SB1863 Engrossed LRB094 11581 BDD 42602 b

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. conditions and
11     procedures required for public disclosure pursuant to
12     paragraph (6). For hospitals, the billing data to be
13     reported shall include all inpatient surgical cases.
14     Billing data submitted under this Act shall not include a
15     patient's name, address, or Social Security number.
16         (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).
28         (6) The Department shall make available on its website
29     the "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
33     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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1     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.
5     Information disclosed pursuant to this paragraph on
6     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.
14         (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.
17         (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:
21             (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;
30             (ii) The entire methodology for collecting
31         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;
36             (iii) Data collection and analytical methodologies



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1         are used that meet accepted standards of validity and
2         reliability before any information is made available
3         to the public;
4             (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;
9             (v) To the greatest extent possible, comparative
10         hospital and ambulatory surgical treatment center
11         information initiatives use standard-based norms
12         derived from widely accepted provider-developed
13         practice guidelines;
14             (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.
19             (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
27         helpful explanatory comments about the information
28         before the publication;
29             (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;
33             (viii) Effective safeguards to protect against the
34         unauthorized use or disclosure of hospital and
35         ambulatory surgical treatment center information are
36         developed and implemented;



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1             (ix) Effective safeguards to protect against the
2         dissemination of inconsistent, incomplete, invalid,
3         inaccurate, or subjective provider data are developed
4         and implemented;
5             (x) The quality and accuracy of hospital and
6         ambulatory surgical treatment center information
7         reported under this Act and its data collection,
8         analysis, and dissemination methodologies are
9         evaluated regularly; and
10             (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.
15         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.
18         (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".
21         (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.
29         (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.
34         (12) The Department must adopt rules for inpatient and
35     outpatient data collection and reporting this no later than
36     January 1, 2006.



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