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

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Bill Title: Amends the Medical Patient 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.

Sponsorship: Partisan Bill (Democrat 1)

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

Download: Illinois-2015-HB3209-Introduced.html

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99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 HB3209 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED:
410 ILCS 50/3.3
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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AN ACT concerning health.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
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.
(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

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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 requirements of this Section do not apply 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 .
(4) any physician-owned laboratory.
(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 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 microscopic assessment of a patient specimen
for the detection, localization, measurement, or
microscopic analysis of one or more protein or nucleic acid
targets; and
(5) blood-banking services performed by pathologists.

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(i) Nothing in this Section 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.
(Source: P.A. 98-1127, eff. 1-1-15.)