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| [ Introduced ] | [ Engrossed ] | [ Senate Amendment 001 ] |
91_SB1657enr SB1657 Enrolled LRB9110302MWgc 1 AN ACT to amend the Illinois Health Finance Reform Act by 2 changing Sections 2-1, 4-1, 4-2, 4-3, and 4-5. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Illinois Health Finance Reform Act is 6 amended by changing Sections 2-1, 4-1, 4-2, 4-3, and 4-5 as 7 follows: 8 (20 ILCS 2215/2-1) (from Ch. 111 1/2, par. 6502-1) 9 Sec. 2-1. Council Authorized. There is hereby created 10 the Illinois Health Care Cost Containment Council. It shall 11 consist of 1311members appointed by the Governor with the 12 advice and consent of the Senate as follows: 53members to 13 represent providers as follows: 2 members to represent 14 Illinois hospitals at least one of which must represent a 15 small rural hospital, 2 members to represent physicians 16 licensed to practice medicine in all its branches, and 1 17 member to represent ambulatory surgical treatment centers; 3 18 members to represent consumers; 2 members to represent 19 insurance companies; and 3 members to represent businesses. 20 The members of the Council shall be appointed for 3-year 21three yearterms. 22 No more than 7sixmembers may be from the same political 23 party. 24 Members shall be appointed within 30thirtydays after 25 the effective date of this Act. The additional members 26 appointed under the amendatory Act of the 91st General 27 Assembly must be appointed within 30 days after the effective 28 date of this amendatory Act of the 91st General Assembly. The 29 members of the Council shall receive reimbursement of their 30 actual expenses incurred in connection with their service; in 31 addition, each member shall receive compensation of $150 a SB1657 Enrolled -2- LRB9110302MWgc 1 day for each day served at regular or special meetings of the 2 Council, except that such compensation shall not exceed 3 $20,000 in any one year for any member. The Council shall 4 elect a Chairman from among its members, and shall have the 5 power to organize and appoint such other officers as it may 6 deem necessary. 7 All appointments shall be made in writing and filed with 8 the Secretary of State as a public record. 9 (Source: P.A. 83-1243.) 10 (20 ILCS 2215/4-1) (from Ch. 111 1/2, par. 6504-1) 11 Sec. 4-1. Illinois Health Finance Data Collection. The 12 General Assembly finds thataccurate, comparable data on the13costs of health care are not currently available in Illinois.14Therefore, it is extremely difficult to make careful policy15choices for future health care cost management strategies.16Further, neither thepublic sector andnorprivate sector 17 purchasers of health care need health care cost and 18 utilizationhave availabledata to enable them to make 19 informed choices among health care providers in the market 20 place.While the gathering of health care cost data has21been attempted on a voluntary basis in the past, the lack of22a uniform system for the collection and analysis of data, and23the lack of full participation by providers and payors has24led to inadequate and unusable data. In order to remedy this25problem,The General Assembly finds it necessary to create a 26 mandated uniform system in Illinois for the collection, 27 analysis, and distribution of health care cost and 28 utilization data. 29 The purpose of this Article is to insure that data are 30 available to make valid comparisons among health care 31 providershospitalsof prices and utilization offorservices 32 provided and to support ongoing analysis of the health care 33 delivery system so that the Council can fulfill its mandate. SB1657 Enrolled -3- LRB9110302MWgc 1 (Source: P.A. 83-1243.) 2 (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2) 3 Sec. 4-2. Powers and duties. 4 (a) The Illinois Health Care Cost Containment Council 5 may enter into any agreement with any corporation, 6 association or other entity it deems appropriate to undertake 7 the process described in this Article for the compilation and 8 analysis of data collected by the Council and to conduct or 9 contract for studies on health-related questions carried out 10 in pursuance of the purposes of this Article. The agreement 11 may provide for the corporation, association or entity to 12 prepare and distribute or make available data to health care 13 providers, health care subscribers, third-party payors, 14 government and the general public, in accordance with the 15 rules of confidentiality and review to be developed under 16 this Act. 17 (b) The input data collected by and furnished to the 18 Council or designated corporation, association or entity 19 pursuant to this Section shall not be a public record under 20 the Illinois Freedom of Information Act. It is the intent of 21 this Act and of the regulations written pursuant to it to 