Full Text of SB1630 98th General Assembly
SB1630sam003 98TH GENERAL ASSEMBLY | Sen. William R. Haine Filed: 4/12/2013
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| 1 | | AMENDMENT TO SENATE BILL 1630
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1630, AS AMENDED, | 3 | | by replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 5. The Illinois Clinical Laboratory and Blood Bank | 6 | | Act is amended by adding Section 7-105 as follows: | 7 | | (210 ILCS 25/7-105 new) | 8 | | Sec. 7-105. Direct billing of anatomic pathology services. | 9 | | (a) A clinical laboratory
that provides anatomic pathology | 10 | | services for patients in this State shall present or
cause to | 11 | | be presented a claim, bill, or demand for payment for these | 12 | | services only to: | 13 | | (1) the patient directly; | 14 | | (2) the responsible insurer or other third-party | 15 | | payor; | 16 | | (3) the hospital, public health clinic, or nonprofit |
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| 1 | | health clinic ordering such
services; | 2 | | (4) the referring laboratory, excluding a laboratory | 3 | | of a physician's office or group
practice that does not | 4 | | perform the professional component of the anatomic
| 5 | | pathology service for which the claim, bill, or demand is | 6 | | presented; | 7 | | (5) governmental agencies, specified public or private | 8 | | agents of government agencies, or
organizations, working | 9 | | on behalf of the recipient of the services. | 10 | | (b) Clinical laboratories shall not, directly or | 11 | | indirectly,
charge, bill, or otherwise solicit payment for | 12 | | anatomic pathology services unless
the services were rendered | 13 | | by the clinical laboratory or by the laboratory's employee or | 14 | | agent in accordance with Section 353 of the
Public Health | 15 | | Service Act (42 U.S.C. 263a). | 16 | | (c) No patient, insurer, third-party payor, hospital, | 17 | | public health clinic, or nonprofit
health clinic shall be | 18 | | required to reimburse any clinical laboratory for charges or
| 19 | | claims submitted in violation of this Section. | 20 | | (d) Nothing in this Section shall be construed to mandate | 21 | | the assignment of benefits
for anatomic pathology services as | 22 | | defined in this Section. | 23 | | (e) For purposes of this Section, the term "anatomic | 24 | | pathology services" means: | 25 | | (1) histopathology or surgical pathology, meaning the | 26 | | gross and microscopic
examination performed by a physician |
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| 1 | | or under the supervision of a physician,
including | 2 | | histologic processing; | 3 | | (2) cytopathology, meaning the microscopic examination | 4 | | of cells from the
following: (i) fluids, (ii) aspirates, | 5 | | (iii) washings, (iv) brushings, or (v) smears,
including | 6 | | the Pap test examination performed by a physician or under | 7 | | the
supervision of a physician; | 8 | | (3) hematology, meaning the microscopic evaluation of | 9 | | bone marrow aspirates
and biopsies performed by a | 10 | | physician, or under the supervision of a physician, and
| 11 | | peripheral blood smears when the attending or treating | 12 | | physician or technologist
requests that a blood smear be | 13 | | reviewed by a pathologist; | 14 | | (4) sub-cellular pathology or molecular pathology, | 15 | | meaning the assessment of a
patient specimen for the | 16 | | detection, localization, measurement, or analysis of one | 17 | | or
more protein or nucleic acid targets; and | 18 | | (5) blood-banking services performed by pathologists. | 19 | | (f) The provisions of this Section do not prohibit billing | 20 | | of a referring laboratory for
anatomic pathology services in | 21 | | instances where a sample or samples must be sent
to another | 22 | | laboratory for consultation or histologic processing. For | 23 | | purposes of this subsection (f), the term "referring | 24 | | laboratory" does not
include a laboratory of a physician's | 25 | | office or group practice that does not perform
the professional | 26 | | component of the anatomic pathology service involved. |
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| 1 | | (g) The Department may revoke, suspend, or
deny renewal of | 2 | | the license of any clinical laboratory who violates the | 3 | | provisions of this
Section. | 4 | | (h) A person who receives a bill for an anatomic pathology | 5 | | service made in
knowing and willful violation of this Section | 6 | | may maintain an action to recover the
