Bill Amendment: IL HB3209 | 2015-2016 | 99th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: ANATOMIC PATHOLOGY SERVICES

Status: 2015-03-27 - House Committee Amendment No. 1 Rule 19(a) / Re-referred to Rules Committee [HB3209 Detail]

Download: Illinois-2015-HB3209-House_Amendment_001.html

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Rep. Jay Hoffman

Filed: 3/23/2015

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AMENDMENT TO HOUSE BILL 3209
AMENDMENT NO. ______. Amend House Bill 3209 by replacing
everything after the enacting clause with the following:
"Section 5. The Medical Patient Rights Act is amended by
changing Section 3.3 as follows:
(410 ILCS 50/3.3)
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.

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(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 only exemptions to the requirements of this Section
do not apply are the following 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; or .

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(4) an anatomic pathology laboratory certified or
accredited under Section 263a of the Public Health Service
Act, 42 U.S.C. 263a, when owned and operated by a physician
or physician group practice who orders such services,
provided that:
(A) the referral and billing for the anatomic
pathology service would otherwise be permitted under
paragraph (2) of subsection (b) of 42 U.S.C. 13955nn as
an in-office ancillary service;
(B) the professional component of the anatomic
pathology service is provided at the laboratory
exclusively for patients of the physician or group
practice who owns and operates the laboratory; and
(C) the physician performing the anatomic
pathology services is in an employee, group practice,
or contractual arrangement in compliance with Section
20 of the Health Care Worker Self-Referral Act and
subsections (a) and (b) of Section 22.2 of the Medical
Practice Act of 1987.
(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.

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(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
"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.
"Professional component of the anatomic pathology service"

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means the entire anatomic pathology service other than
histologic processing.
(Source: P.A. 98-1127, eff. 1-1-15.)".