Full Text of HB2194 99th General Assembly
HB2194ham001 99TH GENERAL ASSEMBLY | Rep. David Reis Filed: 4/17/2015
| | 09900HB2194ham001 | | LRB099 08198 MLM 33874 a |
|
| 1 | | AMENDMENT TO HOUSE BILL 2194
| 2 | | AMENDMENT NO. ______. Amend House Bill 2194 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Medical Practice Act of 1987 is amended by | 5 | | changing Section 22 as follows:
| 6 | | (225 ILCS 60/22) (from Ch. 111, par. 4400-22)
| 7 | | (Section scheduled to be repealed on December 31, 2015)
| 8 | | Sec. 22. Disciplinary action.
| 9 | | (A) The Department may revoke, suspend, place on probation, | 10 | | reprimand, refuse to issue or renew, or take any other | 11 | | disciplinary or non-disciplinary action as the Department may | 12 | | deem proper
with regard to the license or permit of any person | 13 | | issued
under this Act, including imposing fines not to exceed | 14 | | $10,000 for each violation, upon any of the following grounds:
| 15 | | (1) Performance of an elective abortion in any place, | 16 | | locale,
facility, or
institution other than:
|
| | | 09900HB2194ham001 | - 2 - | LRB099 08198 MLM 33874 a |
|
| 1 | | (a) a facility licensed pursuant to the Ambulatory | 2 | | Surgical Treatment
Center Act;
| 3 | | (b) an institution licensed under the Hospital | 4 | | Licensing Act;
| 5 | | (c) an ambulatory surgical treatment center or | 6 | | hospitalization or care
facility maintained by the | 7 | | State or any agency thereof, where such department
or | 8 | | agency has authority under law to establish and enforce | 9 | | standards for the
ambulatory surgical treatment | 10 | | centers, hospitalization, or care facilities
under its | 11 | | management and control;
| 12 | | (d) ambulatory surgical treatment centers, | 13 | | hospitalization or care
facilities maintained by the | 14 | | Federal Government; or
| 15 | | (e) ambulatory surgical treatment centers, | 16 | | hospitalization or care
facilities maintained by any | 17 | | university or college established under the laws
of | 18 | | this State and supported principally by public funds | 19 | | raised by
taxation.
| 20 | | (2) Performance of an abortion procedure in a wilful | 21 | | and wanton
manner on a
woman who was not pregnant at the | 22 | | time the abortion procedure was
performed.
| 23 | | (3) A plea of guilty or nolo contendere, finding of | 24 | | guilt, jury verdict, or entry of judgment or sentencing, | 25 | | including, but not limited to, convictions, preceding | 26 | | sentences of supervision, conditional discharge, or first |
| | | 09900HB2194ham001 | - 3 - | LRB099 08198 MLM 33874 a |
|
| 1 | | offender probation, under the laws of any jurisdiction of | 2 | | the United States of any crime that is a felony.
| 3 | | (4) Gross negligence in practice under this Act.
| 4 | | (5) Engaging in dishonorable, unethical or | 5 | | unprofessional
conduct of a
character likely to deceive, | 6 | | defraud or harm the public.
| 7 | | (6) Obtaining any fee by fraud, deceit, or
| 8 | | misrepresentation.
| 9 | | (7) Habitual or excessive use or abuse of drugs defined | 10 | | in law
as
controlled substances, of alcohol, or of any | 11 | | other substances which results in
the inability to practice | 12 | | with reasonable judgment, skill or safety.
| 13 | | (8) Practicing under a false or, except as provided by | 14 | | law, an
assumed
name.
| 15 | | (9) Fraud or misrepresentation in applying for, or | 16 | | procuring, a
license
under this Act or in connection with | 17 | | applying for renewal of a license under
this Act.
| 18 | | (10) Making a false or misleading statement regarding | 19 | | their
skill or the
efficacy or value of the medicine, | 20 | | treatment, or remedy prescribed by them at
their direction | 21 | | in the treatment of any disease or other condition of the | 22 | | body
or mind.
| 23 | | (11) Allowing another person or organization to use | 24 | | their
license, procured
under this Act, to practice.
