97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB1903

 

Introduced , by Rep. David R. Leitch

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-31 new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for the purpose of measuring and publicly reporting the quality, efficiency, and effectiveness of healthcare services received by medical assistance recipients, the Department of Healthcare and Family Services shall make available to certain not-for-profit corporations standardized extracts of data on the claims paid by the Department to healthcare providers for services rendered to medical assistance recipients in specific geographic areas. Sets forth the criteria a not-for-profit corporation must meet in order to qualify for such disclosure. Contains provisions concerning costs and funding; and the disclosure of certain data by managed care organizations, healthcare providers, or other companies under contract with the Department for the delivery of care to medical assistance recipients.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-31 as follows:
 
6    (305 ILCS 5/5-31 new)
7    Sec. 5-31. Availability of medical assistance data for
8performance measurement.
9    (a) In General. The Department shall make available to
10qualified entities (as described in subsection (b)) data (as
11described in subsection (c)) for the purpose of measuring and
12publicly reporting the quality, efficiency, and effectiveness
13of healthcare services received by medical assistance
14recipients.
15    (b) Qualified entities. For the purposes of this
16subsection, a "qualified entity" is a not-for-profit
17corporation that:
18        (1) has a primary mission of improving the quality and
19    controlling the costs of healthcare services delivered in
20    one or more geographic areas within the State;
21        (2) is governed by a board of directors that includes
22    members representing physicians, hospitals, health plans,
23    businesses, and healthcare consumers;

 

 

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1        (3) has demonstrated capabilities to use healthcare
2    provider claims data and other forms of data on healthcare
3    encounters and services to produce and publicly report
4    measures of the quality, efficiency, or effectiveness of
5    healthcare services while protecting the privacy of
6    individual patients; and
7        (4) makes available confidentially, to any provider of
8    services to be identified in a public report, the measures
9    to be reported regarding that provider prior to the public
10    release of such report, and provides an opportunity for the
11    provider to identify and request corrections of errors.
12    (c) Data to be made available. The Department shall provide
13qualified entities with standardized extracts of data on the
14claims paid by the Department to healthcare providers for
15services rendered to medical assistance recipients in specific
16geographic areas and during time periods as requested by the
17qualified entity. The Department shall enter into a contract
18with the qualified entity for the use of this data with
19provisions designed to ensure that the identity of medical
20assistance recipients is protected, that the data will be used
21solely for public reporting and for quality improvement
22activities, and that the measures reported will be
23statistically valid.
24    (d) Extension to insurance plans and managed care
25organizations. To the extent that the Department contracts with
26an insurance plan, managed care organization, healthcare

 

 

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1provider, or other company to deliver or arrange for the
2delivery of care to medical assistance recipients and pays that
3company on a basis other than for individual services rendered,
4the Department shall require that such company make data on
5individual services and encounters with healthcare providers
6available to qualified entities in order to support measurement
7of the quality, efficiency, and effectiveness of the healthcare
8services they receive equivalent to what would be measured
9through the claims data described in subsection (c).
10    (e) Costs and funding. The Department shall provide the
11data described in subsection (c) to qualified entities on a
12quarterly basis at no charge, but if more frequent releases of
13data are needed, the Department may require payment of a fee
14equal to the costs associated with the release of the
15additional data. Companies under contract to the Department
16shall provide the data described in subsection (d) to qualified
17entities on a quarterly basis at no charge, but if more
18frequent releases of data are needed, such companies may
19require payment of a fee equal to the costs associated with the
20release of the additional data. The Department may provide
21funding to qualified entities to assist them in analyzing and
22publicly reporting performance measures using the data
23provided.