HB2684 99TH GENERAL ASSEMBLY

LRB099 09532 KTG 29740 b

99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB2684

Introduced , by Rep. Greg Harris

SYNOPSIS AS INTRODUCED:

See Index

Provides that the Act may be referred to as the Medicaid Reform Research Act. Provides that, given that Illinois' Medical Assistance Program is undergoing a transition to managed care for Medicaid populations subject to the Medicaid Reform Act of 2011, the Save Medicaid Access Together (SMART) Act of 2012, and other Acts affecting Medicaid populations and delivery systems, a lawful and well-regulated dissemination of Medicaid data to qualified researchers is the best way to create accurate and creative unbiased analysis and information about Illinois' Medical Assistance Program that will lead to better health outcomes at a lower cost. Amends the Commission on Government Forecasting and Accountability Act. Provides that the Commission on Government Forecasting and Accountability may, subject to appropriations, coordinate and enter into agreements with the Department of Healthcare and Family Services and certain institutions and entities for research on medical assistance managed care or other State medical assistance programs pursuant to the analysis purposes of the State-Funded Health Care Quality Assurance and Research Fund. Contains provisions concerning individual patient medical claims information provided by the Department to those institutions and entities and other matters. Amends the State Finance Act. Creates the State-Funded Health Care Quality Assurance and Research Fund to provide the General Assembly with an independent analysis on certain matters, including the efficacy of State managed care programs to improve continuity of care, ensure adequate provider participation, and maintain appropriate utilization of health services. Provides that the Fund shall consist of certain moneys, including transfers from the Healthcare Provider Relief Fund and other matters. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning State government.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be referred to as the Medicaid Reform Research Act.

Section 5. Findings. Whereas Illinois' Medical Assistance program is undergoing a transition to managed care for Medicaid populations subject to the Medicaid Reform Act of 2011, the Save Medicaid Access Together (SMART) Act of 2012, and other Acts affecting Medicaid populations and delivery systems; and

Whereas Illinois possesses an abundance of academic research entities with expertise in the academic fields related to health care practices, health outcomes, special needs populations, and health care delivery design, the General Assembly finds that:

(1) A lawful and well-regulated dissemination of Medicaid data to qualified researchers is the best way to create accurate and creative unbiased analysis and information about Illinois' Medical Assistance Program that will lead to better health outcomes at a lower cost.

(2) Accurate research findings should be made available to the General Assembly from a variety of independent qualified research entities.

(3) As Illinois' Medical Assistance Program transforms from a fee-for-service system to a system based on capitated contracts, there must be sufficient transparency in those contracts to allow for evaluation of their effectiveness by the General Assembly through receipt of data analysis performed by qualified independent research institutions.

(4) Any data received under this Act must be used solely for research purposes by the research entity; and the confidentiality of any data provided to authorized individuals pursuant to this Act must be maintained in accordance with the provisions of this Act and other applicable laws.

(5) Any use of the data for commercial purposes in violation of this Act shall be subject to the fines and penalties specified in the State Finance Act, including the loss of access to data.

Section 10. The Commission on Government Forecasting and Accountability Act is amended by changing Section 3 as follows:

(25 ILCS 155/3) (from Ch. 63, par. 343)

Sec. 3.

(a) The Commission shall:

(1) Study from time to time and report to the General Assembly on economic development and trends in the State.

(2) Make such special economic and fiscal studies as it deems appropriate or desirable or as the General Assembly may request.

(3) Based on its studies, recommend such State fiscal and economic policies as it deems appropriate or desirable to improve the functioning of State government and the economy of the various regions within the State.

(4) Prepare annually a State economic report.

(5) Provide information for all appropriate legislative organizations and personnel on economic trends in relation to long range planning and budgeting.

(6) Study and make such recommendations as it deems appropriate to the General Assembly on local and regional economic and fiscal policy and on federal fiscal policy as it may affect Illinois.

(7) Review capital expenditures, appropriations and authorizations for both the State's general obligation and revenue bonding authorities. At the direction of the Commission, specific reviews may include economic feasibility reviews of existing or proposed revenue bond projects to determine the accuracy of the original estimate of useful life of the projects, maintenance requirements and ability to meet debt service requirements through their operating expenses.

