Full Text of HB2343 94th General Assembly
HB2343eng 94TH GENERAL ASSEMBLY
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| AN ACT concerning State government.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Health Finance Reform Act is | 5 |
| amended by changing Section 4-2 as follows:
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| (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
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| Sec. 4-2. Powers and duties.
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| (a) (Blank).
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| (b) (Blank).
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| (c) (Blank).
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| (d) Uniform Provider Utilization and Charge Information.
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| (1) The Department of Public Health shall require that | 13 |
| all hospitals and ambulatory surgical treatment centers
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| 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
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| electronic hospital billing form pursuant to the Health | 19 |
| Insurance
Portability and Accountability Act.
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| (2) (Blank).
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| (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
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| 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.
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| (4) By no later than 60 days after the end of each |
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| 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.
conditions and | 11 |
| procedures required
for public disclosure pursuant to | 12 |
| paragraph (6).
For hospitals, the billing
data to be
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| reported shall include all inpatient surgical
cases.
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| Billing data submitted under this Act
shall not include a | 15 |
| patient's name,
address,
or
Social Security number.
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| (5) By no later than January 1, 2006
January 1, 2005 , | 17 |
| the Department must collect and
compile
claims and | 18 |
| encounter
billing data related to surgical and invasive | 19 |
| procedures
required under paragraph (6) according to | 20 |
| uniform electronic
submission formats as required under | 21 |
| the Health Insurance Portability and
Accountability Act. | 22 |
| By no later than January 1, 2006, the Department must | 23 |
| collect and compile from ambulatory surgical treatment | 24 |
| centers the claims and encounter data according to uniform | 25 |
| electronic data element formats as required under the | 26 |
| Health Insurance Portability and Accountability Act of | 27 |
| 1996 (HIPAA).
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| (6) The Department shall make available on its website | 29 |
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"Consumer Guide to Health Care" by January 1, 2006. The | 30 |
| "Consumer
Guide to Health Care" shall include information | 31 |
| on at least 30 inpatient conditions and
procedures | 32 |
| identified by the Department that demonstrate the highest
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| degree of variation in patient charges and quality of care . | 34 |
| By no later than January 1, 2007, the "Consumer Guide to | 35 |
| Health Care" shall include information for both inpatient | 36 |
| and outpatient conditions and procedures . As to each
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| condition or procedure, the "Consumer Guide to Health Care" | 2 |
| shall include
up-to-date comparison information relating | 3 |
| to volume of cases, average
charges, risk-adjusted | 4 |
| mortality rates, and nosocomial infection rates.
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| Information disclosed pursuant to this paragraph on
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| mortality and infection rates shall be based upon | 7 |
| information hospitals
and ambulatory surgical treatment | 8 |
| centers have either (i)
previously submitted to the | 9 |
| Department pursuant to their obligations
to report health | 10 |
| care information under this Act or other public health | 11 |
| reporting laws
and regulations outside of this Act or (ii) | 12 |
| submitted to the Department under the provisions of the | 13 |
| Hospital Report Card Act .
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| (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.
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| (8) None of the information the Department discloses to | 18 |
| the public
under this subsection may be made available | 19 |
| unless the information has
been reviewed, adjusted, and | 20 |
| validated according to the following process:
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| (i) Hospitals , ambulatory surgical treatment | 22 |
| centers,
and organizations
representing hospitals , | 23 |
| ambulatory surgical treatment centers, purchasers, | 24 |
| consumer groups, and health plans are
meaningfully | 25 |
| involved in the development of all aspects of
the | 26 |
| Department's methodology for collecting, analyzing, | 27 |
| and
disclosing the information collected under this | 28 |
| Act, including
collection methods, formatting, and | 29 |
| methods and means for
release and dissemination;
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| (ii) The entire methodology for collecting
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| collection and
analyzing the data is disclosed to all | 32 |
| relevant organizations
and to all providers that are | 33 |
| the subject of any information to
be made available to | 34 |
| the public before any public disclosure
of such | 35 |
| information;
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| (iii) Data collection and analytical methodologies |
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| are
used that meet accepted standards of validity and | 2 |
| reliability
before any information is made available | 3 |
| to the public;
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| (iv) The limitations of the data sources and | 5 |
| analytic
methodologies used to develop comparative | 6 |
| provider
information are clearly identified and | 7 |
| acknowledged,
including, but not limited to, | 8 |
| appropriate and inappropriate
uses of the data;
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| (v) To the greatest extent possible, comparative
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| hospital and ambulatory surgical treatment center
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| information initiatives use standard-based
norms | 12 |
| derived from widely accepted provider-developed
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| practice guidelines;
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| (v-5) For ambulatory services, information is | 15 |
| provided on surgical infections and mortality for | 16 |
| selected procedures, as determined by the Department, | 17 |
| based on review by the Department of its own, local, or | 18 |
| national studies.
