HB1903 97TH GENERAL ASSEMBLY

LRB097 09294 KTG 49429 b

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.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

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

Section 5. The Illinois Public Aid Code is amended by adding Section 5-31 as follows:

(305 ILCS 5/5-31 new)

Sec. 5-31. Availability of medical assistance data for performance measurement.

(a) In General. The Department shall make available to qualified entities (as described in subsection (b)) data (as described in subsection (c)) for the purpose of measuring and publicly reporting the quality, efficiency, and effectiveness of healthcare services received by medical assistance recipients.

(b) Qualified entities. For the purposes of this subsection, a "qualified entity" is a not-for-profit corporation that:

(1) has a primary mission of improving the quality and controlling the costs of healthcare services delivered in one or more geographic areas within the State;

(2) is governed by a board of directors that includes members representing physicians, hospitals, health plans, businesses, and healthcare consumers;

(3) has demonstrated capabilities to use healthcare provider claims data and other forms of data on healthcare encounters and services to produce and publicly report measures of the quality, efficiency, or effectiveness of healthcare services while protecting the privacy of individual patients; and

(4) makes available confidentially, to any provider of services to be identified in a public report, the measures to be reported regarding that provider prior to the public release of such report, and provides an opportunity for the provider to identify and request corrections of errors.

(c) Data to be made available. The Department shall provide qualified entities with 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 and during time periods as requested by the qualified entity. The Department shall enter into a contract with the qualified entity for the use of this data with provisions designed to ensure that the identity of medical assistance recipients is protected, that the data will be used solely for public reporting and for quality improvement activities, and that the measures reported will be statistically valid.

(d) Extension to insurance plans and managed care organizations. To the extent that the Department contracts with an insurance plan, managed care organization, healthcare provider, or other company to deliver or arrange for the delivery of care to medical assistance recipients and pays that company on a basis other than for individual services rendered, the Department shall require that such company make data on individual services and encounters with healthcare providers available to qualified entities in order to support measurement of the quality, efficiency, and effectiveness of the healthcare services they receive equivalent to what would be measured through the claims data described in subsection (c).

(e) Costs and funding. The Department shall provide the data described in subsection (c) to qualified entities on a quarterly basis at no charge, but if more frequent releases of data are needed, the Department may require payment of a fee equal to the costs associated with the release of the additional data. Companies under contract to the Department shall provide the data described in subsection (d) to qualified entities on a quarterly basis at no charge, but if more frequent releases of data are needed, such companies may require payment of a fee equal to the costs associated with the release of the additional data. The Department may provide funding to qualified entities to assist them in analyzing and publicly reporting performance measures using the data provided.