Illinois General Assembly - Full Text of HB2343
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Full Text of HB2343  94th General Assembly



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1     AN ACT concerning State government.
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4     Section 5. The Illinois Health Finance Reform Act is
5 amended 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 charges for payment from public and private payors.
17     This system shall be based upon adoption of the uniform
18     electronic hospital billing form pursuant to the Health
19     Insurance 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,
24     health maintenance organizations, and self-funded employee
25     health plans, to accept the uniform billing form, without
26     attachment as submitted by hospitals pursuant to paragraph
27     (1) of subsection (d) above, effective January 1, 1985;
28     provided, however, nothing shall prevent all such third
29     party payors from requesting additional information
30     necessary to determine eligibility for benefits or
31     liability for reimbursement for services provided.
32         (4) By no later than 60 days after the end of each



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1     calendar quarter, each Each hospital licensed in the State
2     shall electronically submit to the Department inpatient
3     and outpatient claims and encounter patient billing data
4     related to surgical and invasive procedures collected
5     under paragraph (5) for each patient.
6         By no later than 60 days after the end of each calendar
7     quarter, each ambulatory surgical treatment center
8     licensed in the State shall electronically submit to the
9     Department outpatient claims and encounter data collected
10     under paragraph (5) for each patient, provided however,
11     that, until July 1, 2006, ambulatory surgical treatment
12     centers who cannot electronically submit data may submit
13     data by computer diskette. conditions and procedures
14     required for public disclosure pursuant to paragraph (6).
15     For hospitals, the claims and encounter billing data to be
16     reported shall include all inpatient surgical cases.
17     Claims and encounter Billing data submitted under this Act
18     shall not include a patient's name, address, or Social
19     Security number.
20         (5) By no later than January 1, 2006 January 1, 2005,
21     the Department must collect and compile claims and
22     encounter billing data related to surgical and invasive
23     procedures required under paragraph (6) according to
24     uniform electronic submission formats as required under
25     the Health Insurance Portability and Accountability Act.
26     By no later than January 1, 2006, the Department must
27     collect and compile from ambulatory surgical treatment
28     centers the claims and encounter data according to uniform
29     electronic data element formats as required under the
30     Health Insurance Portability and Accountability Act of
31     1996 (HIPAA).
32         (6) The Department shall make available on its website
33     the "Consumer Guide to Health Care" by January 1, 2006. The
34     "Consumer Guide to Health Care" shall include information
35     on at least 30 inpatient conditions and procedures
36     identified by the Department that demonstrate the highest



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1     degree of variation in patient charges and quality of care.
2     By no later than January 1, 2007, the "Consumer Guide to
3     Health Care" shall also include information on at least 30
4     outpatient conditions and procedures identified by the
5     Department that demonstrate the highest degree of
6     variation in patient charges and quality care. As to each
7     condition or procedure, the "Consumer Guide to Health Care"
8     shall include up-to-date comparison information relating
9     to volume of cases, average charges, risk-adjusted
10     mortality rates, and nosocomial infection rates and, with
11     respect to outpatient surgical and invasive procedures,
12     shall include information regarding surgical infections,
13     complications, and direct admissions of outpatient cases
14     to hospitals for selected procedures, as determined by the
15     Department, based on review by the Department of its own,
16     local, or national studies. Information disclosed pursuant
17     to this paragraph on mortality and infection rates shall be
18     based upon information hospitals and ambulatory surgical
19     treatment centers have either (i) previously submitted to
20     the Department pursuant to their obligations to report
21     health care information under this Act or other public
22     health reporting laws and regulations outside of this Act
23     or (ii) submitted to the Department under the provisions of
24     the Hospital Report Card Act.
25         (7) Publicly disclosed information must be provided in
26     language that is easy to understand and accessible to
27     consumers using an interactive query system. The guide
28     shall include such additional information as is necessary
29     to enhance decision making among consumer and health care
30     purchasers, which shall include, at a minimum, appropriate
31     guidance on how to interpret the data and an explanation of
32     why the data may vary from provider to provider. The
33     "Consumer Guide to Health Care" shall also cite standards
34     that facilities meet under state and federal law and, if
35     applicable, to achieve voluntary accreditation.
36         (8) None of the information the Department discloses to



