102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5327

 

Introduced 1/31/2022, by Rep. Denyse Wang Stoneback

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Creates the All Payer Claims Database Act. Provides that the Department of Insurance shall establish an All Payer Claims database for sharing limited use health care data. Provides that the All Payer Claims database shall not include or disclose any data that contains direct, primary, or obvious personal identifiers, and that the Department shall develop criteria and procedures to ensure that limited use health care data complies with the requirements of Health Insurance Portability and Accountability Act of 1996. Provides that the Department shall make available to the public on its website a public limited use health care data set for purposes of facilitating transparency in health care costs; that the public limited use health care data set shall be publicly accessible, publicly searchable, contain current information, and have easy to use online tools; and that the Department shall publish the data set in a standardized, consumer-friendly format. Provides that in presenting limited use health care data for public access, the Department shall make comparative considerations regarding geography, demographics, general economic factors, and institutional size. Provides that all health care payers shall annually submit health insurance claims information as claims data without personally identifying information to the Department. Provides that the Department shall adopt rules as may be necessary to provide for the release of health care data from the database. Defines terms. Amends the Hospital Licensing Act. Provides that before providing any nonemergency medical services, each licensed hospital shall provide in writing or by electronic means a good faith estimate of reasonably anticipated charges by the hospital for the treatment of the patient's specific condition. Provides that the hospital shall provide the estimate to the patient within 7 business days after recommending a specific course of treatment or set of services. Provides that a hospital may not charge the patient more than 110% of the estimate. Provides that a hospital that fails to provide the estimate within the timeframe required shall be liable for a daily fine of $1,000 until the estimate is provided to the patient and that the total fine may not exceed $10,000. Amends the University of Illinois Hospital Act to make similar changes.


LRB102 23513 BMS 32693 b

 

 

A BILL FOR

 

HB5327LRB102 23513 BMS 32693 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the All
5Payer Claims Database Act.
 
6    Section 5. Definitions. As used in this Act:
7    "Department" means the Department of Insurance.
8    "Health care payer" means any organization or program that
9provides accident and health insurance coverage in this State,
10including insurers; self-insured employer plans; the program
11of health benefits under the State Employees Group Insurance
12Act of 1971; providers of health insurance coverage under the
13Counties Code; providers of health insurance coverage under
14under the Illinois Municipal Code; providers of health
15insurance coverage under the School Code; any provider of any
16health plan subject to the Health Maintenance Organization
17Act, the Limited Health Service Organization Act, or the
18Voluntary Health Services Plans Act; the medical assistance
19program under the Medical Assistance Article of the Illinois
20Public Aid Code; the Children's Health Insurance Program; and
21the Covering ALL KIDS Health Insurance Program.
22    "Insurer" means any person, firm, association, or
23corporation licensed in this State under the applicable

 

 

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1provisions of the Illinois Insurance Code as an insurer.
2    "Limited use health care data" means health care price
3data that does not contain any personal identifiers, including
4price data for procedures and services provided by physicians
5and hospitals, inpatient and outpatient procedures and
6services, average amounts charged and average amounts paid for
7procedures and services, and health care price information
8from any health care payer in this State.
 
9    Section 10. All Payer Claims database.
10    (a) The Department shall establish an All Payer Claims
11database for sharing limited use health care data.
12    (b) The All Payer Claims database shall not include or
13disclose any data that contains direct, primary, or obvious
14personal identifiers. The Department shall develop criteria
15and procedures to ensure that limited use health care data
16complies with the requirements of Health Insurance Portability
17and Accountability Act of 1996. To the extent allowed by the
18Health Insurance Portability and Accountability Act of 1996,
19the All Payer Claims database shall be available as a resource
20for insurers, employers, providers, consumers, and State
21agencies to continuously review health care utilization,
22expenditures, and performance in this State and to enhance the
23ability of consumers and employers to make informed and
24cost-effective health care choices.
25    (c) The Department shall make available to the public on

 

 

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1its website a public limited use health care data set for
2purposes of facilitating transparency in health care costs.
3The public limited use health care data set shall be publicly
4accessible, publicly searchable, contain current information,
5and have easy to use online tools. The Department shall
6publish the public limited use health care data set in a
7standardized, consumer-friendly format.
8    (d) In presenting limited use health care data for public
9access, the Department shall make comparative considerations
10regarding geography, demographics, general economic factors,
11and institutional size.
12    (e) All health care payers shall annually submit health
13insurance price information as claims data without personally
14identifying information to the Department.
15    (f) The Department shall adopt rules as may be necessary
16to provide for the release of health care data from the All
17Payer Claims database.
 
