Full Text of HB2343 94th General Assembly
HB2343sam001 94TH GENERAL ASSEMBLY
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Sen. Susan Garrett
Filed: 5/13/2005
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| AMENDMENT TO HOUSE BILL 2343
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| AMENDMENT NO. ______. Amend House Bill 2343 by replacing | 3 |
| everything after the enacting clause with the following:
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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 | 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.
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| (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, provided however, | 19 |
| that, until July 1, 2006, ambulatory surgical treatment | 20 |
| centers who cannot electronically submit data may submit | 21 |
| data by computer diskette.
conditions and procedures | 22 |
| required
for public disclosure pursuant to paragraph (6).
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| For hospitals, the claims and encounter
billing
data to be
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| reported shall include all inpatient surgical
cases.
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| Claims and encounter
Billing data submitted under this Act
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| shall not include a patient's name,
address,
or
Social | 27 |
| Security number.
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| (5) By no later than January 1, 2006
January 1, 2005 , | 29 |
| the Department must collect and
compile
claims and | 30 |
| encounter
billing data related to surgical and invasive | 31 |
| procedures
required under paragraph (6) according to | 32 |
| uniform electronic
submission formats as required under | 33 |
| the Health Insurance Portability and
Accountability Act. | 34 |
| By no later than January 1, 2006, the Department must |
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| collect and compile from ambulatory surgical treatment | 2 |
| centers the claims and encounter data according to uniform | 3 |
| electronic data element formats as required under the | 4 |
| Health Insurance Portability and Accountability Act of | 5 |
| 1996 (HIPAA).
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| (6) The Department shall make available on its website | 7 |
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"Consumer Guide to Health Care" by January 1, 2006. The | 8 |
| "Consumer
Guide to Health Care" shall include information | 9 |
| on at least 30 inpatient conditions and
procedures | 10 |
| identified by the Department that demonstrate the highest
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| degree of variation in patient charges and quality of care . | 12 |
| By no later than January 1, 2007, the "Consumer Guide to | 13 |
| Health Care" shall also include information on at least 30 | 14 |
| outpatient conditions and procedures identified by the | 15 |
| Department that demonstrate the highest degree of | 16 |
| variation in patient charges and quality care . As to each
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| condition or procedure, the "Consumer Guide to Health Care" | 18 |
| shall include
up-to-date comparison information relating | 19 |
| to volume of cases, average
charges, risk-adjusted | 20 |
| mortality rates, and nosocomial infection rates and, with | 21 |
| respect to outpatient surgical and invasive procedures, | 22 |
| shall include information regarding surgical infections, | 23 |
| complications, and direct admissions of outpatient cases | 24 |
| to hospitals for selected procedures, as determined by the | 25 |
| Department, based on review by the Department of its own, | 26 |
| local, or national studies .
Information disclosed pursuant | 27 |
| to this paragraph on
mortality and infection rates shall be | 28 |
| based upon information hospitals
and ambulatory surgical | 29 |
| treatment centers have either (i)
previously submitted to | 30 |
| the Department pursuant to their obligations
to report | 31 |
| health care information under this Act or other public | 32 |
| health reporting laws
and regulations outside of this Act | 33 |
| or (ii) submitted to the Department under the provisions of | 34 |
| the Hospital Report Card Act .
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| (7) Publicly disclosed information must be provided in | 2 |
| language
that is easy to understand and accessible to | 3 |
| consumers using an
interactive query system. The guide | 4 |
| shall include such additional information as is necessary | 5 |
| to enhance decision making among consumer and health care | 6 |
| purchasers, which shall include, at a minimum, appropriate | 7 |
| guidance on how to interpret the data and an explanation of | 8 |
| why the data may vary from provider to provider. The | 9 |
| "Consumer Guide to Health Care" shall also cite standards | 10 |
| that facilities meet under state and federal law and, if | 11 |
| applicable, to achieve voluntary accreditation.