actual amount paid for | 7 | | the bill. | 8 | | (i) This Section does not prohibit a referring physician | 9 | | who takes a patient specimen from charging a patient or a payor | 10 | | an acquisition or processing charge when: | 11 | | (1) the charge is limited to actual costs incurred for | 12 | | specimen collection and transportation; and | 13 | | (2) the charge is separately coded or denoted as a | 14 | | service distinct from the performance of the anatomic | 15 | | pathology service, in conformance with the coding policies | 16 | | of the American Medical Association. | 17 | | (j) Nothing in this Section shall be construed to prohibit | 18 | | a referring physician from sending a patient's specimen to any | 19 | | laboratory providing anatomic pathology services. | 20 | | (k) This Section does not apply to facilities licensed | 21 | | under the Hospital Licensing Act or the University of Illinois | 22 | | Hospital Act or clinical laboratories owned, operated by, or | 23 | | operated within facilities licensed under the Hospital | 24 | | Licensing Act or the University of Illinois Hospital Act, when | 25 | | billing: | 26 | | (1) for inpatient services or outpatient services from |
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| 1 | | those facilities; or | 2 | | (2) any other facility licensed under the Hospital | 3 | | Licensing Act or University of Illinois Hospital Act. | 4 | | (l) A physician who orders and who does not perform a | 5 | | component of anatomic pathology services shall notify in | 6 | | writing a clinical laboratory or physician who performs or | 7 | | supervises those services for a patient that the laboratory | 8 | | performing the services is not participating in the patient's | 9 | | insurance or third-party payor network. | 10 | | (m) When a physician or laboratory receives written | 11 | | notification as provided under subsection (l), notwithstanding | 12 | | the prohibitions of this Section, the laboratory or physician | 13 | | providing the anatomic pathology service shall bill the | 14 | | physician that refers the patient specimen. | 15 | | (n) A physician that receives a bill for services in | 16 | | accordance with subsection (m) may bill an insurer or other | 17 | | third-party payor, provided that: | 18 | | (1) the physician discloses in a bill for the services | 19 | | presented to insurer or other third-party payor: | 20 | | (A) the name and address of the physician or | 21 | | laboratory
that provided the anatomic pathology | 22 | | service; and | 23 | | (B) the actual amount paid or to be paid for each | 24 | | anatomic pathology service provided to the patient by | 25 | | the physician or laboratory that performed the | 26 | | service; |
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| 1 | | (2) the bill for anatomic pathology services is not | 2 | | directly or indirectly increased from the amount required | 3 | | to be disclosed under subparagraph (B) of paragraph (1) of | 4 | | this subsection (n) in any bill presented to the | 5 | | third-party payor; and | 6 | | (3) the billing by a referring physician as provided | 7 | | under subsection (m) is not contrary to the terms, | 8 | | contract, or policies upon which the insurer or other | 9 | | third-party payor provides payment to the billing | 10 | | physician. | 11 | | Section 10. The Medical Practice Act of 1987 is amended by | 12 | | adding Section 70 as follows: | 13 | | (225 ILCS 60/70 new) | 14 | | Sec. 70. Direct billing of anatomic pathology services. | 15 | | (a) A physician that provides anatomic pathology services | 16 | | for patients in this State shall present or
cause to be | 17 | | presented a claim, bill, or demand for payment for these | 18 | | services only to: | 19 | | (1) the patient directly; | 20 | | (2) the responsible insurer or other third-party | 21 | | payor; | 22 | | (3) the hospital, public health clinic, or nonprofit | 23 | | health clinic ordering such
services; | 24 | | (4) the referring laboratory, excluding a laboratory |
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| 1 | | of a physician's office or group
practice that does not | 2 | | perform the professional component of the anatomic
| 3 | | pathology service for which the claim, bill, or demand is | 4 | | presented; | 5 | | (5) governmental agencies, specified public or private | 6 | | agents of government agencies, or
organizations, working | 7 | | on behalf of the recipient of the services. | 8 | | (b) Except for a physician at a referring laboratory that | 9 | | has been billed pursuant to
subsection (f), physicians shall | 10 | | not, directly or indirectly,
charge, bill, or otherwise solicit | 11 | | payment for anatomic pathology services unless
the services | 12 | | were rendered personally by the physician or under the
| 13 | | physician's direct supervision in accordance with Section 353 | 14 | | of the
Public Health Service Act (42 U.S.C. 263a). | 15 | | (c) No patient, insurer, third-party payor, hospital, | 16 | | public health clinic, or nonprofit
health clinic shall be | 17 | | required to reimburse any physician for charges or
claims | 18 | | submitted in violation of this Section. | 19 | | (d) Nothing in this Section shall be construed to mandate | 20 | | the assignment of benefits
for anatomic pathology services as | 21 | | defined in this Section. | 22 | | (e) For purposes of this Section, the term "anatomic | 23 | | pathology services" means: | 24 | | (1) histopathology or surgical pathology, meaning the | 25 | | gross and microscopic
