Full Text of SB1282 97th General Assembly
SB1282enr 97TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning State government.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Health Finance Reform Act is | 5 | | amended by changing Section 4-2 as follows:
| 6 | | (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
| 7 | | Sec. 4-2. Powers and duties.
| 8 | | (a) (Blank).
| 9 | | (b) (Blank).
| 10 | | (c) (Blank).
| 11 | | (d) Uniform Provider Utilization and Charge Information.
| 12 | | (1) The Department of Public Health shall require that | 13 | | all hospitals and ambulatory surgical treatment centers
| 14 | | licensed to operate in the State of Illinois adopt a | 15 | | uniform system for
submitting patient claims and encounter | 16 | | data
for payment from public and private payors. This | 17 | | system shall be based upon adoption of the uniform
| 18 | | electronic billing form pursuant to the Health Insurance
| 19 | | Portability and Accountability Act.
| 20 | | (2) (Blank).
| 21 | | (3) The Department of Insurance shall require all | 22 | | third-party payors,
including but not limited to, licensed | 23 | | insurers, medical and hospital service
corporations, |
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| 1 | | health maintenance organizations, and self-funded employee
| 2 | | health plans, to accept the uniform billing form, without | 3 | | attachment as
submitted by hospitals pursuant to paragraph | 4 | | (1) of subsection (d) above,
effective January 1, 1985; | 5 | | provided, however, nothing shall prevent all
such third | 6 | | party payors from requesting additional information | 7 | | necessary to
determine eligibility for benefits or | 8 | | liability for reimbursement for
services provided.
| 9 | | (4) By no later than 60 days after the end of each | 10 | | calendar quarter, each hospital
licensed in the State shall | 11 | | electronically submit to
the Department inpatient and | 12 | | outpatient claims and encounter data related to surgical | 13 | | and invasive procedures collected under paragraph (5) for | 14 | | each patient. | 15 | | By no later than 60 days after the end of each calendar | 16 | | quarter, each ambulatory surgical treatment center | 17 | | licensed in the State shall electronically submit to the | 18 | | Department outpatient claims and encounter data collected | 19 | | under paragraph (5) for each patient, provided however, | 20 | | that, until July 1, 2006, ambulatory surgical treatment | 21 | | centers who cannot electronically submit data may submit | 22 | | data by computer diskette.
For hospitals, the claims and | 23 | | encounter
data to be
reported shall include all inpatient | 24 | | surgical
cases.
Claims and encounter data submitted under | 25 | | this Act
shall not include a patient's name,
address,
or
| 26 | | Social Security number ; provided, however, that the |
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| 1 | | Department may require, by rule, the inclusion of a unique | 2 | | patient identifier that may be based upon the last four | 3 | | digits of the patient's Social Security number. The | 4 | | Department shall promulgate regulations to protect the | 5 | | patient's rights of confidentiality and privacy. The | 6 | | regulations shall ensure that patient names, addresses, | 7 | | Social Security numbers, or any other data that the | 8 | | Department believes could be used to determine the identity | 9 | | of an individual patient shall be stored and processed in | 10 | | the most secure manner possible .
| 11 | | (5) By no later than January 1, 2006, the Department | 12 | | must collect and
compile
claims and encounter data related | 13 | | to surgical and invasive procedures according to uniform | 14 | | electronic
submission formats as required under the Health | 15 | | Insurance Portability and
Accountability Act. By no later | 16 | | than January 1, 2006, the Department must collect and | 17 | | compile from ambulatory surgical treatment centers the | 18 | | claims and encounter data according to uniform electronic | 19 | | data element formats as required under the Health Insurance | 20 | | Portability and Accountability Act of 1996 (HIPAA).
