HB5327 102ND GENERAL ASSEMBLY

LRB102 23513 BMS 32693 b

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.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the All Payer Claims Database Act.

Section 5. Definitions. As used in this Act:

"Department" means the Department of Insurance.

"Health care payer" means any organization or program that provides accident and health insurance coverage in this State, including insurers; self-insured employer plans; the program of health benefits under the State Employees Group Insurance Act of 1971; providers of health insurance coverage under the Counties Code; providers of health insurance coverage under under the Illinois Municipal Code; providers of health insurance coverage under the School Code; any provider of any health plan subject to the Health Maintenance Organization Act, the Limited Health Service Organization Act, or the Voluntary Health Services Plans Act; the medical assistance program under the Medical Assistance Article of the Illinois Public Aid Code; the Children's Health Insurance Program; and the Covering ALL KIDS Health Insurance Program.

"Insurer" means any person, firm, association, or corporation licensed in this State under the applicable provisions of the Illinois Insurance Code as an insurer.

"Limited use health care data" means health care price data that does not contain any personal identifiers, including price data for procedures and services provided by physicians and hospitals, inpatient and outpatient procedures and services, average amounts charged and average amounts paid for procedures and services, and health care price information from any health care payer in this State.

Section 10. All Payer Claims database.

(a) The Department shall establish an All Payer Claims database for sharing limited use health care data.

(b) The All Payer Claims database shall not include or disclose any data that contains direct, primary, or obvious personal identifiers. 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. To the extent allowed by the Health Insurance Portability and Accountability Act of 1996, the All Payer Claims database shall be available as a resource for insurers, employers, providers, consumers, and State agencies to continuously review health care utilization, expenditures, and performance in this State and to enhance the ability of consumers and employers to make informed and cost-effective health care choices.

(c) 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. The public limited use health care data set shall be publicly accessible, publicly searchable, contain current information, and have easy to use online tools. The Department shall publish the public limited use health care data set in a standardized, consumer-friendly format.

(d) 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.

(e) All health care payers shall annually submit health insurance price information as claims data without personally identifying information to the Department.

(f) The Department shall adopt rules as may be necessary to provide for the release of health care data from the All Payer Claims database.

Section 100. The University of Illinois Hospital Act is amended by adding Section 8g as follows:

(110 ILCS 330/8g new)

Sec. 8g. Price transparency.

(a) The University of Illinois Hospital shall provide timely and accurate financial information and quality of service measures to patients and prospective patients of the University of Illinois Hospital, or to patients' survivors or legal guardians, as appropriate.

(b) Before providing any nonemergency medical services, the University of Illinois Hospital shall provide in writing or by electronic means a good faith estimate of reasonably anticipated charges by the University of Illinois Hospital for the treatment of the patient's or prospective patient's specific condition. The University of Illinois Hospital shall provide the estimate to the patient or prospective patient within 7 business days after recommending a specific course of treatment or set of services and is not required to adjust the estimate for any potential insurance coverage.

(c) The University of Illinois Hospital may not charge the patient more than 110% of the estimate. However, if the University of Illinois Hospital determines that additional charges are warranted due to unforeseen circumstances or the provision of additional services, the University of Illinois Hospital shall provide the patient with a written explanation of the excess charges as part of the detailed, itemized statement or bill.

(d) In the estimate, the University of Illinois Hospital shall provide to the patient or prospective patient information on the hospital's financial assistance policy, including the application process, payment plans, discounts, and the hospital's charity care policy and collection procedures.

(e) The estimate shall clearly identify any facility fees and, if applicable, include a statement notifying the patient or prospective patient that a facility fee is included in the estimate, the purpose of the fee, and that the patient may pay less for the procedure or service at another facility or in another health care setting.

(f) The University of Illinois Hospital shall notify the patient or prospective patient of any revision to the estimate.

(g) In the estimate, the University of Illinois Hospital must notify the patient or prospective patient that services may be provided in the hospital by the facility as well as by other health care providers that may separately bill the patient, if applicable.

(h) If the University of Illinois Hospital fails to provide the estimate within the timeframe required in subsection (b), the University of Illinois Hospital shall be liable for a daily fine of $1,000 until the estimate is provided to the patient or prospective patient. The total fine may not exceed $10,000.

(i) The University of Illinois Hospital shall establish an appeal process designed to allow patients to dispute charges that appear on the patient's itemized statement or bill. The University of Illinois Hospital shall prominently post on its website, and indicate in bold print on each itemized statement or bill, the instructions for initiating an appeal and the direct contact information needed to initiate the appeal process. The University of Illinois Hospital must provide an initial response to a patient appeal within 7 business days after the patient formally files an appeal disputing all or a portion of an itemized statement or bill.

Section 105. The Hospital Licensing Act is amended by adding Section 11.9 as follows:

(210 ILCS 85/11.9 new)

Sec. 11.9. Price transparency.

(a) A hospital licensed under this Act shall provide timely and accurate financial information and quality of service measures to patients and prospective patients of the hospital, or to patients' survivors or legal guardians, as appropriate.

(b) 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 or prospective patient's specific condition. The hospital shall provide the estimate to the patient or prospective patient within 7 business days after recommending a specific course of treatment or set of services and is not required to adjust the estimate for any potential insurance coverage.

(c) A hospital may not charge the patient more than 110% of the estimate. However, if the hospital determines that additional charges are warranted due to unforeseen circumstances or the provision of additional services, the hospital shall provide the patient with a written explanation of the excess charges as part of the detailed, itemized statement or bill.

(d) In the estimate, the hospital shall provide to the patient or prospective patient information on the hospital's financial assistance policy, including the application process, payment plans, discounts, and the hospital's charity care policy and collection procedures.

(e) The estimate shall clearly identify any facility fees and, if applicable, include a statement notifying the patient or prospective patient that a facility fee is included in the estimate, the purpose of the fee, and that the patient may pay less for the procedure or service at another facility or in another health care setting.

(f) The hospital shall notify the patient or prospective patient of any revision to the estimate.

(g) In the estimate, the hospital must notify the patient or prospective patient that services may be provided in the hospital by the facility as well as by other health care providers that may separately bill the patient, if applicable.

(h) A hospital that fails to provide the estimate within the timeframe required in subsection (b) shall be liable for a daily fine of $1,000 until the estimate is provided to the patient or prospective patient. The total fine may not exceed $10,000.

(i) Each hospital shall establish an appeal process designed to allow patients to dispute charges that appear on the patient's itemized statement or bill. The hospital shall prominently post on its website, and indicate in bold print on each itemized statement or bill, the instructions for initiating an appeal and the direct contact information needed to initiate the appeal process. The hospital must provide an initial response to a patient appeal within 7 business days after the patient formally files an appeal disputing all or a portion of an itemized statement or bill.