a physician, and
|
25 | | peripheral blood smears when the attending or treating |
26 | | physician or technologist
requests that a blood smear be |
|
| | SB1630 | - 6 - | LRB098 08625 MGM 38744 b |
|
|
1 | | reviewed by a pathologist; |
2 | | (4) sub-cellular pathology or molecular pathology, |
3 | | meaning the assessment of a
patient specimen for the |
4 | | detection, localization, measurement, or analysis of one |
5 | | or
more protein or nucleic acid targets; and |
6 | | (5) blood-banking services performed by pathologists. |
7 | | (f) The provisions of this Section do not prohibit billing |
8 | | of a referring laboratory for
anatomic pathology services in |
9 | | instances where a sample or samples must be sent
to another |
10 | | physician or laboratory for consultation or histologic |
11 | | processing. For purposes of this subsection (f), the term |
12 | | "referring laboratory" does not
include a laboratory of a |
13 | | physician's office or group practice that does not perform
the |
14 | | professional component of the anatomic pathology service |
15 | | involved. |
16 | | (g) The Department may revoke, suspend, or
deny renewal of |
17 | | the license of any physician who violates the provisions of |
18 | | this
Section. |
19 | | (h) A person who receives a bill for an anatomic pathology |
20 | | service made in
knowing and willful violation of this Section |
21 | | may maintain an action to recover the
actual amount paid for |
22 | | the bill.
|
23 | | Section 99. Effective date. This Act takes effect December |
24 | | 31, 2013.
|