| 21 | | (6) The Department shall make available on its website | 22 | | the
"Consumer Guide to Health Care" by January 1, 2006. The | 23 | | "Consumer
Guide to Health Care" shall include information | 24 | | on at least 30 inpatient conditions and
procedures | 25 | | identified by the Department that demonstrate the highest
| 26 | | degree of variation in patient charges and quality of care. |
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| 1 | | By no later than January 1, 2007, the "Consumer Guide to | 2 | | Health Care" shall also include information on at least 30 | 3 | | outpatient conditions and procedures identified by the | 4 | | Department that demonstrate the highest degree of | 5 | | variation in patient charges and quality care. As to each
| 6 | | condition or procedure, the "Consumer Guide to Health Care" | 7 | | shall include
up-to-date comparison information relating | 8 | | to volume of cases, average
charges, risk-adjusted | 9 | | mortality rates, and nosocomial infection rates and, with | 10 | | respect to outpatient surgical and invasive procedures, | 11 | | shall include information regarding surgical infections, | 12 | | complications, and direct admissions of outpatient cases | 13 | | to hospitals for selected procedures, as determined by the | 14 | | Department, based on review by the Department of its own, | 15 | | local, or national studies.
Information disclosed pursuant | 16 | | to this paragraph on
mortality and infection rates shall be | 17 | | based upon information hospitals
and ambulatory surgical | 18 | | treatment centers have either (i)
previously submitted to | 19 | | the Department pursuant to their obligations
to report | 20 | | health care information under this Act or other public | 21 | | health reporting laws
and regulations outside of this Act | 22 | | or (ii) submitted to the Department under the provisions of | 23 | | the Hospital Report Card Act.
| 24 | | (7) Publicly disclosed information must be provided in | 25 | | language
that is easy to understand and accessible to | 26 | | consumers using an
interactive query system. The guide |
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| 1 | | shall include such additional information as is necessary | 2 | | to enhance decision making among consumer and health care | 3 | | purchasers, which shall include, at a minimum, appropriate | 4 | | guidance on how to interpret the data and an explanation of | 5 | | why the data may vary from provider to provider. The | 6 | | "Consumer Guide to Health Care" shall also cite standards | 7 | | that facilities meet under state and federal law and, if | 8 | | applicable, to achieve voluntary accreditation.
| 9 | | (8) None of the information the Department discloses to | 10 | | the public
under this subsection may be made available | 11 | | unless the information has
been reviewed, adjusted, and | 12 | | validated according to the following process:
| 13 | | (i) Hospitals, ambulatory surgical treatment | 14 | | centers,
and organizations
representing hospitals, | 15 | | ambulatory surgical treatment centers, purchasers, | 16 | | consumer groups, and health plans are
meaningfully | 17 | | involved in providing advice and consultation to the | 18 | | Department in the development of all aspects of
the | 19 | | Department's methodology for collecting, analyzing, | 20 | | and
disclosing the information collected under this | 21 | | Act, including
collection methods, formatting, and | 22 | | methods and means for
release and dissemination;
| 23 | | (ii) The entire methodology for collecting and
| 24 | | analyzing the data is disclosed to all relevant | 25 | | organizations
and to all providers that are the subject | 26 | | of any information to
be made available to the public |
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| 1 | | before any public disclosure
of such information;
| 2 | | (iii) Data collection and analytical methodologies | 3 | | are
used that meet accepted standards of validity and | 4 | | reliability
before any information is made available | 5 | | to the public;
| 6 | | (iv) The limitations of the data sources and | 7 | | analytic
methodologies used to develop comparative | 8 | | provider
information are clearly identified and | 9 | | acknowledged,
including, but not limited to, | 10 | | appropriate and inappropriate
uses of the data;
| 11 | | (v) To the greatest extent possible, comparative
| 12 | | hospital and ambulatory surgical treatment center
| 13 | | information initiatives use standard-based
norms | 14 | | derived from widely accepted provider-developed
| 15 | | practice guidelines;
| 16 | | (vi) Comparative hospital and ambulatory surgical | 17 | | treatment center information and other
information | 18 | | that the Department has compiled regarding
