97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB1282

 

Introduced 2/8/2011, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 2215/4-2  from Ch. 111 1/2, par. 6504-2

    Amends the Illinois Health Finance Reform Act. Removes a provision prohibiting the inclusion of a patient's name, address, or Social Security number in patient claims and encounter data submitted by hospitals and ambulatory surgical treatment centers.


LRB097 05293 KTG 45347 b

 

 

A BILL FOR

 

SB1282LRB097 05293 KTG 45347 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Health Finance Reform Act is
5amended 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.

 

 

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1        (5) By no later than January 1, 2006, the Department
2    must collect and compile claims and encounter data related
3    to surgical and invasive procedures according to uniform
4    electronic submission formats as required under the Health
5    Insurance Portability and Accountability Act. By no later
6    than January 1, 2006, the Department must collect and
7    compile from ambulatory surgical treatment centers the
8    claims and encounter data according to uniform electronic
9    data element formats as required under the Health Insurance
10    Portability and Accountability Act of 1996 (HIPAA).
11        (6) The Department shall make available on its website
12    the "Consumer Guide to Health Care" by January 1, 2006. The
13    "Consumer Guide to Health Care" shall include information
14    on at least 30 inpatient conditions and procedures
15    identified by the Department that demonstrate the highest
16    degree of variation in patient charges and quality of care.
17    By no later than January 1, 2007, the "Consumer Guide to
18    Health Care" shall also include information on at least 30
19    outpatient conditions and procedures identified by the
20    Department that demonstrate the highest degree of
21    variation in patient charges and quality care. As to each
22    condition or procedure, the "Consumer Guide to Health Care"
23    shall include up-to-date comparison information relating
24    to volume of cases, average charges, risk-adjusted
25    mortality rates, and nosocomial infection rates and, with
26    respect to outpatient surgical and invasive procedures,

 

 

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1    shall include information regarding surgical infections,
2    complications, and direct admissions of outpatient cases
3    to hospitals for selected procedures, as determined by the
4    Department, based on review by the Department of its own,
5    local, or national studies. Information disclosed pursuant
6    to this paragraph on mortality and infection rates shall be
7    based upon information hospitals and ambulatory surgical
8    treatment centers have either (i) previously submitted to
9    the Department pursuant to their obligations to report
10    health care information under this Act or other public
11    health reporting laws and regulations outside of this Act
12    or (ii) submitted to the Department under the provisions of
13    the Hospital Report Card Act.
14        (7) Publicly disclosed information must be provided in
15    language that is easy to understand and accessible to
16    consumers using an interactive query system. The guide
17    shall include such additional information as is necessary
18    to enhance decision making among consumer and health care
19    purchasers, which shall include, at a minimum, appropriate
20    guidance on how to interpret the data and an explanation of
21    why the data may vary from provider to provider. The
22    "Consumer Guide to Health Care" shall also cite standards
23    that facilities meet under state and federal law and, if
24    applicable, to achieve voluntary accreditation.
25        (8) None of the information the Department discloses to
26    the public under this subsection may be made available

 

 

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1    unless the information has been reviewed, adjusted, and
2    validated according to the following process:
3            (i) Hospitals, ambulatory surgical treatment
4        centers, and organizations representing hospitals,
5        ambulatory surgical treatment centers, purchasers,
6        consumer groups, and health plans are meaningfully
7        involved in providing advice and consultation to the
8        Department in the development of all aspects of the
9        Department's methodology for collecting, analyzing,
10        and disclosing the information collected under this
11        Act, including collection methods, formatting, and
12        methods and means for release and dissemination;
13            (ii) The entire methodology for collecting and
14        analyzing the data is disclosed to all relevant
15        organizations and to all providers that are the subject
16        of any information to be made available to the public
17        before any public disclosure of such information;
18            (iii) Data collection and analytical methodologies
19        are used that meet accepted standards of validity and
20        reliability before any information is made available
21        to the public;
22            (iv) The limitations of the data sources and
23        analytic methodologies used to develop comparative
24        provider information are clearly identified and
25        acknowledged, including, but not limited to,
26        appropriate and inappropriate uses of the data;

