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Public Act 098-1127


 

Public Act 1127 98TH GENERAL ASSEMBLY

  
  
  

 


 
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