State of Illinois
91st General Assembly

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[ Introduced ][ Engrossed ][ Senate Amendment 001 ]


SB1657 Enrolled                                LRB9110302MWgc

 1        AN ACT to amend the Illinois Health Finance Reform Act by
 2    changing Sections 2-1, 4-1, 4-2, 4-3, and 4-5.

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

 5        Section 5.  The Illinois Health  Finance  Reform  Act  is
 6    amended  by  changing Sections 2-1, 4-1, 4-2, 4-3, and 4-5 as
 7    follows:

 8        (20 ILCS 2215/2-1) (from Ch. 111 1/2, par. 6502-1)
 9        Sec. 2-1.  Council Authorized.  There is  hereby  created
10    the  Illinois Health Care Cost Containment Council.  It shall
11    consist of 13 11 members appointed by the Governor  with  the
12    advice  and  consent of the Senate as follows: 5 3 members to
13    represent  providers  as  follows:  2  members  to  represent
14    Illinois hospitals at least one of  which  must  represent  a
15    small  rural  hospital,  2  members  to  represent physicians
16    licensed to practice medicine in  all  its  branches,  and  1
17    member  to represent ambulatory surgical treatment centers; 3
18    members  to  represent  consumers;  2  members  to  represent
19    insurance companies; and 3 members to represent businesses.
20        The members of the Council shall be appointed for  3-year
21    three year terms.
22        No more than 7 six members may be from the same political
23    party.
24        Members  shall  be  appointed within 30 thirty days after
25    the effective date  of  this  Act.   The  additional  members
26    appointed  under  the  amendatory  Act  of  the  91st General
27    Assembly must be appointed within 30 days after the effective
28    date of this amendatory Act of the 91st General Assembly. The
29    members of the Council shall receive reimbursement  of  their
30    actual expenses incurred in connection with their service; in
31    addition,  each  member  shall receive compensation of $150 a
SB1657 Enrolled             -2-                LRB9110302MWgc
 1    day for each day served at regular or special meetings of the
 2    Council, except  that  such  compensation  shall  not  exceed
 3    $20,000  in  any  one year for any member.  The Council shall
 4    elect a Chairman from among its members, and shall  have  the
 5    power  to  organize and appoint such other officers as it may
 6    deem necessary.
 7        All appointments shall be made in writing and filed  with
 8    the Secretary of State as a public record.
 9    (Source: P.A. 83-1243.)

10        (20 ILCS 2215/4-1) (from Ch. 111 1/2, par. 6504-1)
11        Sec.  4-1.  Illinois Health Finance Data Collection.  The
12    General Assembly finds that accurate, comparable data on  the
13    costs of health care are not currently available in Illinois.
14    Therefore,  it  is extremely difficult to make careful policy
15    choices for future health care  cost  management  strategies.
16    Further,  neither  the  public  sector and nor private sector
17    purchasers  of  health  care  need  health  care   cost   and
18    utilization  have  available  data  to  enable  them  to make
19    informed choices among health care providers  in  the  market
20    place.   While  the  gathering  of  health care cost data has
21    been attempted on a voluntary basis in the past, the lack  of
22    a uniform system for the collection and analysis of data, and
23    the  lack  of  full participation by providers and payors has
24    led to inadequate and unusable data.  In order to remedy this
25    problem, The General Assembly finds it necessary to create  a
26    mandated  uniform  system  in  Illinois  for  the collection,
27    analysis,  and  distribution  of   health   care   cost   and
28    utilization data.
29        The  purpose  of  this Article is to insure that data are
30    available  to  make  valid  comparisons  among  health   care
31    providers hospitals of prices and utilization of for services
32    provided  and  to support ongoing analysis of the health care
33    delivery system so that the Council can fulfill its mandate.
SB1657 Enrolled             -3-                LRB9110302MWgc
 1    (Source: P.A. 83-1243.)