(8) Receive and review all executive agency and revenue bonding authority annual and 3 year plans. The Commission shall prepare a consolidated review of these plans, an updated assessment of current State agency capital plans, a report on the outstanding and unissued bond authorizations, an evaluation of the State's ability to market further bond issues and shall submit them as the "Legislative Capital Plan Analysis" to the House and Senate Appropriations Committees at least once a year. The Commission shall annually submit to the General Assembly on the first Wednesday of April a report on the State's long-term capital needs, with particular emphasis upon and detail of the 5-year period in the immediate future.

(9) Study and make recommendations it deems appropriate to the General Assembly on State bond financing, bondability guidelines, and debt management. At the direction of the Commission, specific studies and reviews may take into consideration short and long-run implications of State bonding and debt management policy.

(10) Comply with the provisions of the "State Debt Impact Note Act" as now or hereafter amended.

(11) Comply with the provisions of the Pension Impact Note Act, as now or hereafter amended.

(12) By August 1st of each year, the Commission must prepare and cause to be published a summary report of State appropriations for the State fiscal year beginning the previous July 1st. The summary report must discuss major categories of appropriations, the issues the General Assembly faced in allocating appropriations, comparisons with appropriations for previous State fiscal years, and other matters helpful in providing the citizens of Illinois with an overall understanding of appropriations for that fiscal year. The summary report must be written in plain language and designed for readability. Publication must be in newspapers of general circulation in the various areas of the State to ensure distribution statewide. The summary report must also be published on the General Assembly's web site.

(13) Comply with the provisions of the State Facilities Closure Act.

(14) For fiscal year 2012 and thereafter, develop a 3-year budget forecast for the State, including opportunities and threats concerning anticipated revenues and expenditures, with an appropriate level of detail.

(b) In addition to any other powers and duties, the Commission may, subject to appropriations, coordinate and enter into agreements with the Department of Healthcare and Family Services and State universities, Tier I and Tier II academic medical centers as defined in the Illinois Public Aid Code, or other entities as designated by the Department of Healthcare and Family Services for research on medical assistance managed care or other State medical assistance programs in accordance with the analysis purposes for which the State-Funded Health Care Quality Assurance and Research Fund is created, as specified in Section 6z-101 of the State Finance Act. As used in this subsection, "research" means a systematic investigation, including research development, testing, and evaluation, that is designed to develop or contribute to generalizable knowledge.

Notwithstanding any other provisions of law to the contrary, subject to appropriations or funds made available by agreement through the Commission, the Department of Healthcare and Family Services is authorized and directed to provide the individual patient medical claims information, including individual data for services provided through capitated contracts, concerning recipients of medical assistance to the following institutions and entities for the analysis purposes for which the State-Funded Health Care Quality Assurance and Research Fund is created, as specified in Section 6z-101 of the State Finance Act:

(1) State universities.

(2) Tier I and Tier II academic medical centers as defined in the Illinois Public Aid Code.

(3) Associations incorporated in Illinois that (i) possess demonstrated research capacity and an institutional review board that is in compliance with the U.S. Health and Human Services' Office for Human Research Protections and (ii) are determined by the Department of Healthcare and Family Services to represent a broad number of providers who serve recipients of medical assistance provided under Article V of the Illinois Public Aid Code.

(4) Other entities designated by the Department of Healthcare and Family Services for the analysis purposes for which the State-Funded Health Care Quality Assurance and Research Fund is created, as specified in Section 6z-101 of the State Finance Act.

The patient medical claims information provided (i) shall include only the Medicaid recipient identification number, which shall not be de-identified, and any other individual medical patient data that has been de-identified in accordance with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) so as to qualify as a "limited data set" and (ii) shall be shared only in accordance with HIPAA.

The Commission, the Department of Healthcare and Family Services, and the entities listed in paragraphs (1) through (4) of this subsection must enter into data sharing agreements and business associate agreements to ensure privacy protection and HIPAA compliance and to safeguard the security and confidentiality of the patient medical claims information provided by the Department. The Department of Healthcare and Family Services shall make as much data available as possible in order to promote transparency and unencumbered data analysis.

The data shall be shared electronically with each participating entity on a State fiscal year basis once the data year is considered complete, and not longer than 8 months after the close of the State fiscal year. A complete State fiscal year data set shall be based on dates of service during a State fiscal year and shall be considered complete when sufficient time has occurred after the end of the State fiscal year to process all claims and make corrections to improperly filed claims.