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| (vi) Comparative hospital and ambulatory surgical | 20 |
| treatment center information and other
information | 21 |
| that the Department has compiled regarding
hospitals | 22 |
| and ambulatory surgical treatment centers is shared | 23 |
| with the hospitals and ambulatory surgical treatment | 24 |
| centers under review prior to
public dissemination of | 25 |
| the information and these providers
have an | 26 |
| opportunity to make corrections and additions of
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| helpful explanatory comments about the information | 28 |
| before
the publication;
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| (vii) Comparisons among hospitals and ambulatory | 30 |
| surgical treatment centers adjust for
patient case mix | 31 |
| and other relevant risk factors and control
for | 32 |
| provider peer groups , if applicable ;
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| (viii) Effective safeguards to protect against the
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| unauthorized use or disclosure of hospital and | 35 |
| ambulatory surgical treatment center information are
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| developed and implemented;
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| (ix) Effective safeguards to protect against the
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| dissemination of inconsistent, incomplete, invalid,
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| inaccurate, or subjective provider data are developed | 4 |
| and
implemented;
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| (x) The quality and accuracy of hospital and | 6 |
| ambulatory surgical treatment center information
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| reported under this Act and its data collection, | 8 |
| analysis, and
dissemination methodologies are | 9 |
| evaluated regularly; and
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| (xi) Only the most basic identifying information | 11 |
| from
mandatory reports is used, and patient | 12 |
| identifiable
information is not released. The input | 13 |
| data collected
by the Department shall not be a public | 14 |
| record under the
Illinois Freedom of Information Act.
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| None of the information
the Department discloses to the | 16 |
| public under this Act may be
used to establish a standard | 17 |
| of care in a private civil action.
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| (9) The Department must develop and implement an | 19 |
| outreach
campaign to educate the public regarding the | 20 |
| availability of the "Consumer
Guide to Health Care".
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| (10) By January 1, 2006,
Within 12 months after the | 22 |
| effective date of this amendatory
Act of the 93rd General | 23 |
| Assembly, the Department must study the
most effective | 24 |
| methods for public disclosure of patient claims and | 25 |
| encounter
charge data and
health care quality information | 26 |
| that will be useful to consumers in making
health care | 27 |
| decisions and report its recommendations to the
Governor | 28 |
| and to the General Assembly.
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| (11) The Department must undertake all steps necessary | 30 |
| under
State and Federal law , including the | 31 |
| Gramm-Leach-Bliley Act and the HIPAA privacy regulations, | 32 |
| to protect patient confidentiality in order to prevent
the | 33 |
| identification of individual patient records.
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| (12) The Department must adopt rules for inpatient and | 35 |
| outpatient data collection and report this no later than | 36 |
| January 1, 2006. |
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| (13) In addition to the data products indicated above, | 2 |
| the Department shall respond to requests by government | 3 |
| agencies, academic research organizations, and private | 4 |
| sector organizations for purposes of clinical performance | 5 |
| measurements and analyses of data collected pursuant to | 6 |
| this Section. | 7 |
| (14) The Department must evaluate additional methods | 8 |
| for comparing the performance of hospitals and ambulatory | 9 |
| surgical treatment centers, including the value of | 10 |
| disclosing additional measures that are adopted by the | 11 |
| National Quality Forum, The Joint Commission on | 12 |
| Accreditation of Healthcare Organizations, the Centers for | 13 |
| Medicare and Medicaid Services, or a similar national | 14 |
| entity that establishes standards to measure the | 15 |
| performance of health care providers. The Department shall | 16 |
| report its findings and recommendations on its Internet | 17 |
| website and to the Governor and General Assembly no later | 18 |
| than January 1, 2006.
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| (e) (Blank).
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| (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
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| Section 99. Effective date. This Act takes effect upon | 22 |
| becoming law.
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