Full Text of HB3209 99th General Assembly
HB3209 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB3209 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED: |
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Amends the Medical Patients Rights Act. Provides that the prohibition on the markup of anatomic pathology services does not apply to any physician-owned laboratory. Provides that nothing regarding this prohibition shall be construed to prohibit a physician from billing for services rendered and testing performed in the physician's office or a laboratory owned by a physician or medical group. Makes other changes.
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| | A BILL FOR |
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| | | HB3209 | | LRB099 09073 JLK 29263 b |
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| 1 | | AN ACT concerning health.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Medical Patient Rights Act is amended by | 5 | | changing Section 3.3 as follows: | 6 | | (410 ILCS 50/3.3) | 7 | | Sec. 3.3. Prohibition on the markup of anatomic pathology | 8 | | services. | 9 | | (a) A physician who orders, but who does not supervise or | 10 | | perform, an anatomic pathology service shall disclose in a bill | 11 | | for 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 | 19 | | third-party payer shall not markup, or directly or indirectly | 20 | | increase, the amount subject to disclosure under paragraph (2) | 21 | | of subsection (a) of this Section in any bill presented to a | 22 | | patient, insurer, or third-party payer. | 23 | | (c) This Section does not prohibit a referring physician |
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| 1 | | from 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 | 9 | | anatomic 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 ; or . | 19 | | (4) any physician-owned laboratory. | 20 | | (e) No patient, insurer, or other third-party payer, shall | 21 | | be required to reimburse any licensed health care professional | 22 | | for charges or claims submitted in violation of this Section. | 23 | | (f) A person who receives a bill for an anatomic pathology | 24 | | service made in knowing and willful violation of this Section | 25 | | may maintain an action to recover the actual amount paid for | 26 | | the bill. |
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| 1 | | (g) The Department of Insurance shall enforce the | 2 | | provisions of this Section for any bill submitted to a payer in | 3 | | violation of this Section. | 4 | | (h) For the purposes of this Section, "anatomic pathology | 5 | | services" means: | 6 | | (1) histopathology or surgical pathology, meaning the | 7 | | gross and microscopic examination performed by a physician | 8 | | or under the supervision of a physician, including | 9 | | histologic processing; | 10 | | (2) cytopathology, meaning the microscopic examination | 11 | | of cells from (A) fluids, (B) aspirates, (C) washings, (D) | 12 | | brushings, or (E) smears, including the Pap smear test | 13 | | examination performed by a physician or under the | 14 | | supervision of a physician; | 15 | | (3) hematology, meaning the microscopic evaluation of | 16 | | bone marrow aspirates and biopsies performed by a | 17 | | physician, or under the supervision of a physician, and | 18 | | peripheral blood smears when the attending or treating | 19 | | physician or technologist requests that a blood smear be | 20 | | reviewed by a pathologist; | 21 | | (4) sub-cellular pathology or molecular pathology, | 22 | | meaning the microscopic assessment of a patient specimen | 23 | | for the detection, localization, measurement, or | 24 | | microscopic analysis of one or more protein or nucleic acid | 25 | | targets; and | 26 | | (5) blood-banking services performed by pathologists.
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| 1 | | (i) Nothing in this Section shall be construed to prohibit | 2 | | a physician from billing for services rendered and testing | 3 | | performed in the physician's office or a laboratory owned by a | 4 | | physician or medical group. | 5 | | (Source: P.A. 98-1127, eff. 1-1-15.)
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