Public Act 098-1127
 
SB1630 EnrolledLRB098 08625 MGM 38744 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  

  
 
    Section 5. The Medical Patient Rights Act is amended  by 
adding Section 3.3 as follows:
 
    (410 ILCS 50/3.3 new)
    Sec. 3.3. Prohibition on the markup of anatomic pathology 
services.
    (a) A physician who orders, but who does not supervise or 
perform, an anatomic pathology service shall disclose in a bill 
for such service presented to the patient:
        (1) the name and address of the physician or laboratory

    that provided the anatomic pathology service; and
        (2) the actual amount paid or to be paid for each 
    anatomic pathology service provided to the patient by the 
    physician or laboratory that performed the service.
    (b) A physician subject to the requirement of subsection 
(a) of this Section when billing a patient, insurer, or 
third-party payer shall not markup, or directly or indirectly 
increase, the amount subject to disclosure under paragraph (2) 
of subsection (a) of this Section in any bill presented to a 
patient, insurer, or third-party payer.
    (c)  This Section does not prohibit a referring physician 
from charging a specimen acquisition or processing charge if:
        (1) the charge is limited to actual costs incurred for 
    specimen collection and transportation; and
        (2) the charge is separately coded or denoted as a 
    service distinct from the performance of the anatomic 
    pathology service, in conformance with the coding policies 
    of the American Medical Association.
    (d) The requirements of this Section do not apply to an 
anatomic pathology service ordered or provided by:
        (1) facilities licensed under the Hospital Licensing 
    Act or the University of Illinois Hospital Act or clinical 
    laboratories owned, operated by, or operated within 
    facilities licensed under the Hospital Licensing Act or the 
    University of Illinois Hospital Act;
        (2) any public health clinic or nonprofit health 
    clinic; or
        (3) any government agency, or their specified public or 
    private agents.
    (e) No patient, insurer, or other third-party payer, shall 
be required to reimburse any   licensed health care professional 
for charges or claims submitted in violation of this Section.
    (f) A person who receives a bill for an anatomic pathology 
service made in knowing and willful violation of this Section 
may maintain an action to recover the actual amount paid for 
the bill.
    (g) The Department of Insurance shall enforce the 
provisions of this Section for any bill submitted to a payer in 
violation of this Section.
    (h)   For the purposes of this Section, "anatomic pathology 
services" means:
        (1)    histopathology or surgical pathology, meaning the 
    gross and microscopic examination performed by a physician 
    or under the supervision of a physician, including 
    histologic processing;
        (2)    cytopathology, meaning the microscopic examination 
    of cells from  (A) fluids, (B) aspirates, (C) washings, (D) 
    brushings, or (E) smears, including the Pap smear test 
    examination performed by a physician or under the 
    supervision of a physician;
        (3)    hematology, meaning the microscopic evaluation of 
    bone marrow aspirates and biopsies performed by a 
    physician, or under the supervision of a physician, and 
    peripheral blood smears when the attending or treating 
    physician or technologist requests that a blood smear be 
    reviewed by a pathologist;
        (4)    sub-cellular pathology or molecular pathology, 
    meaning the assessment of a patient specimen for the 
    detection, localization, measurement, or analysis of one 
    or more protein or nucleic acid targets; and
        (5)   blood-banking services performed by pathologists.


Effective Date:  1/1/2015