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.)".