|
| | SB1630 Engrossed | | 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 Medical Patient Rights Act is amended by |
5 | | adding Section 3.3 as follows: |
6 | | (410 ILCS 50/3.3 new) |
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. |
17 | | (b) A physician subject to the requirement of subsection |
18 | | (a) of this Section when billing a patient, insurer, or |
19 | | third-party payer shall not markup, or directly or indirectly |
20 | | increase, the amount subject to disclosure under paragraph (2) |
21 | | of subsection (a) of this Section in any bill presented to a |
22 | | patient, insurer, or third-party payer. |
23 | | (c) This Section does not prohibit a referring physician |
|
| | SB1630 Engrossed | - 2 - | LRB098 08625 MGM 38744 b |
|
|
1 | | from charging a specimen acquisition or processing charge if: |
2 | | (1) the charge is limited to actual costs incurred for |
3 | | specimen collection and transportation; and |
4 | | (2) the charge is separately coded or denoted as a |
5 | | service distinct from the performance of the anatomic |
6 | | pathology service, in conformance with the coding policies |
7 | | of the American Medical Association. |
8 | | (d) The requirements of this Section do not apply to an |
9 | | anatomic pathology service ordered or provided by: |
10 | | (1) facilities licensed under the Hospital Licensing |
11 | | Act or the University of Illinois Hospital Act or clinical |
12 | | laboratories owned, operated by, or operated within |
13 | | facilities licensed under the Hospital Licensing Act or the |
14 | | University of Illinois Hospital Act; |
15 | | (2) any public health clinic or nonprofit health |
16 | | clinic; or |
17 | | (3) any government agency, or their specified public or |
18 | | private agents. |
19 | | (e) No patient, insurer, or other third-party payer, shall |
20 | | be required to reimburse any licensed health care professional |
21 | | for charges or claims submitted in violation of this Section. |
22 | | (f) 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. |
26 | | (g) The Department of Insurance shall enforce the |
|
| | SB1630 Engrossed | - 3 - | LRB098 08625 MGM 38744 b |
|
|
1 | | provisions of this Section for any bill submitted to a payer in |
2 | | violation of this Section. |
3 | | (h) For the purposes of this Section, "anatomic pathology |
4 | | services" means: |
5 | | (1) histopathology or surgical pathology, meaning the |
6 | | gross and microscopic examination performed by a physician |
7 | | or under the supervision of a physician, including |
8 | | histologic processing; |
9 | | (2) cytopathology, meaning the microscopic examination |
10 | | of cells from (A) fluids, (B) aspirates, (C) washings, (D) |
11 | | brushings, or (E) smears, including the Pap smear test |
12 | | examination performed by a physician or under the |
13 | | supervision of a physician; |
14 | | (3) hematology, meaning the microscopic evaluation of |
15 | | bone marrow aspirates and biopsies performed by a |
16 | | physician, or under the supervision of a physician, and |
17 | | peripheral blood smears when the attending or treating |
18 | | physician or technologist requests that a blood smear be |
19 | | reviewed by a pathologist; |
20 | | (4) sub-cellular pathology or molecular pathology, |
21 | | meaning the assessment of a patient specimen for the |
22 | | detection, localization, measurement, or analysis of one |
23 | | or more protein or nucleic acid targets; and |
24 | | (5) blood-banking services performed by pathologists.
|