22 protect the confidentiality of individual patient information 23 and the proprietary information of commercial insurance 24 carriers and health care providershospitals.To accomplish25this, the data specified in subsection (c) shall be released26in the following manner. Total gross revenue, total27deductions from gross revenue and gross inpatient revenue28shall be reported to the Council and released by the Council29on a hospital specific basis. The remaining data elements in30subsection (c) shall not be released on a hospital-specific31basis except as needed by the executive, legislative, and32judicial branches of government for the performance of their33duties.Data specified in subsectionssubsection(e) and SB1657 Enrolled -4- LRB9110302MWgc 1 (e-5) shall be released on a hospital specific and licensed 2 ambulatory surgical treatment center specific basis to 3 facilitate comparisons among hospitals and licensed 4 ambulatory surgical treatment centers by purchasers. 5 (c) The Council shall require the Departments of Public 6 Health and Public Aid and hospitals located in the State to 7 assist the Council in gathering and submitting the following 8 hospital-specific financial information, and the Council is 9 authorized to share this data with both Departments to reduce 10 the burden on hospitals by avoiding duplicate data 11 collection: 12 OPERATING REVENUES 13 (1) Net patient service revenue 14 (2) Other revenue 15 (3) Total operating revenue 16 OPERATING EXPENSES 17 (4) Bad debt expense 18 (5) Total operating expenses 19 NON-OPERATING GAINS/LOSSES 20 (6) Total non-operating gains 21 (7) Total non-operating losses 22 PATIENT CARE REVENUES 23 (8) Gross inpatient revenue 24 (9) Gross outpatient revenue 25 (10) Other Patient care revenue 26 (11) Total patient revenue 27 (12) Total gross patient care revenue 28 (13) Medicare gross revenue 29 (14) Medicaid gross revenue 30 (15) Total other gross revenue 31 DEDUCTIONS FROM REVENUE 32 (16) Charity care SB1657 Enrolled -5- LRB9110302MWgc 1 (17) Medicare allowance 2 (18) Medicaid allowance 3 (19) Other contractual allowances 4 (20) Other allowances 5 (21) Total Deductions 6 ASSETS 7 (22) Operating cash and short-term investments 8 (23) Estimated patient accounts receivable 9 (24) Other current assets 10 (25) Total current assets 11 (26) Total other assets 12 (27) Total Assets 13 LIABILITIES AND FUND BALANCES 14 (28) Total current liabilities 15 (29) Long Term Debt 16 (30) Other liabilities 17 (31) Total liabilities 18 (32) Total liabilities and fund balances 19In addition, each hospital shall annually submit to the20Council a duplicate copy of the hospital's Medicaid Cost21Report at the same time that the hospital submits the cost22report to the Illinois Department of Public Aid and any23settled cost report upon receipt by the hospital of a notice24of amount of program reimbursement.25On and after the effective date of this Act, such26information shall be annually submitted from each hospital in27the State of Illinois no later than 120 days after the close28of its fiscal year. The information submitted in the report29shall be based upon audited financial statements and shall be30attested to by the Chief Executive Officer of each hospital.31 All financial data collected by the Council from publicly 32 available sources such as the HCFAElectronic Medicare33Reportsis releasable by the Council on a hospital specific SB1657 Enrolled -6- LRB9110302MWgc 1 basis when appropriate. 2 (d) Uniform Provider Utilization and Charge 3 Information. The Council shall require that: 4 (1) Hospitals licensed to operate in the State of 5 Illinois adopt a uniform system for submitting patient 6 charges for payment from public and private payors 7 effective January 1, 1985. This system shall be based 8 upon adoption of the uniform hospital billing form 9 (UB-92)(UB-82/HCFA-1450)or its successor form developed 10 by the National Uniform Billing Committee. 11 (2) (Blank)The Illinois Department of Public Aid12accept the uniform billing form effective October 1,131985. In addition, the Illinois Department of Public Aid14shall report the data listed in subsection (e) for the15period January 1, 1985 through October 1, 1985. 16 (3) The Department of Insurance require all 17 third-party payors, including but not limited to, 18 licensed insurers, medical and hospital service 19 corporations, health maintenance organizations, and 20 self-funded employee health plans, to accept the uniform 21 billing form, without attachment as submitted by 22 hospitals pursuant to paragraph (1) of subsection (d) 23 above, effective January 1, 1985; provided, however, 24 nothing shall prevent all such third party payors from 25 requesting additional information necessary to determine 26 eligibility for benefits or liability for reimbursement 27 for services provided. 