Rep. Julie Hamos

Filed: 5/16/2005





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2     AMENDMENT NO. ______. Amend Senate Bill 1863 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, 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).
23     For hospitals, the claims and encounter billing data to be
24     reported shall include all inpatient surgical cases.
25     Claims and encounter Billing data submitted under this Act
26     shall not include a patient's name, address, or Social
27     Security number.
28         (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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1     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).
6         (6) The Department shall make available on its website
7     the "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
11     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
17     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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1         (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.
12         (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:
16             (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 providing advice and consultation to the
21         Department in the development of all aspects of the
22         Department's methodology for collecting, analyzing,
23         and disclosing the information collected under this
24         Act, including collection methods, formatting, and
25         methods and means for release and dissemination;
26             (ii) The entire methodology for collecting
27         collection and analyzing the data is disclosed to all
28         relevant organizations and to all providers that are
29         the subject of any information to be made available to
30         the public before any public disclosure of such
31         information;
32             (iii) Data collection and analytical methodologies
33         are used that meet accepted standards of validity and
34         reliability before any information is made available



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1         to the public;
2             (iv) The limitations of the data sources and
3         analytic methodologies used to develop comparative
4         provider information are clearly identified and
5         acknowledged, including, but not limited to,
6         appropriate and inappropriate uses of the data;
7             (v) To the greatest extent possible, comparative
8         hospital and ambulatory surgical treatment center
9         information initiatives use standard-based norms
10         derived from widely accepted provider-developed
11         practice guidelines;
12             (vi) Comparative hospital and ambulatory surgical
13         treatment center information and other information
14         that the Department has compiled regarding hospitals
15         and ambulatory surgical treatment centers is shared
16         with the hospitals and ambulatory surgical treatment
17         centers under review prior to public dissemination of
18         the information and these providers have an
19         opportunity to make corrections and additions of
20         helpful explanatory comments about the information
21         before the publication;
22             (vii) Comparisons among hospitals and ambulatory
23         surgical treatment centers adjust for patient case mix
24         and other relevant risk factors and control for
25         provider peer groups, if applicable;
26             (viii) Effective safeguards to protect against the
27         unauthorized use or disclosure of hospital and
28         ambulatory surgical treatment center information are
29         developed and implemented;
30             (ix) Effective safeguards to protect against the
31         dissemination of inconsistent, incomplete, invalid,
32         inaccurate, or subjective provider data are developed
33         and implemented;
34             (x) The quality and accuracy of hospital and



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1         ambulatory surgical treatment center information
2         reported under this Act and its data collection,
3         analysis, and dissemination methodologies are
4         evaluated regularly; and
5             (xi) Only the most basic hospital or ambulatory
6         surgical treatment center identifying information from
7         mandatory reports is used. Information regarding a
8         hospital or ambulatory surgical center may be released
9         regardless of the number of employees or health care
10         professionals whose data are reflected in the data for
11         the hospital or ambulatory surgical treatment center
12         as long as no specific information identifying an
13         employee or a health care professional is released.
14         identifying information from mandatory reports is
15         used, and Further, patient identifiable information is
16         not released. The input data collected by the
17         Department shall not be a public record under the
18         Illinois Freedom of Information Act.
19         None of the information the Department discloses to the
20     public under this Act may be used to establish a standard
21     of care in a private civil action.
22         (9) The Department must develop and implement an
23     outreach campaign to educate the public regarding the
24     availability of the "Consumer Guide to Health Care".
25         (10) By January 1, 2006, Within 12 months after the
26     effective date of this amendatory Act of the 93rd General
27     Assembly, the Department must study the most effective
28     methods for public disclosure of patient claims and
29     encounter charge data and health care quality information
30     that will be useful to consumers in making health care
31     decisions and report its recommendations to the Governor
32     and to the General Assembly.
33         (11) The Department must undertake all steps necessary
34     under State and Federal law to protect patient



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1     confidentiality in order to prevent the identification of
2     individual patient records.
3         (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.
29     (e) (Blank).
30 (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
31     Section 99. Effective date. This Act takes effect upon
32 becoming law.".