SB1630 98TH GENERAL ASSEMBLY

LRB098 08625 MGM 38744 b

98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB1630

Introduced 2/13/2013, by Sen. William R. Haine

SYNOPSIS AS INTRODUCED:

210 ILCS 25/7-105 new
225 ILCS 60/70 new

Amends the Medical Practice Act of 1987 and the Illinois Clinical Laboratory and Blood Bank Act. Provides that a clinical laboratory or physician that provides anatomic pathology services for patients in this State shall present or cause to be presented a claim, bill, or demand for payment for these services only to specified people. Provides that the clinical laboratory or physician shall not charge, bill, or otherwise solicit payment for anatomic pathology services unless the services were rendered personally by the clinical laboratory or physician or under the clinical laboratory's or physician's direct supervision. Defines "anatomic pathology services". Makes other changes. Effective December 31, 2013.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Clinical Laboratory and Blood Bank Act is amended by adding Section 7-105 as follows:

(210 ILCS 25/7-105 new)

Sec. 7-105. Direct billing of anatomic pathology services.

(a) A clinical laboratory that provides anatomic pathology services for patients in this State shall present or cause to be presented a claim, bill, or demand for payment for these services only to:

(1) the patient directly;

(2) the responsible insurer or other third-party payor;

(3) the hospital, public health clinic, or nonprofit health clinic ordering such services;

(4) the referring laboratory, excluding a laboratory of a physician's office or group practice that does not perform the professional component of the anatomic pathology service for which the claim, bill, or demand is presented;

(5) governmental agencies, specified public or private agents of government agencies, or organizations, working on behalf of the recipient of the services.

(b) Clinical laboratories shall not, directly or indirectly, charge, bill, or otherwise solicit payment for anatomic pathology services unless the services were rendered by the clinical laboratory or by the laboratory's employee or agent in accordance with Section 353 of the Public Health Service Act (42 U.S.C. 263a).

(c) No patient, insurer, third-party payor, hospital, public health clinic, or nonprofit health clinic shall be required to reimburse any clinical laboratory for charges or claims submitted in violation of this Section.

(d) Nothing in this Section shall be construed to mandate the assignment of benefits for anatomic pathology services as defined in this Section.

(e) For purposes of this Section, the term "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 the following: (i) fluids, (ii) aspirates, (iii) washings, (iv) brushings, or (v) smears, including the Pap 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.

(f) The provisions of this Section do not prohibit billing of a referring laboratory for anatomic pathology services in instances where a sample or samples must be sent to another laboratory for consultation or histologic processing. For purposes of this subsection (f), the term "referring laboratory" does not include a laboratory of a physician's office or group practice that does not perform the professional component of the anatomic pathology service involved.

(g) The Department may revoke, suspend, or deny renewal of the license of any clinical laboratory who violates the provisions of this Section.

(h) 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.

Section 10. The Medical Practice Act of 1987 is amended by adding Section 70 as follows:

(225 ILCS 60/70 new)

Sec. 70. Direct billing of anatomic pathology services.

(a) A physician that provides anatomic pathology services for patients in this State shall present or cause to be presented a claim, bill, or demand for payment for these services only to:

(1) the patient directly;

(2) the responsible insurer or other third-party payor;

(3) the hospital, public health clinic, or nonprofit health clinic ordering such services;

(4) the referring laboratory, excluding a laboratory of a physician's office or group practice that does not perform the professional component of the anatomic pathology service for which the claim, bill, or demand is presented;

(5) governmental agencies, specified public or private agents of government agencies, or organizations, working on behalf of the recipient of the services.

(b) Except for a physician at a referring laboratory that has been billed pursuant to subsection (f), physicians shall not, directly or indirectly, charge, bill, or otherwise solicit payment for anatomic pathology services unless the services were rendered personally by the physician or under the physician's direct supervision in accordance with Section 353 of the Public Health Service Act (42 U.S.C. 263a).

(c) No patient, insurer, third-party payor, hospital, public health clinic, or nonprofit health clinic shall be required to reimburse any physician for charges or claims submitted in violation of this Section.

(d) Nothing in this Section shall be construed to mandate the assignment of benefits for anatomic pathology services as defined in this Section.

(e) For purposes of this Section, the term "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 the following: (i) fluids, (ii) aspirates, (iii) washings, (iv) brushings, or (v) smears, including the Pap 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.

(f) The provisions of this Section do not prohibit billing of a referring laboratory for anatomic pathology services in instances where a sample or samples must be sent to another physician or laboratory for consultation or histologic processing. For purposes of this subsection (f), the term "referring laboratory" does not include a laboratory of a physician's office or group practice that does not perform the professional component of the anatomic pathology service involved.

(g) The Department may revoke, suspend, or deny renewal of the license of any physician who violates the provisions of this Section.

(h) 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.

Section 99. Effective date. This Act takes effect December 31, 2013.