18    Section 100. The University of Illinois Hospital Act is
19amended by adding Section 8g as follows:
 
20    (110 ILCS 330/8g new)
21    Sec. 8g. Price transparency.
22    (a) The University of Illinois Hospital shall provide
23timely and accurate financial information and quality of
24service measures to patients and prospective patients of the

 

 

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1University of Illinois Hospital, or to patients' survivors or
2legal guardians, as appropriate.
3    (b) Before providing any nonemergency medical services,
4the University of Illinois Hospital shall provide in writing
5or by electronic means a good faith estimate of reasonably
6anticipated charges by the University of Illinois Hospital for
7the treatment of the patient's or prospective patient's
8specific condition. The University of Illinois Hospital shall
9provide the estimate to the patient or prospective patient
10within 7 business days after recommending a specific course of
11treatment or set of services and is not required to adjust the
12estimate for any potential insurance coverage.
13    (c) The University of Illinois Hospital may not charge the
14patient more than 110% of the estimate. However, if the
15University of Illinois Hospital determines that additional
16charges are warranted due to unforeseen circumstances or the
17provision of additional services, the University of Illinois
18Hospital shall provide the patient with a written explanation
19of the excess charges as part of the detailed, itemized
20statement or bill.
21    (d) In the estimate, the University of Illinois Hospital
22shall provide to the patient or prospective patient
23information on the hospital's financial assistance policy,
24including the application process, payment plans, discounts,
25and the hospital's charity care policy and collection
26procedures.

 

 

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1    (e) The estimate shall clearly identify any facility fees
2and, if applicable, include a statement notifying the patient
3or prospective patient that a facility fee is included in the
4estimate, the purpose of the fee, and that the patient may pay
5less for the procedure or service at another facility or in
6another health care setting.
7    (f) The University of Illinois Hospital shall notify the
8patient or prospective patient of any revision to the
9estimate.
10    (g) In the estimate, the University of Illinois Hospital
11must notify the patient or prospective patient that services
12may be provided in the hospital by the facility as well as by
13other health care providers that may separately bill the
14patient, if applicable.
15    (h) If the University of Illinois Hospital fails to
16provide the estimate within the timeframe required in
17subsection (b), the University of Illinois Hospital shall be
18liable for a daily fine of $1,000 until the estimate is
19provided to the patient or prospective patient. The total fine
20may not exceed $10,000.
21    (i) The University of Illinois Hospital shall establish an
22appeal process designed to allow patients to dispute charges
23that appear on the patient's itemized statement or bill. The
24University of Illinois Hospital shall prominently post on its
25website, and indicate in bold print on each itemized statement
26or bill, the instructions for initiating an appeal and the

 

 

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1direct contact information needed to initiate the appeal
2process. The University of Illinois Hospital must provide an
3initial response to a patient appeal within 7 business days
4after the patient formally files an appeal disputing all or a
5portion of an itemized statement or bill.
 
6    Section 105. The Hospital Licensing Act is amended by
7adding Section 11.9 as follows:
 
8    (210 ILCS 85/11.9 new)
9    Sec. 11.9. Price transparency.
10    (a) A hospital licensed under this Act shall provide
11timely and accurate financial information and quality of
12service measures to patients and prospective patients of the
13hospital, or to patients' survivors or legal guardians, as
14appropriate.
15    (b) Before providing any nonemergency medical services,
16each licensed hospital shall provide in writing or by
17electronic means a good faith estimate of reasonably
18anticipated charges by the hospital for the treatment of the
19patient's or prospective patient's specific condition. The
20hospital shall provide the estimate to the patient or
21prospective patient within 7 business days after recommending
22a specific course of treatment or set of services and is not
23required to adjust the estimate for any potential insurance
24coverage.

 

 

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1    (c) A hospital may not charge the patient more than 110% of
2the estimate. However, if the hospital determines that
3additional charges are warranted due to unforeseen
4circumstances or the provision of additional services, the
5hospital shall provide the patient with a written explanation
6of the excess charges as part of the detailed, itemized
7statement or bill.
8    (d) In the estimate, the hospital shall provide to the
9patient or prospective patient information on the hospital's
10financial assistance policy, including the application
11process, payment plans, discounts, and the hospital's charity
12care policy and collection procedures.
13    (e) The estimate shall clearly identify any facility fees
14and, if applicable, include a statement notifying the patient
15or prospective patient that a facility fee is included in the
16estimate, the purpose of the fee, and that the patient may pay
17less for the procedure or service at another facility or in
18another health care setting.
19    (f) The hospital shall notify the patient or prospective
20patient of any revision to the estimate.
21    (g) In the estimate, the hospital must notify the patient
22or prospective patient that services may be provided in the
23hospital by the facility as well as by other health care
24providers that may separately bill the patient, if applicable.
25    (h) A hospital that fails to provide the estimate within
26the timeframe required in subsection (b) shall be liable for a

 

 

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1daily fine of $1,000 until the estimate is provided to the
2patient or prospective patient. The total fine may not exceed
3$10,000.
4    (i) Each hospital shall establish an appeal process
5designed to allow patients to dispute charges that appear on
6the patient's itemized statement or bill. The hospital shall
7prominently post on its website, and indicate in bold print on
8each itemized statement or bill, the instructions for
9initiating an appeal and the direct contact information needed
10to initiate the appeal process. The hospital must provide an
11initial response to a patient appeal within 7 business days
12after the patient formally files an appeal disputing all or a
13portion of an itemized statement or bill.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    New Act
4    110 ILCS 330/8g new
5    210 ILCS 85/11.9 new