28 (e) The Council, in cooperation with the State 29 Departments of Public Aid, Insurance, and Public Health, 30 shall establish a system for the collection of the following 31 information from hospitals utilizing the raw data available 32 on the uniform billing forms. Such data shall include the 33 following elements and other elements contained on the 34 uniform billing form or its successor form determined as SB1657 Enrolled -7- LRB9110302MWgc 1 necessary by the Council: 2 (1) Patient date of birth 3 (2) Patient sex 4 (3) Patient zip code 5 (4) Third-party coverage 6 (5) Date of admission 7 (6) Source of admission 8 (7) Type of admission 9 (8) Discharge date 10 (9) Principal and up to 8fourother diagnoses 11 (10) Principal procedure and date 12 (11) Patient status 13 (12) Other procedures and dates 14 (13) Total charges and components of those charges 15 (14) Attending and consulting physician identification 16 numbersnumber17 (15) Hospital identification number 18 (16) An alphanumeric number based on the information to 19 identify the payor 20 (17) Principal source of payment. 21 (e-5) The Council, in cooperation with the Department of 22 Public Aid, the Department of Insurance, and the Department 23 of Public Health, shall establish a system for the collection 24 of the following information for each outpatient surgery 25 performed at hospitals and licensed ambulatory surgical 26 treatment centers using the raw data available on outpatient 27 billing forms submitted by hospitals and licensed ambulatory 28 surgical treatment centers to payors. The data must include 29 the following elements, if available on the billing forms, 30 and other elements contained on the billing forms that the 31 Council determines are necessary: 32 (1) patient date of birth; 33 (2) patient sex; 34 (3) patient zip code; SB1657 Enrolled -8- LRB9110302MWgc 1 (4) third-party coverage; 2 (5) date of admission; 3 (6) source of admission; 4 (7) type of admission; 5 (8) discharge date; 6 (9) principal diagnosis and up to 8 other 7 diagnoses; 8 (10) principal procedure and the date of the 9 procedure; 10 (11) patient status; 11 (12) other procedures and the dates of those 12 procedures; 13 (13) attending and consulting physician 14 identification numbers; 15 (14) hospital or licensed ambulatory surgical 16 treatment center identification number; 17 (15) an alphanumeric number based on the 18 information needed to identify the payor; and 19 (16) principal source of payment. 20 (f) Extracts of the UB-92UB82transactions shall be 21 prepared by hospitals according to regulations promulgated by 22 the Council and submitted in electronicmagnetic tapeformat 23 to the Council or the corporation, association or entity 24 designated by the Council. 25 For hospitals unable to submit extracts in electronic 26magnetic tapeformat, the Council shall determine an 27 alternate method forelectronicsubmission of data. Such 28 extract reporting systems shall be in operation before 29 January 1, 1987; however, the Council may grant time 30 extensions to individual hospital. 31 (f-5) Extracts of the billing forms shall be prepared by 32 licensed ambulatory surgical treatment centers according to 33 rules adopted by the Council and submitted to the Council or 34 a corporation, association, or entity designated by the SB1657 Enrolled -9- LRB9110302MWgc 1 Council. Electronic submissions shall be encouraged. For 2 licensed ambulatory surgical treatment centers unable to 3 submit extracts in an electronic format the Council must 4 determine an alternate method for submission of data. 5 (g) Under no circumstances shall patient name and social 6 security number appear on the extracts. 7 (h) Hospitals and licensed ambulatory surgical treatment 8 centers shall be assigned a standard identification number by 9 the Council to be used in the submission of all data. 10 (i) The Council shall collect a 100% inpatient sample 11 from hospitals annually. The Council shall require each 12 hospital in the State to submit the UB-92UB-82data extracts 13 required in subsection (e) to the Council, except that 14 hospitals with fewer than 50 beds may be exempted by the 15 Council from the filing requirements if they prove to the 16 Council's satisfaction that the requirements would impose 17 undue economic hardship and if the Council determines that 18 the data submitted from these hospitals are not essential to 19 its data base and its concomitant health care cost comparison 20 efforts. 