 

 

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1            (v) To the greatest extent possible, comparative
2        hospital and ambulatory surgical treatment center
3        information initiatives use standard-based norms
4        derived from widely accepted provider-developed
5        practice guidelines;
6            (vi) Comparative hospital and ambulatory surgical
7        treatment center information and other information
8        that the Department has compiled regarding hospitals
9        and ambulatory surgical treatment centers is shared
10        with the hospitals and ambulatory surgical treatment
11        centers under review prior to public dissemination of
12        the information and these providers have an
13        opportunity to make corrections and additions of
14        helpful explanatory comments about the information
15        before the publication;
16            (vii) Comparisons among hospitals and ambulatory
17        surgical treatment centers adjust for patient case mix
18        and other relevant risk factors and control for
19        provider peer groups, if applicable;
20            (viii) Effective safeguards to protect against the
21        unauthorized use or disclosure of hospital and
22        ambulatory surgical treatment center information are
23        developed and implemented;
24            (ix) Effective safeguards to protect against the
25        dissemination of inconsistent, incomplete, invalid,
26        inaccurate, or subjective provider data are developed

 

 

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1        and implemented;
2            (x) The quality and accuracy of hospital and
3        ambulatory surgical treatment center information
4        reported under this Act and its data collection,
5        analysis, and dissemination methodologies are
6        evaluated regularly; and
7            (xi) Only the most basic hospital or ambulatory
8        surgical treatment center identifying information from
9        mandatory reports is used. Information regarding a
10        hospital or ambulatory surgical center may be released
11        regardless of the number of employees or health care
12        professionals whose data are reflected in the data for
13        the hospital or ambulatory surgical treatment center
14        as long as no specific information identifying an
15        employee or a health care professional is released.
16        Further, patient identifiable information is not
17        released. The input data collected by the Department
18        shall not be a public record under the Illinois Freedom
19        of Information Act.
20        None of the information the Department discloses to the
21    public under this Act may be used to establish a standard
22    of care in a private civil action.
23        (9) The Department must develop and implement an
24    outreach campaign to educate the public regarding the
25    availability of the "Consumer Guide to Health Care".
26        (10) By January 1, 2006, the Department must study the

 

 

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1    most effective methods for public disclosure of patient
2    claims and encounter data and health care quality
3    information that will be useful to consumers in making
4    health care decisions and report its recommendations to the
5    Governor and to the General Assembly.
6        (11) The Department must undertake all steps necessary
7    under State and Federal law to protect patient
8    confidentiality in order to prevent the identification of
9    individual patient records.
10        (12) The Department must adopt rules for inpatient and
11    outpatient data collection and reporting no later than
12    January 1, 2006.
13        (13) In addition to the data products indicated above,
14    the Department shall respond to requests by government
15    agencies, academic research organizations, and private
16    sector organizations for purposes of clinical performance
17    measurements and analyses of data collected pursuant to
18    this Section.
19        (14) The Department, with the advice of and in
20    consultation with hospitals, ambulatory surgical treatment
21    centers, organizations representing hospitals,
22    organizations representing ambulatory treatment centers,
23    purchasers, consumer groups, and health plans, must
24    evaluate additional methods for comparing the performance
25    of hospitals and ambulatory surgical treatment centers,
26    including the value of disclosing additional measures that

 

 

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1    are adopted by the National Quality Forum, The Joint
2    Commission on Accreditation of Healthcare Organizations,
3    the Accreditation Association for Ambulatory Health Care,
4    the Centers for Medicare and Medicaid Services, or similar
5    national entities that establish standards to measure the
6    performance of health care providers. The Department shall
7    report its findings and recommendations on its Internet
8    website and to the Governor and General Assembly no later
9    than July 1, 2006.
10    (e) (Blank).
11(Source: P.A. 93-144, eff. 7-10-03; 94-27, eff. 6-14-05.)