| 25 | | (12) Adverse action taken by another state or | 26 | | jurisdiction
against a license
or other authorization to |
| | | 09900HB2194ham001 | - 4 - | LRB099 08198 MLM 33874 a |
|
| 1 | | practice as a medical doctor, doctor of osteopathy,
doctor | 2 | | of osteopathic medicine or
doctor of chiropractic, a | 3 | | certified copy of the record of the action taken by
the | 4 | | other state or jurisdiction being prima facie evidence | 5 | | thereof. This includes any adverse action taken by a State | 6 | | or federal agency that prohibits a medical doctor, doctor | 7 | | of osteopathy, doctor of osteopathic medicine, or doctor of | 8 | | chiropractic from providing services to the agency's | 9 | | participants.
| 10 | | (13) Violation of any provision of this Act or of the | 11 | | Medical
Practice Act
prior to the repeal of that Act, or | 12 | | violation of the rules, or a final
administrative action of | 13 | | the Secretary, after consideration of the
recommendation | 14 | | of the Disciplinary Board.
| 15 | | (14) Violation of the prohibition against fee | 16 | | splitting in Section 22.2 of this Act.
| 17 | | (15) A finding by the Disciplinary Board that the
| 18 | | registrant after
having his or her license placed on | 19 | | probationary status or subjected to
conditions or | 20 | | restrictions violated the terms of the probation or failed | 21 | | to
comply with such terms or conditions.
| 22 | | (16) Abandonment of a patient.
| 23 | | (17) Prescribing, selling, administering, | 24 | | distributing, giving
or
self-administering any drug | 25 | | classified as a controlled substance (designated
product) | 26 | | or narcotic for other than medically accepted therapeutic
|
| | | 09900HB2194ham001 | - 5 - | LRB099 08198 MLM 33874 a |
|
| 1 | | purposes.
| 2 | | (18) Promotion of the sale of drugs, devices, | 3 | | appliances or
goods provided
for a patient in such manner | 4 | | as to exploit the patient for financial gain of
the | 5 | | physician.
| 6 | | (19) Offering, undertaking or agreeing to cure or treat
| 7 | | disease by a secret
method, procedure, treatment or | 8 | | medicine, or the treating, operating or
prescribing for any | 9 | | human condition by a method, means or procedure which the
| 10 | | licensee refuses to divulge upon demand of the Department.
| 11 | | (20) Immoral conduct in the commission of any act | 12 | | including,
but not limited to, commission of an act of | 13 | | sexual misconduct related to the
licensee's
practice.
| 14 | | (21) Wilfully making or filing false records or reports | 15 | | in his
or her
practice as a physician, including, but not | 16 | | limited to, false records to
support claims against the | 17 | | medical assistance program of the Department of Healthcare | 18 | | and Family Services (formerly Department of
Public Aid)
| 19 | | under the Illinois Public Aid Code.
| 20 | | (22) Wilful omission to file or record, or wilfully | 21 | | impeding
the filing or
recording, or inducing another | 22 | | person to omit to file or record, medical
reports as | 23 | | required by law, or wilfully failing to report an instance | 24 | | of
suspected abuse or neglect as required by law.
| 25 | | (23) Being named as a perpetrator in an indicated | 26 | | report by
the Department
of Children and Family Services |
| | | 09900HB2194ham001 | - 6 - | LRB099 08198 MLM 33874 a |
|
| 1 | | under the Abused and Neglected Child Reporting
Act, and | 2 | | upon proof by clear and convincing evidence that the | 3 | | licensee has
caused a child to be an abused child or | 4 | | neglected child as defined in the
Abused and Neglected | 5 | | Child Reporting Act.
| 6 | | (24) Solicitation of professional patronage by any
| 7 | | corporation, agents or
persons, or profiting from those | 8 | | representing themselves to be agents of the
licensee.