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1     the public under this subsection may be made available
2     unless the information has been reviewed, adjusted, and
3     validated according to the following process:
4             (i) Hospitals, ambulatory surgical treatment
5         centers, and organizations representing hospitals,
6         ambulatory surgical treatment centers, purchasers,
7         consumer groups, and health plans are meaningfully
8         involved in providing advice and consultation to the
9         Department in the development of all aspects of the
10         Department's methodology for collecting, analyzing,
11         and disclosing the information collected under this
12         Act, including collection methods, formatting, and
13         methods and means for release and dissemination;
14             (ii) The entire methodology for collecting
15         collection and analyzing the data is disclosed to all
16         relevant organizations and to all providers that are
17         the subject of any information to be made available to
18         the public before any public disclosure of such
19         information;
20             (iii) Data collection and analytical methodologies
21         are used that meet accepted standards of validity and
22         reliability before any information is made available
23         to the public;
24             (iv) The limitations of the data sources and
25         analytic methodologies used to develop comparative
26         provider information are clearly identified and
27         acknowledged, including, but not limited to,
28         appropriate and inappropriate uses of the data;
29             (v) To the greatest extent possible, comparative
30         hospital and ambulatory surgical treatment center
31         information initiatives use standard-based norms
32         derived from widely accepted provider-developed
33         practice guidelines;
34             (vi) Comparative hospital and ambulatory surgical
35         treatment center information and other information
36         that the Department has compiled regarding hospitals



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1         and ambulatory surgical treatment centers is shared
2         with the hospitals and ambulatory surgical treatment
3         centers under review prior to public dissemination of
4         the information and these providers have an
5         opportunity to make corrections and additions of
6         helpful explanatory comments about the information
7         before the publication;
8             (vii) Comparisons among hospitals and ambulatory
9         surgical treatment centers adjust for patient case mix
10         and other relevant risk factors and control for
11         provider peer groups, if applicable;
12             (viii) Effective safeguards to protect against the
13         unauthorized use or disclosure of hospital and
14         ambulatory surgical treatment center information are
15         developed and implemented;
16             (ix) Effective safeguards to protect against the
17         dissemination of inconsistent, incomplete, invalid,
18         inaccurate, or subjective provider data are developed
19         and implemented;
20             (x) The quality and accuracy of hospital and
21         ambulatory surgical treatment center information
22         reported under this Act and its data collection,
23         analysis, and dissemination methodologies are
24         evaluated regularly; and
25             (xi) Only the most basic hospital or ambulatory
26         surgical treatment center identifying information from
27         mandatory reports is used. Information regarding a
28         hospital or ambulatory surgical center may be released
29         regardless of the number of employees or health care
30         professionals whose data are reflected in the data for
31         the hospital or ambulatory surgical treatment center
32         as long as no specific information identifying an
33         employee or a health care professional is released.
34         identifying information from mandatory reports is
35         used, and Further, patient identifiable information is
36         not released. The input data collected by the



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1         Department shall not be a public record under the
2         Illinois Freedom of Information Act.
3         None of the information the Department discloses to the
4     public under this Act may be used to establish a standard
5     of care in a private civil action.
6         (9) The Department must develop and implement an
7     outreach campaign to educate the public regarding the
8     availability of the "Consumer Guide to Health Care".
9         (10) By January 1, 2006, Within 12 months after the
10     effective date of this amendatory Act of the 93rd General
11     Assembly, the Department must study the most effective
12     methods for public disclosure of patient claims and
13     encounter charge data and health care quality information
14     that will be useful to consumers in making health care
15     decisions and report its recommendations to the Governor
16     and to the General Assembly.
17         (11) The Department must undertake all steps necessary
18     under State and Federal law to protect patient
19     confidentiality in order to prevent the identification of
20     individual patient records.
21         (12) The Department must adopt rules for inpatient and
22     outpatient data collection and reporting no later than
23     January 1, 2006.
24         (13) In addition to the data products indicated above,
25     the Department shall respond to requests by government
26     agencies, academic research organizations, and private
27     sector organizations for purposes of clinical performance
28     measurements and analyses of data collected pursuant to
29     this Section.
30         (14) The Department, with the advice of and in
31     consultation with hospitals, ambulatory surgical treatment
32     centers, organizations representing hospitals,
33     organizations representing ambulatory treatment centers,
34     purchasers, consumer groups, and health plans, must
35     evaluate additional methods for comparing the performance
36     of hospitals and ambulatory surgical treatment centers,



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1     including the value of disclosing additional measures that
2     are adopted by the National Quality Forum, The Joint
3     Commission on Accreditation of Healthcare Organizations,
4     the Accreditation Association for Ambulatory Health Care,
5     the Centers for Medicare and Medicaid Services, or similar
6     national entities that establish standards to measure the
7     performance of health care providers. The Department shall
8     report its findings and recommendations on its Internet
9     website and to the Governor and General Assembly no later
10     than July 1, 2006.
11     (e) (Blank).
12 (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
13     Section 99. Effective date. This Act takes effect upon
14 becoming law.