examination performed by a physician | 26 | | or under the supervision of a physician,
including |
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| 1 | | histologic processing; | 2 | | (2) cytopathology, meaning the microscopic examination | 3 | | of cells from the
following: (i) fluids, (ii) aspirates, | 4 | | (iii) washings, (iv) brushings, or (v) smears,
including | 5 | | the Pap test examination performed by a physician or under | 6 | | the
supervision of a physician; | 7 | | (3) hematology, meaning the microscopic evaluation of | 8 | | bone marrow aspirates
and biopsies performed by a | 9 | | physician, or under the supervision of a physician, and
| 10 | | peripheral blood smears when the attending or treating | 11 | | physician or technologist
requests that a blood smear be | 12 | | reviewed by a pathologist; | 13 | | (4) sub-cellular pathology or molecular pathology, | 14 | | meaning the assessment of a
patient specimen for the | 15 | | detection, localization, measurement, or analysis of one | 16 | | or
more protein or nucleic acid targets; and | 17 | | (5) blood-banking services performed by pathologists. | 18 | | (f) The provisions of this Section do not prohibit billing | 19 | | of a referring laboratory for
anatomic pathology services in | 20 | | instances where a sample or samples must be sent
to another | 21 | | physician or laboratory for consultation or histologic | 22 | | processing. For purposes of this subsection (f), the term | 23 | | "referring laboratory" does not
include a laboratory of a | 24 | | physician's office or group practice that does not perform
the | 25 | | professional component of the anatomic pathology service | 26 | | involved. |
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| 1 | | (g) The Department may revoke, suspend, or
deny renewal of | 2 | | the license of any physician who violates the provisions of | 3 | | this
Section. | 4 | | (h) A person who receives a bill for an anatomic pathology | 5 | | service made in
knowing and willful violation of this Section | 6 | | may maintain an action to recover the
actual amount paid for | 7 | | the bill. | 8 | | (i) This Section does not prohibit a referring physician | 9 | | who takes a patient specimen from charging a patient or a payor | 10 | | an acquisition or processing charge when: | 11 | | (1) the charge is limited to actual costs incurred for | 12 | | specimen collection and transportation; and | 13 | | (2) the charge is separately coded or denoted as a | 14 | | service distinct from the performance of the anatomic | 15 | | pathology service, in conformance with the coding policies | 16 | | of the American Medical Association. | 17 | | (j) Nothing in this Section shall be construed to prohibit | 18 | | a referring physician from sending a patient's specimen to any | 19 | | laboratory providing anatomic pathology services. | 20 | | (k) A physician who orders and who does not perform a | 21 | | component of anatomic pathology services shall notify in | 22 | | writing a clinical laboratory or physician who performs or | 23 | | supervises those services for a patient that the laboratory | 24 | | performing the services is not participating in the patient's | 25 | | insurance or third-party payor network. | 26 | | (l) When a physician or laboratory receives written |
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| 1 | | notification as provided under subsection (k), notwithstanding | 2 | | the prohibitions of this Section, the laboratory or physician | 3 | | providing the anatomic pathology service shall bill the | 4 | | physician that refers the patient specimen. | 5 | | (m) A physician that receives a bill for services in | 6 | | accordance with subsection (l) may bill an insurer or other | 7 | | third-party payor, provided that: | 8 | | (1) the physician discloses in a bill for the services | 9 | | presented to insurer, or other third-party payor: | 10 | | (A) the name and address of the physician or | 11 | | laboratory
that provided the anatomic pathology | 12 | | service; and | 13 | | (B) the actual amount paid or to be paid for each | 14 | | anatomic pathology service provided to the patient by | 15 | | the physician or laboratory that performed the | 16 | | service; | 17 | | (2) the bill for anatomic pathology services is not | 18 | | directly or indirectly increased from the amount required | 19 | | to be disclosed under subparagraph (B) of paragraph (1) of | 20 | | this subsection (m) in any bill presented to the | 21 | | third-party payor; and | 22 | | (3) the billing by a referring physician as provided | 23 | | under subsection (l) is not contrary to the terms, | 24 | | contract, or policies upon which the insurer or other | 25 | | third-party payor provides payment to the billing | 26 | | physician.
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| 1 | | Section 99. Effective date. This Act takes effect December | 2 | | 31, 2013.".
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