| 9 | | (25) Gross and wilful and continued overcharging for
| 10 | | professional services,
including filing false statements | 11 | | for collection of fees for which services are
not rendered, | 12 | | including, but not limited to, filing such false statements | 13 | | for
collection of monies for services not rendered from the | 14 | | medical assistance
program of the Department of Healthcare | 15 | | and Family Services (formerly Department of Public Aid)
| 16 | | under the Illinois Public Aid
Code.
| 17 | | (26) A pattern of practice or other behavior which
| 18 | | demonstrates
incapacity
or incompetence to practice under | 19 | | this Act.
| 20 | | (27) Mental illness or disability which results in the
| 21 | | inability to
practice under this Act with reasonable | 22 | | judgment, skill or safety.
| 23 | | (28) Physical illness, including, but not limited to,
| 24 | | deterioration through
the aging process, or loss of motor | 25 | | skill which results in a physician's
inability to practice | 26 | | under this Act with reasonable judgment, skill or
safety.
|
| | | 09900HB2194ham001 | - 7 - | LRB099 08198 MLM 33874 a |
|
| 1 | | (29) Cheating on or attempt to subvert the licensing
| 2 | | examinations
administered under this Act.
| 3 | | (30) Wilfully or negligently violating the | 4 | | confidentiality
between
physician and patient except as | 5 | | required by law.
| 6 | | (31) The use of any false, fraudulent, or deceptive | 7 | | statement
in any
document connected with practice under | 8 | | this Act.
| 9 | | (32) Aiding and abetting an individual not licensed | 10 | | under this
Act in the
practice of a profession licensed | 11 | | under this Act.
| 12 | | (33) Violating state or federal laws or regulations | 13 | | relating
to controlled
substances, legend
drugs, or | 14 | | ephedra as defined in the Ephedra Prohibition Act.
| 15 | | (34) Failure to report to the Department any adverse | 16 | | final
action taken
against them by another licensing | 17 | | jurisdiction (any other state or any
territory of the | 18 | | United States or any foreign state or country), by any peer
| 19 | | review body, by any health care institution, by any | 20 | | professional society or
association related to practice | 21 | | under this Act, by any governmental agency, by
any law | 22 | | enforcement agency, or by any court for acts or conduct | 23 | | similar to acts
or conduct which would constitute grounds | 24 | | for action as defined in this
Section.
| 25 | | (35) Failure to report to the Department surrender of a
| 26 | | license or
authorization to practice as a medical doctor, a |
| | | 09900HB2194ham001 | - 8 - | LRB099 08198 MLM 33874 a |
|
| 1 | | doctor of osteopathy, a
doctor of osteopathic medicine, or | 2 | | doctor
of chiropractic in another state or jurisdiction, or | 3 | | surrender of membership on
any medical staff or in any | 4 | | medical or professional association or society,
while | 5 | | under disciplinary investigation by any of those | 6 | | authorities or bodies,
for acts or conduct similar to acts | 7 | | or conduct which would constitute grounds
for action as | 8 | | defined in this Section.
| 9 | | (36) Failure to report to the Department any adverse | 10 | | judgment,
settlement,
or award arising from a liability | 11 | | claim related to acts or conduct similar to
acts or conduct | 12 | | which would constitute grounds for action as defined in | 13 | | this
Section.
| 14 | | (37) Failure to provide copies of medical records as | 15 | | required
by law.
| 16 | | (38) Failure to furnish the Department, its | 17 | | investigators or
representatives, relevant information, | 18 | | legally requested by the Department
after consultation | 19 | | with the Chief Medical Coordinator or the Deputy Medical
| 20 | | Coordinator.
| 21 | | (39) Violating the Health Care Worker Self-Referral
| 22 | | Act.
| 23 | | (40) Willful failure to provide notice when notice is | 24 | | required
under the
Parental Notice of Abortion Act of 1995.
| 25 | | (41) Failure to establish and maintain records of | 26 | | patient care and
treatment as required by this law.
|
| | | 09900HB2194ham001 | - 9 - | LRB099 08198 MLM 33874 a |
|
| 1 | | (42) Entering into an excessive number of written | 2 | | collaborative
agreements with licensed advanced practice | 3 | | nurses resulting in an inability to
adequately | 4 | | collaborate.
