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


Human Services Committee

Filed: 3/2/2005





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2     AMENDMENT NO. ______. Amend House Bill 2343 by replacing
3 everything after the enacting clause with the following:
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



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1     health plans, to accept the uniform billing form, without
2     attachment as submitted by hospitals pursuant to paragraph
3     (1) of subsection (d) above, effective January 1, 1985;
4     provided, however, nothing shall prevent all such third
5     party payors from requesting additional information
6     necessary to determine eligibility for benefits or
7     liability for reimbursement for services provided.
8         (4) By no later than 60 days after the end of each
9     calendar quarter, each Each hospital licensed in the State
10     shall electronically submit to the Department inpatient
11     and outpatient claims and encounter patient billing data
12     related to surgical and invasive procedures collected
13     under paragraph (5) for each patient.
14         By no later than 60 days after the end of each calendar
15     quarter, each ambulatory surgical treatment center
16     licensed in the State shall electronically submit to the
17     Department outpatient claims and encounter data collected
18     under paragraph (5) for each patient. conditions and
19     procedures required for public disclosure pursuant to
20     paragraph (6). For hospitals, the billing data to be
21     reported shall include all inpatient surgical cases.
22     Billing data submitted under this Act shall not include a
23     patient's name, address, or Social Security number.
24         (5) By no later than January 1, 2006 January 1, 2005,
25     the Department must collect and compile claims and
26     encounter billing data related to surgical and invasive
27     procedures required under paragraph (6) according to
28     uniform electronic submission formats as required under
29     the Health Insurance Portability and Accountability Act.
30     By no later than January 1, 2006, the Department must
31     collect and compile from ambulatory surgical treatment
32     centers the claims and encounter data according to uniform
33     electronic data element formats as required under the
34     Health Insurance Portability and Accountability Act of



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1     1996 (HIPAA).
2         (6) The Department shall make available on its website
3     the "Consumer Guide to Health Care" by January 1, 2006. The
4     "Consumer Guide to Health Care" shall include information
5     on at least 30 inpatient conditions and procedures
6     identified by the Department that demonstrate the highest
7     degree of variation in patient charges and quality of care.
8     By no later than January 1, 2007, the "Consumer Guide to
9     Health Care" shall include information for both inpatient
10     and outpatient conditions and procedures. As to each
11     condition or procedure, the "Consumer Guide to Health Care"
12     shall include up-to-date comparison information relating
13     to volume of cases, average charges, risk-adjusted
14     mortality rates, and nosocomial infection rates.
15     Information disclosed pursuant to this paragraph on
16     mortality and infection rates shall be based upon
17     information hospitals and ambulatory surgical treatment
18     centers have either (i) previously submitted to the
19     Department pursuant to their obligations to report health
20     care information under this Act or other public health
21     reporting laws and regulations outside of this Act or (ii)
22     submitted to the Department under the provisions of the
23     Hospital Report Card Act.
24         (7) Publicly disclosed information must be provided in
25     language that is easy to understand and accessible to
26     consumers using an interactive query system.
27         (8) None of the information the Department discloses to
28     the public under this subsection may be made available
29     unless the information has been reviewed, adjusted, and
30     validated according to the following process:
31             (i) Hospitals, ambulatory surgical treatment
32         centers, and organizations representing hospitals,
33         ambulatory surgical treatment centers, purchasers,
34         consumer groups, and health plans are meaningfully



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1         involved in the development of all aspects of the
2         Department's methodology for collecting, analyzing,
3         and disclosing the information collected under this
4         Act, including collection methods, formatting, and
5         methods and means for release and dissemination;
6             (ii) The entire methodology for collecting
7         collection and analyzing the data is disclosed to all
8         relevant organizations and to all providers that are
9         the subject of any information to be made available to
10         the public before any public disclosure of such
11         information;
12             (iii) Data collection and analytical methodologies
13         are used that meet accepted standards of validity and
14         reliability before any information is made available
15         to the public;
16             (iv) The limitations of the data sources and
17         analytic methodologies used to develop comparative
18         provider information are clearly identified and
19         acknowledged, including, but not limited to,
20         appropriate and inappropriate uses of the data;
21             (v) To the greatest extent possible, comparative
22         hospital and ambulatory surgical treatment center
23         information initiatives use standard-based norms
24         derived from widely accepted provider-developed
25         practice guidelines;
26             (v-5) For ambulatory services, information is
27         provided on surgical infections and mortality for
28         selected procedures, as determined by the Department,
29         based on review by the Department of its own, local, or
30         national studies.
31             (vi) Comparative hospital and ambulatory surgical
32         treatment center information and other information
33         that the Department has compiled regarding hospitals
34         and ambulatory surgical treatment centers is shared



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1         with the hospitals and ambulatory surgical treatment
2         centers under review prior to public dissemination of
3         the information and these providers have an
4         opportunity to make corrections and additions of
5         helpful explanatory comments about the information
6         before the publication;
7             (vii) Comparisons among hospitals and ambulatory
8         surgical treatment centers adjust for patient case mix
9         and other relevant risk factors and control for
10         provider peer groups, if applicable;
11             (viii) Effective safeguards to protect against the
12         unauthorized use or disclosure of hospital and
13         ambulatory surgical treatment center information are
14         developed and implemented;
15             (ix) Effective safeguards to protect against the
16         dissemination of inconsistent, incomplete, invalid,
17         inaccurate, or subjective provider data are developed
18         and implemented;
19             (x) The quality and accuracy of hospital and
20         ambulatory surgical treatment center information
21         reported under this Act and its data collection,
22         analysis, and dissemination methodologies are
23         evaluated regularly; and
24             (xi) Only the most basic identifying information
25         from mandatory reports is used, and patient
26         identifiable information is not released. The input
27         data collected by the Department shall not be a public
28         record under the Illinois Freedom of Information Act.
29         None of the information the Department discloses to the
30     public under this Act may be used to establish a standard
31     of care in a private civil action.
32         (9) The Department must develop and implement an
33     outreach campaign to educate the public regarding the
34     availability of the "Consumer Guide to Health Care".



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1         (10) By January 1, 2006, Within 12 months after the
2     effective date of this amendatory Act of the 93rd General
3     Assembly, the Department must study the most effective
4     methods for public disclosure of patient claims and
5     encounter charge data and health care quality information
6     that will be useful to consumers in making health care
7     decisions and report its recommendations to the Governor
8     and to the General Assembly.
9         (11) The Department must undertake all steps necessary
10     under State and Federal law, including the
11     Gramm-Leach-Bliley Act and the HIPAA privacy regulations,
12     to protect patient confidentiality in order to prevent the
13     identification of individual patient records.
14         (12) The Department must adopt rules for inpatient and
15     outpatient data collection and reporting this no later than
16     January 1, 2006.
17         (13) In addition to the data products indicated above,
18     the Department shall respond to requests by government
19     agencies, academic research organizations, and private
20     sector organizations for purposes of clinical performance
21     measurements and analyses of data collected pursuant to
22     this Section.
23         (14) The Department must evaluate additional methods
24     for comparing the performance of hospitals and ambulatory
25     surgical treatment centers, including the value of
26     disclosing additional measures that are adopted by the
27     National Quality Forum, The Joint Commission on
28     Accreditation of Healthcare Organizations, the Centers for
29     Medicare and Medicaid Services, or a similar national
30     entity that establishes standards to measure the
31     performance of health care providers. The Department shall
32     report its findings and recommendations on its Internet
33     website and to the Governor and General Assembly no later
34     than January 1, 2006.



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1     (e) (Blank).
2 (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
3     Section 99. Effective date. This Act takes effect upon
4 becoming law.".