21 (i-5) The Council shall collect up to a 100% outpatient 22 sample annually from hospitals and licensed ambulatory 23 surgical treatment centers. The Council shall require each 24 hospital and licensed ambulatory surgical treatment center in 25 the State to submit the data extracts required under 26 subsection (e-5) to the Council, except that hospitals and 27 licensed ambulatory surgical treatment centers may be 28 exempted by the Council from the filing requirements if the 29 hospitals or licensed ambulatory surgical treatment centers 30 prove to the Council's satisfaction that the requirements 31 would impose undue economic hardship and if the Council 32 determines that the data submitted from those hospitals and 33 licensed ambulatory surgical treatment centers are not 34 essential to the Council's database and its concomitant SB1657 Enrolled -10- LRB9110302MWgc 1 health care comparison efforts. 2 (i-10) The outpatient data shall be collected by the 3 Council on a phase-in and trial basis for a one-year period 4 beginning on January 1, 2001. The Council shall implement 5 outpatient data collection for reporting purposes beginning 6 on January 1, 2002. 7 (j) The information submitted to the Council pursuant to 8 subsectionssubsection(e) and (e-5) shall be reported for 9 each primary payor category, including Medicare, Medicaid, 10 other government programs, private insurance, health 11 maintenance organizations, self-insured, private pay 12 patients, and others. Preferred provider organization 13 reimbursement shall also be reported for each primary third 14 party payor category. 15 (k) The Council shall require and the designated 16 corporation, association or entity, if applicable, shall 17 prepare quarterly basic reports in the aggregate on health 18 care cost and utilizationcoststrends in Illinois. The 19 Council shall provide these reports to the public, if 20 requested. These shall include, but not be limited to, 21 comparative information on average charges, total and 22 ancillary charge components, length of stay on 23 diagnosis-specific and procedure specific cases, and number 24 of discharges, compiled in aggregate by hospital and licensed 25 ambulatory surgical treatment center, by diagnosis, and by 26 primary payor category. 27 (l) The Council shall, from information submitted 28 pursuant to subsection (e), prepare an annual report in the 29 aggregate by hospital containing the following: 30 (1) the ratio of caesarean section deliveries to 31 total deliveries; 32 (2) the average length of stay for patients who 33 undergo caesarean sections; 34 (3) the average total charges for patients who have SB1657 Enrolled -11- LRB9110302MWgc 1 normal deliveries without any significant complications; 2 (4) the average total charges for patients who 3 deliver by caesarean section. 4 The Council shall provide this report to the public, if 5 requested. 6 (l-5) (Blank)The Council, in cooperation with the State7Departments of Public Aid, Insurance, and Public Health,8shall establish a system for the collection of outpatient9surgical data from hospitals and licensed ambulatory surgical10treatment centers utilizing raw data available on an11outpatient uniform billing form that conforms with pertinent12State and federal standards. Under no circumstances shall a13patient's name or social security number appear on the14abstract of the billing form provided to the Council.15Beginning July 1, 1996, the Council is authorized to collect16ambulatory surgery information from hospitals and licensed17freestanding surgery centers by means of surveys. No later18than January 1, 1997, the Council shall begin a pilot study19that includes the collection of some hospital and licensed20freestanding ambulatory surgery data from the same health21care markets. No later than July 1, 1997, the Council shall22begin a field test of the ambulatory surgery data collection23system with the collection of all defined outpatient surgery24data from a sample of licensed freestanding ambulatory25surgical treatment centers and the hospitals that serve the26same health care markets. No later than January 1, 1998, the27Council shall begin to collect comments from providers and28consumers and from advisory groups regarding the field29testing of a system for the collection of outpatient surgical30data. The Council shall report its findings, summary of31comments received, conclusions and recommendations regarding32the collection of outpatient surgical data no later than33March 1, 1998 to the General Assembly.34The Council shall seek authorization from the GeneralSB1657 Enrolled -12- LRB9110302MWgc 1Assembly prior to beginning the collection of all defined2outpatient surgery data from all licensed freestanding3ambulatory surgical treatment centers and hospitals.4Beginning July 1, 1996, the Council is authorized to5develop a process to use existing third party payers and6other voluntarily available existing databases, surveys, and7sampling techniques to develop cost and utilization8information on outpatient care primarily for areas other than9ambulatory surgery in Illinois.10To ensure both equity and data integrity, no ambulatory11survey data shall be released other than to the individual12hospitals and licensed freestanding ambulatory surgical13treatment centers that provided the data until the data is14being required from all facilities in the same health care15market and the Council determines the collection program is16effective. 