Illinois General Assembly - Full Text of HB3209
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Full Text of HB3209  99th General Assembly

HB3209 99TH GENERAL ASSEMBLY

  
  

 


 
99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB3209

 

Introduced , by Rep. Jay Hoffman

 

SYNOPSIS AS INTRODUCED:
 
410 ILCS 50/3.3

    Amends the Medical Patients Rights Act. Provides that the prohibition on the markup of anatomic pathology services does not apply to any physician-owned laboratory. Provides that nothing regarding this prohibition shall be construed to prohibit a physician from billing for services rendered and testing performed in the physician's office or a laboratory owned by a physician or medical group. Makes other changes.


LRB099 09073 JLK 29263 b

 

 

A BILL FOR

 

HB3209LRB099 09073 JLK 29263 b

1    AN ACT concerning health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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.
17    (b) A physician subject to the requirement of subsection
18(a) of this Section when billing a patient, insurer, or
19third-party payer shall not markup, or directly or indirectly
20increase, the amount subject to disclosure under paragraph (2)
21of subsection (a) of this Section in any bill presented to a
22patient, insurer, or third-party payer.
23    (c) This Section does not prohibit a referring physician

 

 

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1from 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
9anatomic 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; or .
19        (4) any physician-owned laboratory.
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 pathology
5services" 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 microscopic assessment of a patient specimen
23    for the detection, localization, measurement, or
24    microscopic analysis of one or more protein or nucleic acid
25    targets; and
26        (5) blood-banking services performed by pathologists.

 

 

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1    (i) Nothing in this Section shall be construed to prohibit
2a physician from billing for services rendered and testing
3performed in the physician's office or a laboratory owned by a
4physician or medical group.
5(Source: P.A. 98-1127, eff. 1-1-15.)