| 5 | | (43) Repeated failure to adequately collaborate with a | 6 | | licensed advanced practice nurse. | 7 | | (44) Violating the Compassionate Use of Medical | 8 | | Cannabis Pilot Program Act.
| 9 | | (45) Entering into an excessive number of written | 10 | | collaborative agreements with licensed prescribing | 11 | | psychologists resulting in an inability to adequately | 12 | | collaborate. | 13 | | (46) Repeated failure to adequately collaborate with a | 14 | | licensed prescribing psychologist. | 15 | | (47) Violating Section 3.3 of the Medical Patient | 16 | | Rights Act. | 17 | | Except
for actions involving the ground numbered (26), all | 18 | | proceedings to suspend,
revoke, place on probationary status, | 19 | | or take any
other disciplinary action as the Department may | 20 | | deem proper, with regard to a
license on any of the foregoing | 21 | | grounds, must be commenced within 5 years next
after receipt by | 22 | | the Department of a complaint alleging the commission of or
| 23 | | notice of the conviction order for any of the acts described | 24 | | herein. Except
for the grounds numbered (8), (9), (26), and | 25 | | (29), no action shall be commenced more
than 10 years after the | 26 | | date of the incident or act alleged to have violated
this |
| | | 09900HB2194ham001 | - 10 - | LRB099 08198 MLM 33874 a |
|
| 1 | | Section. For actions involving the ground numbered (26), a | 2 | | pattern of practice or other behavior includes all incidents | 3 | | alleged to be part of the pattern of practice or other behavior | 4 | | that occurred, or a report pursuant to Section 23 of this Act | 5 | | received, within the 10-year period preceding the filing of the | 6 | | complaint. In the event of the settlement of any claim or cause | 7 | | of action
in favor of the claimant or the reduction to final | 8 | | judgment of any civil action
in favor of the plaintiff, such | 9 | | claim, cause of action or civil action being
grounded on the | 10 | | allegation that a person licensed under this Act was negligent
| 11 | | in providing care, the Department shall have an additional | 12 | | period of 2 years
from the date of notification to the | 13 | | Department under Section 23 of this Act
of such settlement or | 14 | | final judgment in which to investigate and
commence formal | 15 | | disciplinary proceedings under Section 36 of this Act, except
| 16 | | as otherwise provided by law. The time during which the holder | 17 | | of the license
was outside the State of Illinois shall not be | 18 | | included within any period of
time limiting the commencement of | 19 | | disciplinary action by the Department.
| 20 | | The entry of an order or judgment by any circuit court | 21 | | establishing that any
person holding a license under this Act | 22 | | is a person in need of mental treatment
operates as a | 23 | | suspension of that license. That person may resume their
| 24 | | practice only upon the entry of a Departmental order based upon | 25 | | a finding by
the Disciplinary Board that they have been | 26 | | determined to be recovered
from mental illness by the court and |
| | | 09900HB2194ham001 | - 11 - | LRB099 08198 MLM 33874 a |
|
| 1 | | upon the Disciplinary Board's
recommendation that they be | 2 | | permitted to resume their practice.
| 3 | | The Department may refuse to issue or take disciplinary | 4 | | action concerning the license of any person
who fails to file a | 5 | | return, or to pay the tax, penalty or interest shown in a
filed | 6 | | return, or to pay any final assessment of tax, penalty or | 7 | | interest, as
required by any tax Act administered by the | 8 | | Illinois Department of Revenue,
until such time as the | 9 | | requirements of any such tax Act are satisfied as
determined by | 10 | | the Illinois Department of Revenue.
| 11 | | The Department, upon the recommendation of the | 12 | | Disciplinary Board, shall
adopt rules which set forth standards | 13 | | to be used in determining:
| 14 | | (a) when a person will be deemed sufficiently | 15 | | rehabilitated to warrant the
public trust;
| 16 | | (b) what constitutes dishonorable, unethical or | 17 | | unprofessional conduct of
a character likely to deceive, | 18 | | defraud, or harm the public;
| 19 | | (c) what constitutes immoral conduct in the commission | 20 | | of any act,
including, but not limited to, commission of an | 21 | | act of sexual misconduct
related
to the licensee's | 22 | | practice; and
| 23 | | (d) what constitutes gross negligence in the practice | 24 | | of medicine.