17 (m) Prior to the release or dissemination of these 18 reports, the Council or the designated corporation shall 19 permit providers the opportunity to verify the accuracy of 20 any information pertaining to the provider. The providers 21 may submit to the Council any corrections or errors in the 22 compilation of the data with any supporting evidence and 23 documents the providers may submit. The Council or 24 corporation shall correct data found to be in error and 25 include additional commentary as requested by the provider 26 for major deviations in the charges from the average charges. 27 For purposes of this subsection (m), "providers" includes 28 physicians licensed to practice medicine in all of its 29 branches. 30 (n) In addition to the reports indicated above, the 31 Council shall respond to requests by agencies of government 32 and organizations in the private sector for data products, 33 special studies and analysis of data collected pursuant to 34 this Section. Such reports shall be undertaken only by the SB1657 Enrolled -13- LRB9110302MWgc 1 agreement of a majority of the members of the Council who 2 shall designate the form in which the information shall be 3 made available. The Council or the corporation, association 4 or entity in consultation with the Council shall also 5 determine a fee to be charged to the requesting agency or 6 private sector organization to cover the direct and indirect 7 costs for producing such a report, and shall permit affected 8 providers the rights to review the accuracy of the report 9 before it is released. Such reports shall not be subject to 10 The Freedom of Information Act. 11 (Source: P.A. 88-535; 89-554, eff. 7-26-96.) 12 (20 ILCS 2215/4-3) (from Ch. 111 1/2, par. 6504-3) 13 Sec. 4-3. Confidentiality. 14 (a) As indicated elsewhere in this Act, all steps 15 necessary under State and Federal law to protect patient 16 confidentiality shall be undertaken by the Council to prevent 17 the identification of individual patient records. 18 Regulations are to be written to assure the confidentiality 19 of patient records when gathering and submitting data to the 20 Council or designated corporation, association or entity. 21 (b) The information submitted to the Council, designated 22 corporation, association or entity by hospitals pursuant to 23 subsections (c),and(e), and (e-5) of Section 4-2 shall be 24 privileged and confidential, and shall not be disclosed in 25 any manner. The foregoing includes, but shall not be limited 26 to, disclosure, inspection or copying under the Freedom of 27 Information Act, the State Records Act, and paragraph (1) of 28 Section 404 of the Illinois Insurance Code. However, the 29 prohibitions stated in this subsection shall not apply to the 30 compilations of information assembled by the Council pursuant 31 to subsections (k) and (m) of Section 4-2. 32 (c) Any person or organization, including but not 33 limited to, hospitals, government agencies, associations, SB1657 Enrolled -14- LRB9110302MWgc 1 businesses, or researchers receiving data under an agreement 2 with the Council under the terms indicated in Section 6504-2 3 shall be required to adhere strictly to the terms of the 4 agreement, especially the terms that are related to 5 preserving patient confidentiality. The use of Council data 6 either alone or in combination with data from another source 7 or sources to identify specific patients is prohibited unless 8 such identification is specifically authorized by Illinois 9 Statute and agreed to in writing by the Council. An 10 intentional breach of patient confidentiality not authorized 11 by statute and the Council shall render the responsible 12 individual or organization liable to the penalties under 13 Section 5-2. 14 (Source: P.A. 91-357, eff. 7-29-99.) 15 (20 ILCS 2215/4-5) (from Ch. 111 1/2, par. 6504-5) 16 Sec. 4-5. Expenses. The Council or designated 17 corporation, association or entity shall establish a 18 procedure by which it will pay hospitals and licensed 19 ambulatory surgical treatment centers for submitting data 20 pursuant to subsectionssubsection(e) and (e-5) of Section 21 4-2. Operating expenses of the Council or the designated 22 corporation, association or entity for such payments, for the 23 conversion of hard copy reports to tape, and for the 24 compilation and analysis of basic reports shall be paid for 25 by appropriation of the General Assembly. Expenses for 26 additional reports shall be billed to those requesting the 27 reports. 28 (Source: P.A. 83-1243.) 29 Section 99. Effective date. This Act takes effect upon 30 becoming law.