 2        (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
 3        Sec. 4-2.  Powers and duties.
 4        (a)  The Illinois Health Care  Cost  Containment  Council
 5    may   enter   into   any   agreement  with  any  corporation,
 6    association or other entity it deems appropriate to undertake
 7    the process described in this Article for the compilation and
 8    analysis of data collected by the Council and to  conduct  or
 9    contract  for studies on health-related questions carried out
10    in pursuance of the purposes of this Article.  The  agreement
11    may  provide  for  the  corporation, association or entity to
12    prepare and distribute or make available data to health  care
13    providers,   health  care  subscribers,  third-party  payors,
14    government and the general public,  in  accordance  with  the
15    rules  of  confidentiality  and  review to be developed under
16    this Act.
17        (b)  The input data collected by  and  furnished  to  the
18    Council  or  designated  corporation,  association  or entity
19    pursuant to this Section shall not be a public  record  under
20    the Illinois Freedom of Information Act.  It is the intent of
21    this  Act  and  of the regulations written pursuant to it  to
22    protect the confidentiality of individual patient information
23    and  the  proprietary  information  of  commercial  insurance
24    carriers and health care providers hospitals.  To  accomplish
25    this,  the data specified in subsection (c) shall be released
26    in  the  following  manner.   Total  gross   revenue,   total
27    deductions  from  gross  revenue  and gross inpatient revenue
28    shall be reported to the Council and released by the  Council
29    on a hospital specific basis.  The remaining data elements in
30    subsection  (c)  shall not be released on a hospital-specific
31    basis except as needed by  the  executive,  legislative,  and
32    judicial  branches of government for the performance of their
33    duties.  Data specified in  subsections  subsection  (e)  and
SB1657 Enrolled             -4-                LRB9110302MWgc
 1    (e-5)  shall  be released on a hospital specific and licensed
 2    ambulatory  surgical  treatment  center  specific  basis   to
 3    facilitate   comparisons   among   hospitals   and   licensed
 4    ambulatory surgical treatment centers by purchasers.
 5        (c)  The  Council shall require the Departments of Public
 6    Health and Public Aid and hospitals located in the  State  to
 7    assist  the Council in gathering and submitting the following
 8    hospital-specific financial information, and the  Council  is
 9    authorized to share this data with both Departments to reduce
10    the   burden   on   hospitals   by  avoiding  duplicate  data
11    collection:

13        (1)  Net patient service revenue
14        (2)  Other revenue
15        (3)  Total operating revenue

17        (4)  Bad debt expense
18        (5)  Total operating expenses

20        (6)  Total non-operating gains
21        (7)  Total non-operating losses

23        (8)  Gross inpatient revenue
24        (9)  Gross outpatient revenue
25        (10)  Other Patient care revenue
26        (11)  Total patient revenue
27        (12)  Total gross patient care revenue
28        (13)  Medicare gross revenue
29        (14)  Medicaid gross revenue
30        (15)  Total other gross revenue

32        (16)  Charity care
SB1657 Enrolled             -5-                LRB9110302MWgc
 1        (17)  Medicare allowance
 2        (18)  Medicaid allowance
 3        (19)  Other contractual allowances
 4        (20)  Other allowances
 5        (21)  Total Deductions

 6    ASSETS
 7        (22)  Operating cash and short-term investments
 8        (23)  Estimated patient accounts receivable
 9        (24)  Other current assets
10        (25)  Total current assets
11        (26)  Total other assets
12        (27)  Total Assets