| 25 | | However, no such rule shall be admissible into evidence in | 26 | | any civil action
except for review of a licensing or other |
| | | 09900HB2194ham001 | - 12 - | LRB099 08198 MLM 33874 a |
|
| 1 | | disciplinary action under this Act.
| 2 | | In enforcing this Section, the Disciplinary Board or the | 3 | | Licensing Board,
upon a showing of a possible violation, may | 4 | | compel, in the case of the Disciplinary Board, any individual | 5 | | who is licensed to
practice under this Act or holds a permit to | 6 | | practice under this Act, or, in the case of the Licensing | 7 | | Board, any individual who has applied for licensure or a permit
| 8 | | pursuant to this Act, to submit to a mental or physical | 9 | | examination and evaluation, or both,
which may include a | 10 | | substance abuse or sexual offender evaluation, as required by | 11 | | the Licensing Board or Disciplinary Board and at the expense of | 12 | | the Department. The Disciplinary Board or Licensing Board shall | 13 | | specifically designate the examining physician licensed to | 14 | | practice medicine in all of its branches or, if applicable, the | 15 | | multidisciplinary team involved in providing the mental or | 16 | | physical examination and evaluation, or both. The | 17 | | multidisciplinary team shall be led by a physician licensed to | 18 | | practice medicine in all of its branches and may consist of one | 19 | | or more or a combination of physicians licensed to practice | 20 | | medicine in all of its branches, licensed chiropractic | 21 | | physicians, licensed clinical psychologists, licensed clinical | 22 | | social workers, licensed clinical professional counselors, and | 23 | | other professional and administrative staff. Any examining | 24 | | physician or member of the multidisciplinary team may require | 25 | | any person ordered to submit to an examination and evaluation | 26 | | pursuant to this Section to submit to any additional |
| | | 09900HB2194ham001 | - 13 - | LRB099 08198 MLM 33874 a |
|
| 1 | | supplemental testing deemed necessary to complete any | 2 | | examination or evaluation process, including, but not limited | 3 | | to, blood testing, urinalysis, psychological testing, or | 4 | | neuropsychological testing.
The Disciplinary Board, the | 5 | | Licensing Board, or the Department may order the examining
| 6 | | physician or any member of the multidisciplinary team to | 7 | | provide to the Department, the Disciplinary Board, or the | 8 | | Licensing Board any and all records, including business | 9 | | records, that relate to the examination and evaluation, | 10 | | including any supplemental testing performed. The Disciplinary | 11 | | Board, the Licensing Board, or the Department may order the | 12 | | examining physician or any member of the multidisciplinary team | 13 | | to present testimony concerning this examination
and | 14 | | evaluation of the licensee, permit holder, or applicant, | 15 | | including testimony concerning any supplemental testing or | 16 | | documents relating to the examination and evaluation. No | 17 | | information, report, record, or other documents in any way | 18 | | related to the examination and evaluation shall be excluded by | 19 | | reason of
any common
law or statutory privilege relating to | 20 | | communication between the licensee, permit holder, or
| 21 | | applicant and
the examining physician or any member of the | 22 | | multidisciplinary team.
No authorization is necessary from the | 23 | | licensee, permit holder, or applicant ordered to undergo an | 24 | | evaluation and examination for the examining physician or any | 25 | | member of the multidisciplinary team to provide information, | 26 | | reports, records, or other documents or to provide any |
| | | 09900HB2194ham001 | - 14 - | LRB099 08198 MLM 33874 a |
|
| 1 | | testimony regarding the examination and evaluation. The | 2 | | individual to be examined may have, at his or her own expense, | 3 | | another
physician of his or her choice present during all | 4 | | aspects of the examination.