hospitals | 19 | | and ambulatory surgical treatment centers is shared | 20 | | with the hospitals and ambulatory surgical treatment | 21 | | centers under review prior to
public dissemination of | 22 | | the information and these providers
have an | 23 | | opportunity to make corrections and additions of
| 24 | | helpful explanatory comments about the information | 25 | | before
the publication;
| 26 | | (vii) Comparisons among hospitals and ambulatory |
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| 1 | | surgical treatment centers adjust for
patient case mix | 2 | | and other relevant risk factors and control
for | 3 | | provider peer groups, if applicable;
| 4 | | (viii) Effective safeguards to protect against the
| 5 | | unauthorized use or disclosure of hospital and | 6 | | ambulatory surgical treatment center information are
| 7 | | developed and implemented;
| 8 | | (ix) Effective safeguards to protect against the
| 9 | | dissemination of inconsistent, incomplete, invalid,
| 10 | | inaccurate, or subjective provider data are developed | 11 | | and
implemented;
| 12 | | (x) The quality and accuracy of hospital and | 13 | | ambulatory surgical treatment center information
| 14 | | reported under this Act and its data collection, | 15 | | analysis, and
dissemination methodologies are | 16 | | evaluated regularly; and
| 17 | | (xi) Only the most basic hospital or ambulatory | 18 | | surgical treatment center identifying information from | 19 | | mandatory reports is used. Information regarding a | 20 | | hospital or ambulatory surgical center may be released | 21 | | regardless of the number of employees or health care | 22 | | professionals whose data are reflected in the data for | 23 | | the hospital or ambulatory surgical treatment center | 24 | | as long as no specific information identifying an | 25 | | employee or a health care professional is released.
| 26 | | Further, patient identifiable
information is not |
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| 1 | | released. The input data collected
by the Department | 2 | | shall not be a public record under the
Illinois Freedom | 3 | | of Information Act.
| 4 | | None of the information
the Department discloses to the | 5 | | public under this Act may be
used to establish a standard | 6 | | of care in a private civil action.
| 7 | | (9) The Department must develop and implement an | 8 | | outreach
campaign to educate the public regarding the | 9 | | availability of the "Consumer
Guide to Health Care".
| 10 | | (10) By January 1, 2006, the Department must study the
| 11 | | most effective methods for public disclosure of patient | 12 | | claims and encounter data and
health care quality | 13 | | information that will be useful to consumers in making
| 14 | | health care decisions and report its recommendations to the
| 15 | | Governor and to the General Assembly.
| 16 | | (11) The Department must undertake all steps necessary | 17 | | under
State and Federal law to protect patient | 18 | | confidentiality in order to prevent
the identification of | 19 | | individual patient records.
| 20 | | (12) The Department must adopt rules for inpatient and | 21 | | outpatient data collection and reporting no later than | 22 | | January 1, 2006. | 23 | | (13) In addition to the data products indicated above, | 24 | | the Department shall respond to requests by government | 25 | | agencies, academic research organizations, and private | 26 | | sector organizations for purposes of clinical performance |
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| 1 | | measurements and analyses of data collected pursuant to | 2 | | this Section. | 3 | | (14) The Department, with the advice of and in | 4 | | consultation with hospitals, ambulatory surgical treatment | 5 | | centers, organizations representing hospitals, | 6 | | organizations representing ambulatory treatment centers, | 7 | | purchasers, consumer groups, and health plans, must | 8 | | evaluate additional methods for comparing the performance | 9 | | of hospitals and ambulatory surgical treatment centers, | 10 | | including the value of disclosing additional measures that | 11 | | are adopted by the National Quality Forum, The Joint | 12 | | Commission on Accreditation of Healthcare Organizations, | 13 | | the Accreditation Association for Ambulatory Health Care, | 14 | | the Centers for Medicare and Medicaid Services, or similar | 15 | | national entities that establish standards to measure the | 16 | | performance of health care providers. The Department shall | 17 | | report its findings and recommendations on its Internet | 18 | | website and to the Governor and General Assembly no later | 19 | | than July 1, 2006.
| 20 | | (e) (Blank).
| 21 | | (Source: P.A. 93-144, eff. 7-10-03; 94-27, eff. 6-14-05.)
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