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| (8) None of the information the Department discloses to | 13 |
| the public
under this subsection may be made available | 14 |
| unless the information has
been reviewed, adjusted, and | 15 |
| validated according to the following process:
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| (i) Hospitals , ambulatory surgical treatment | 17 |
| centers,
and organizations
representing hospitals , | 18 |
| ambulatory surgical treatment centers, purchasers, | 19 |
| consumer groups, and health plans are
meaningfully | 20 |
| involved in the development of all aspects of
the | 21 |
| Department's methodology for collecting, analyzing, | 22 |
| and
disclosing the information collected under this | 23 |
| Act, including
collection methods, formatting, and | 24 |
| 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 | 27 |
| relevant organizations
and to all providers that are | 28 |
| the subject of any information to
be made available to | 29 |
| the public before any public disclosure
of such | 30 |
| information;
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| (iii) Data collection and analytical methodologies | 32 |
| are
used that meet accepted standards of validity and | 33 |
| reliability
before any information is made available | 34 |
| to the public;
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| (iv) The limitations of the data sources and | 2 |
| analytic
methodologies used to develop comparative | 3 |
| provider
information are clearly identified and | 4 |
| acknowledged,
including, but not limited to, | 5 |
| 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 | 9 |
| derived from widely accepted provider-developed
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| practice guidelines;
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| (vi) Comparative hospital and ambulatory surgical | 12 |
| treatment center information and other
information | 13 |
| that the Department has compiled regarding
hospitals | 14 |
| and ambulatory surgical treatment centers is shared | 15 |
| with the hospitals and ambulatory surgical treatment | 16 |
| centers under review prior to
public dissemination of | 17 |
| the information and these providers
have an | 18 |
| opportunity to make corrections and additions of
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| helpful explanatory comments about the information | 20 |
| before
the publication;
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| (vii) Comparisons among hospitals and ambulatory | 22 |
| surgical treatment centers adjust for
patient case mix | 23 |
| and other relevant risk factors and control
for | 24 |
| 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 | 27 |
| 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 | 32 |
| and
implemented;
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| (x) The quality and accuracy of hospital and | 34 |
| ambulatory surgical treatment center information
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| reported under this Act and its data collection, | 2 |
| analysis, and
dissemination methodologies are | 3 |
| evaluated regularly; and
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| (xi) Only the most basic hospital or ambulatory | 5 |
| surgical treatment center identifying information from | 6 |
| mandatory reports is used. Information regarding a | 7 |
| hospital or ambulatory surgical center may be released | 8 |
| regardless of the number of employees or health care | 9 |
| professionals whose data are reflected in the data for | 10 |
| the hospital or ambulatory surgical treatment center | 11 |
| as long as no specific information identifying an | 12 |
| employee or a health care professional is released.
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| identifying information from
mandatory reports is | 14 |
| used, and
Further, patient identifiable
information is | 15 |
| not released. The input data collected
by the | 16 |
| Department shall not be a public record under the
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| Illinois Freedom of Information Act.
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| None of the information
the Department discloses to the | 19 |
| public under this Act may be
used to establish a standard | 20 |
| of care in a private civil action.
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| (9) The Department must develop and implement an | 22 |
| outreach
campaign to educate the public regarding the | 23 |
| availability of the "Consumer
Guide to Health Care".
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| (10) By January 1, 2006,
Within 12 months after the | 25 |
| effective date of this amendatory
Act of the 93rd General | 26 |
| Assembly, the Department must study the
most effective | 27 |
| methods for public disclosure of patient claims and | 28 |
| encounter
charge data and
health care quality information | 29 |
| that will be useful to consumers in making
health care | 30 |
| decisions and report its recommendations to the
Governor | 31 |
| and to the General Assembly.
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| (11) The Department must undertake all steps necessary | 33 |
| under
State and Federal law , including the | 34 |
| Gramm-Leach-Bliley Act and the HIPAA privacy regulations, |
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| to protect patient confidentiality in order to prevent
the | 2 |
| identification of individual patient records.
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| (12) The Department must adopt rules for inpatient and | 4 |
| outpatient data collection and reporting no later than | 5 |
| January 1, 2006. | 6 |
| (13) In addition to the data products indicated above, | 7 |
| the Department shall respond to requests by government | 8 |
| agencies, academic research organizations, and private | 9 |
| sector organizations for purposes of clinical performance | 10 |
| measurements and analyses of data collected pursuant to | 11 |
| this Section. | 12 |
| (14) The Department, with the advice of and in | 13 |
| consultation with hospitals, ambulatory surgical treatment | 14 |
| centers, organizations representing hospitals, | 15 |
| organizations representing ambulatory treatment centers, | 16 |
| purchasers, consumer groups, and health plans, must | 17 |
| evaluate additional methods for comparing the performance | 18 |
| of hospitals and ambulatory surgical treatment centers, | 19 |
| including the value of disclosing additional measures that | 20 |
| are adopted by the National Quality Forum, The Joint | 21 |
| Commission on Accreditation of Healthcare Organizations, | 22 |
| the Accreditation Association for Ambulatory Health Care, | 23 |
| the Centers for Medicare and Medicaid Services, or similar | 24 |
| national entities that establish standards to measure the | 25 |
| performance of health care providers. The Department shall | 26 |
| report its findings and recommendations on its Internet | 27 |
| website and to the Governor and General Assembly no later | 28 |
| than July 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 | 32 |
| becoming law.".
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