Failure of any individual to submit | 5 | | to mental or physical examination and evaluation, or both, when
| 6 | | directed, shall result in an automatic suspension, without | 7 | | hearing, until such time
as the individual submits to the | 8 | | examination. If the Disciplinary Board or Licensing Board finds | 9 | | a physician unable
to practice following an examination and | 10 | | evaluation because of the reasons set forth in this Section, | 11 | | the Disciplinary
Board or Licensing Board shall require such | 12 | | physician to submit to care, counseling, or treatment
by | 13 | | physicians, or other health care professionals, approved or | 14 | | designated by the Disciplinary Board, as a condition
for | 15 | | issued, continued, reinstated, or renewed licensure to | 16 | | practice. Any physician,
whose license was granted pursuant to | 17 | | Sections 9, 17, or 19 of this Act, or,
continued, reinstated, | 18 | | renewed, disciplined or supervised, subject to such
terms, | 19 | | conditions or restrictions who shall fail to comply with such | 20 | | terms,
conditions or restrictions, or to complete a required | 21 | | program of care,
counseling, or treatment, as determined by the | 22 | | Chief Medical Coordinator or
Deputy Medical Coordinators, | 23 | | shall be referred to the Secretary for a
determination as to | 24 | | whether the licensee shall have their license suspended
| 25 | | immediately, pending a hearing by the Disciplinary Board. In | 26 | | instances in
which the Secretary immediately suspends a license |
| | | 09900HB2194ham001 | - 15 - | LRB099 08198 MLM 33874 a |
|
| 1 | | under this Section, a hearing
upon such person's license must | 2 | | be convened by the Disciplinary Board within 15
days after such | 3 | | suspension and completed without appreciable delay. The
| 4 | | Disciplinary Board shall have the authority to review the | 5 | | subject physician's
record of treatment and counseling | 6 | | regarding the impairment, to the extent
permitted by applicable | 7 | | federal statutes and regulations safeguarding the
| 8 | | confidentiality of medical records.
| 9 | | An individual licensed under this Act, affected under this | 10 | | Section, shall be
afforded an opportunity to demonstrate to the | 11 | | Disciplinary Board that they can
resume practice in compliance | 12 | | with acceptable and prevailing standards under
the provisions | 13 | | of their license.
| 14 | | The Department may promulgate rules for the imposition of | 15 | | fines in
disciplinary cases, not to exceed
$10,000 for each | 16 | | violation of this Act. Fines
may be imposed in conjunction with | 17 | | other forms of disciplinary action, but
shall not be the | 18 | | exclusive disposition of any disciplinary action arising out
of | 19 | | conduct resulting in death or injury to a patient. Any funds | 20 | | collected from
such fines shall be deposited in the Medical | 21 | | Disciplinary Fund.
| 22 | | All fines imposed under this Section shall be paid within | 23 | | 60 days after the effective date of the order imposing the fine | 24 | | or in accordance with the terms set forth in the order imposing | 25 | | the fine. | 26 | | (B) The Department shall revoke the license or
permit |
| | | 09900HB2194ham001 | - 16 - | LRB099 08198 MLM 33874 a |
|
| 1 | | issued under this Act to practice medicine or a chiropractic | 2 | | physician who
has been convicted a second time of committing | 3 | | any felony under the
Illinois Controlled Substances Act or the | 4 | | Methamphetamine Control and Community Protection Act, or who | 5 | | has been convicted a second time of
committing a Class 1 felony | 6 | | under Sections 8A-3 and 8A-6 of the Illinois Public
Aid Code. A | 7 | | person whose license or permit is revoked
under
this subsection | 8 | | B shall be prohibited from practicing
medicine or treating | 9 | | human ailments without the use of drugs and without
operative | 10 | | surgery.
| 11 | | (C) The Disciplinary Board shall recommend to the
| 12 | | Department civil
penalties and any other appropriate | 13 | | discipline in disciplinary cases when the
Board finds that a | 14 | | physician willfully performed an abortion with actual
| 15 | | knowledge that the person upon whom the abortion has been | 16 | | performed is a minor
or an incompetent person without notice as | 17 | | required under the Parental Notice
of Abortion Act of 1995. | 18 | | Upon the Board's recommendation, the Department shall
impose, | 19 | | for the first violation, a civil penalty of $1,000 and for a | 20 | | second or
subsequent violation, a civil penalty of $5,000.
