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


Sen. William R. Haine

Filed: 3/25/2014





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2    AMENDMENT NO. ______. Amend Senate Bill 1630 by replacing
3everything after the enacting clause with the following:
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.



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1    (b) A physician subject to the requirement of subsection
2(a) of this Section when billing a patient, insurer, or
3third-party payer shall not markup, or directly or indirectly
4increase, the amount subject to disclosure under paragraph (2)
5of subsection (a) of this Section in any bill presented to a
6patient, insurer, or third-party payer.
7    (c) This Section does not prohibit a referring physician
8from charging a specimen acquisition or processing charge if:
9        (1) the charge is limited to actual costs incurred for
10    specimen collection and transportation; and
11        (2) the charge is separately coded or denoted as a
12    service distinct from the performance of the anatomic
13    pathology service, in conformance with the coding policies
14    of the American Medical Association.
15    (d) The requirements of this Section do not apply to an
16anatomic pathology service ordered or provided by:
17        (1) facilities licensed under the Hospital Licensing
18    Act or the University of Illinois Hospital Act or clinical
19    laboratories owned, operated by, or operated within
20    facilities licensed under the Hospital Licensing Act or the
21    University of Illinois Hospital Act;
22        (2) any public health clinic or nonprofit health
23    clinic; or
24        (3) any government agency, or their specified public or
25    private agents.
26    (e) No patient, insurer, or other third-party payer, shall



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1be required to reimburse any licensed health care professional
2for charges or claims submitted in violation of this Section.
3    (f) A person who receives a bill for an anatomic pathology
4service made in knowing and willful violation of this Section
5may maintain an action to recover the actual amount paid for
6the bill.
7    (g) The Department of Insurance shall enforce the
8provisions of this Section for any bill submitted to a payer in
9violation of this Section.
10    (h) For the purposes of this Section, "anatomic pathology
11services" means:
12        (1) histopathology or surgical pathology, meaning the
13    gross and microscopic examination performed by a physician
14    or under the supervision of a physician, including
15    histologic processing;
16        (2) cytopathology, meaning the microscopic examination
17    of cells from (A) fluids, (B) aspirates, (C) washings, (D)
18    brushings, or (E) smears, including the Pap smear test
19    examination performed by a physician or under the
20    supervision of a physician;
21        (3) hematology, meaning the microscopic evaluation of
22    bone marrow aspirates and biopsies performed by a
23    physician, or under the supervision of a physician, and
24    peripheral blood smears when the attending or treating
25    physician or technologist requests that a blood smear be
26    reviewed by a pathologist;



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1        (4) sub-cellular pathology or molecular pathology,
2    meaning the assessment of a patient specimen for the
3    detection, localization, measurement, or analysis of one
4    or more protein or nucleic acid targets; and
5        (5) blood-banking services performed by
6    pathologists.".