Participating institutions and entities may, at their own expense and consistent with rules adopted by the Department of Healthcare and Family Services, produce research reports related to the purposes of this amendatory Act of the 99th General Assembly, provided that all patient medical claims information provided in any such report has been aggregated and de-identified. Participating institutions and entities may not use such patient medical claims information for commercial purposes or otherwise transfer such patient medical claims information to any other entity. Nothing in this amendatory Act of the 99th General Assembly shall be construed as prohibiting a participating institution or entity from partnering with another entity voluntarily or by contract to produce research reports, so long as no individually identifiable data is shared with the participating institution or entity.

The Commission shall report to the General Assembly the findings and recommendations resulting from the research and analyses conducted in accordance with Section 6z-101 of the State Finance Act.

(c) The requirement for reporting to the General Assembly shall be satisfied by filing copies of the report with the Speaker, the Minority Leader and the Clerk of the House of Representatives and the President, the Minority Leader and the Secretary of the Senate and the Legislative Research Unit, as required by Section 3.1 of the General Assembly Organization Act, and filing such additional copies with the State Government Report Distribution Center for the General Assembly as is required under paragraph (t) of Section 7 of the State Library Act.

(Source: P.A. 96-958, eff. 7-1-10.)

Section 15. The State Finance Act is amended by adding Section 6z-101 as follows:

(30 ILCS 105/6z-101 new)

Sec. 6z-101. State-Funded Health Care Quality Assurance and Research Fund.

(a) The State-Funded Health Care Quality Assurance and Research Fund is created. The Fund shall consist of:

(1) receipts from State fund transfers, including transfers from the Healthcare Provider Relief Fund;

(2) contributions from participating institutions and entities as provided in subsection (c); and

(3) any receipts from the federal government related to expenditures from the Fund.

All interest earned on moneys in the Fund shall be deposited into the Fund.

(b) The Fund shall be appropriated to the Commission on Government Forecasting and Accountability. The purpose of the Fund is to fund an independent analysis of each of the following:

(1) The efficacy of State managed care programs to improve the patient's experience with healthcare, to improve the health of Medicaid populations, and to reduce healthcare costs.

(2) The efficacy of the Department of Healthcare and Family Services in monitoring healthcare outcomes in managed care and other healthcare settings.

(3) Any possible gaps in healthcare for Medicaid populations served by the State and recommendations on how to close them.

(4) Successful outcomes and best practices in improving the health of Medicaid populations and the quality of care while reducing the cost.

(5) The efficacy of State managed care programs to improve continuity of care, ensure adequate provider participation, and maintain appropriate utilization of health services.

(6) In combination with other data sources, the impact of managed care on the social determinants of health as well as on non-clinical outcomes such as employment and educational attainment.

(7) The degree to which appropriate mechanisms are in place to assess the internal quality assurance processes of the Department of Healthcare and Family Services.

(c) The following institutions and entities may choose to participate in the Fund and the associated research by contributing not more than $250,000 into the Healthcare Provider Relief Fund annually:

(1) State universities.

(2) Tier I or Tier II academic medical centers as defined in the Illinois Public Aid Code.

(3) Associations incorporated in Illinois that possess demonstrated research capacity and an institutional research board and that, as determined by the Department of Healthcare and Family Services, represent a broad number of providers who serve recipients of medical assistance provided under Article V of the Illinois Public Aid Code.

(4) Other entities as designated by the Department of Healthcare and Family Services.

Based upon the number of participants, the costs to the Department of Healthcare and Family Services, and the appropriations made to the Department of Healthcare and Family Services and the Commission on Forecasting and Governmental Accountability, the Department shall determine the contribution amount for participants. All participants shall pay the same amount. Each participant shall be refunded the amount it paid into the Fund if (i) the research data described in subsection (b) of Section 3 of the Commission on Government Forecasting and Accountability Act is not provided to the participating entities free of charge or (ii) the research data or similar data is shared with an entity not identified in subsection (b) of Section 3 of the Commission on Government Forecasting and Accountability Act.

The State shall transfer into the Fund, from the Healthcare Provider Relief Fund, an amount equal to the contributions made by participating entities.

Any use of the data for commercial purposes or for another purpose not authorized under subsection (b) of Section 3 of the Commission on Government Forecasting and Accountability Act shall result in: (i) no access to the data for a period of one year after the data year the last data set had been received; (ii) no refund of the fees authorized under this Section; and (iii) a civil penalty of $2,500 for each violation, which shall be deposited into the State-Funded Quality Care and Research Fund.

Section 99. Effective date. This Act takes effect upon becoming law.