| 21 | | (Source: P.A. 97-622, eff. 11-23-11; 98-601, eff. 12-30-13; | 22 | | 98-668, eff. 6-25-14; 98-1140, eff. 12-30-14.)
| 23 | | Section 10. The Medical Patient Rights Act is amended by | 24 | | changing Section 3.3 as follows: |
| | | 09900HB2194ham001 | - 17 - | LRB099 08198 MLM 33874 a |
|
| 1 | | (410 ILCS 50/3.3) | 2 | | Sec. 3.3. Prohibition on the markup of anatomic pathology | 3 | | services. | 4 | | (a) A physician who orders, but who does not supervise or | 5 | | perform, an anatomic pathology service shall disclose in a bill | 6 | | for such service presented to the patient: | 7 | | (1) the name and address of the physician or laboratory
| 8 | | that provided the anatomic pathology service; and | 9 | | (2) the actual amount paid or to be paid for each | 10 | | anatomic pathology service provided to the patient by the | 11 | | physician or laboratory that performed the service. | 12 | | (b) A physician subject to the requirement of subsection | 13 | | (a) of this Section when billing a patient, insurer, or | 14 | | third-party payer shall not markup, or directly or indirectly | 15 | | increase, the amount subject to disclosure under paragraph (2) | 16 | | of subsection (a) of this Section in any bill presented to a | 17 | | patient, insurer, or third-party payer. | 18 | | (c) This Section does not prohibit a referring physician | 19 | | from charging a specimen acquisition or processing charge if: | 20 | | (1) the charge is limited to actual costs incurred for | 21 | | specimen collection and transportation; and | 22 | | (2) the charge is separately coded or denoted as a | 23 | | service distinct from the performance of the anatomic | 24 | | pathology service, in conformance with the coding policies | 25 | | of the American Medical Association. | 26 | | (d) The requirements of this Section do not apply to an |
| | | 09900HB2194ham001 | - 18 - | LRB099 08198 MLM 33874 a |
|
| 1 | | anatomic pathology service ordered or provided by: | 2 | | (1) facilities licensed under the Hospital Licensing | 3 | | Act or the University of Illinois Hospital Act or clinical | 4 | | laboratories owned, operated by, or operated within | 5 | | facilities licensed under the Hospital Licensing Act or the | 6 | | University of Illinois Hospital Act; | 7 | | (2) any public health clinic or nonprofit health | 8 | | clinic; or | 9 | | (3) any government agency, or their specified public or | 10 | | private agents. | 11 | | (e) No patient, insurer, or other third-party payer, shall | 12 | | be required to reimburse any licensed health care professional | 13 | | for charges or claims submitted in violation of this Section. | 14 | | (f) A person who receives a bill for an anatomic pathology | 15 | | service made in knowing and willful violation of this Section | 16 | | may maintain an action to recover the actual amount paid for | 17 | | the bill. | 18 | | (g) The Department of Financial and Professional | 19 | | Regulation Insurance shall enforce the provisions of this | 20 | | Section for any bill submitted to a payer in violation of this | 21 | | Section. A violation of this Section shall be a violation of | 22 | | the Medical Practice Act of 1987. | 23 | | (h) For the purposes of this Section, "anatomic pathology | 24 | | services" means: | 25 | | (1) histopathology or surgical pathology, meaning the | 26 | | gross and microscopic examination performed by a physician |
| | | 09900HB2194ham001 | - 19 - | LRB099 08198 MLM 33874 a |
|
| 1 | | or under the supervision of a physician, including | 2 | | histologic processing; | 3 | | (2) cytopathology, meaning the microscopic examination | 4 | | of cells from (A) fluids, (B) aspirates, (C) washings, (D) | 5 | | brushings, or (E) smears, including the Pap smear test | 6 | | examination performed by a physician or under the | 7 | | 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 | | (Source: P.A. 98-1127, eff. 1-1-15.)
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.".
|
|