Illinois General Assembly - Full Text of SB1630
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Full Text of SB1630  98th General Assembly




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1    AN ACT concerning regulation.
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
5adding Section 3.3 as follows:
6    (410 ILCS 50/3.3 new)
7    Sec. 3.3. Prohibition on the markup of anatomic pathology
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.
19    (e) No patient, insurer, or other third-party payer, shall
20be required to reimburse any licensed health care professional
21for charges or claims submitted in violation of this Section.
22    (f) A person who receives a bill for an anatomic pathology
23service made in knowing and willful violation of this Section
24may maintain an action to recover the actual amount paid for
25the bill.
26    (g) The Department of Insurance shall enforce the



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1provisions of this Section for any bill submitted to a payer in
2violation of this Section.
3    (h) For the purposes of this Section, "anatomic pathology
4services" 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.