14        (28)  Total current liabilities
15        (29)  Long Term Debt
16        (30)  Other liabilities
17        (31)  Total liabilities
18        (32)  Total liabilities and fund balances
19        In addition, each hospital shall annually submit  to  the
20    Council  a  duplicate  copy  of  the hospital's Medicaid Cost
21    Report at the same time that the hospital  submits  the  cost
22    report  to  the  Illinois  Department  of  Public Aid and any
23    settled cost report upon receipt by the hospital of a  notice
24    of amount of program reimbursement.
25        On  and  after  the  effective  date  of  this  Act, such
26    information shall be annually submitted from each hospital in
27    the State of Illinois no later than 120 days after the  close
28    of  its fiscal year.  The information submitted in the report
29    shall be based upon audited financial statements and shall be
30    attested to by the Chief Executive Officer of each hospital.
31        All financial data collected by the Council from publicly
32    available  sources  such  as  the  HCFA  Electronic  Medicare
33    Reports is releasable by the Council on a  hospital  specific
SB1657 Enrolled             -6-                LRB9110302MWgc
 1    basis when appropriate.
 2        (d)  Uniform     Provider    Utilization    and    Charge
 3    Information.  The Council shall require that:
 4             (1)  Hospitals licensed to operate in the  State  of
 5        Illinois  adopt  a  uniform system for submitting patient
 6        charges  for  payment  from  public  and  private  payors
 7        effective January 1, 1985.  This system  shall  be  based
 8        upon  adoption  of  the  uniform  hospital  billing  form
 9        (UB-92) (UB-82/HCFA-1450) or its successor form developed
10        by the National Uniform Billing Committee.
11             (2)  (Blank)  The  Illinois Department of Public Aid
12        accept the uniform  billing  form  effective  October  1,
13        1985.  In addition, the Illinois Department of Public Aid
14        shall report the data listed in subsection  (e)  for  the
15        period January 1, 1985 through October 1, 1985.
16             (3)  The   Department   of   Insurance  require  all
17        third-party  payors,  including  but  not   limited   to,
18        licensed   insurers,   medical   and   hospital   service
19        corporations,   health   maintenance  organizations,  and
20        self-funded employee health plans, to accept the  uniform
21        billing   form,   without   attachment  as  submitted  by
22        hospitals pursuant to paragraph  (1)  of  subsection  (d)
23        above,  effective  January  1,  1985;  provided, however,
24        nothing shall prevent all such third  party  payors  from
25        requesting  additional information necessary to determine
26        eligibility for benefits or liability  for  reimbursement
27        for services provided.
28        (e)  The   Council,   in   cooperation   with  the  State
29    Departments of Public  Aid,  Insurance,  and  Public  Health,
30    shall  establish a system for the collection of the following
31    information from hospitals utilizing the raw  data  available
32    on  the  uniform  billing forms.  Such data shall include the
33    following  elements  and  other  elements  contained  on  the
34    uniform billing form or  its  successor  form  determined  as
SB1657 Enrolled             -7-                LRB9110302MWgc
 1    necessary by the Council:
 2        (1)  Patient date of birth
 3        (2)  Patient sex
 4        (3)  Patient zip code
 5        (4)  Third-party coverage
 6        (5)  Date of admission
 7        (6)  Source of admission
 8        (7)  Type of admission
 9        (8)  Discharge date
10        (9)  Principal and up to 8 four other diagnoses
11        (10)  Principal procedure and date
12        (11)  Patient status
13        (12)  Other procedures and dates
14        (13)  Total charges and components of those charges
15        (14)  Attending  and  consulting physician identification
16    numbers number
17        (15)  Hospital identification number
18        (16)  An alphanumeric number based on the information  to
19    identify the payor
20        (17)  Principal source of payment.
21        (e-5)  The Council, in cooperation with the Department of
22    Public  Aid,  the Department of Insurance, and the Department
23    of Public Health, shall establish a system for the collection
24    of the following  information  for  each  outpatient  surgery
25    performed  at  hospitals  and  licensed  ambulatory  surgical
26    treatment  centers using the raw data available on outpatient
27    billing forms submitted by hospitals and licensed  ambulatory
28    surgical  treatment centers to payors.  The data must include
29    the following elements, if available on  the  billing  forms,
30    and  other  elements  contained on the billing forms that the
31    Council determines are necessary:
32             (1)  patient date of birth;
33             (2)  patient sex;
34             (3)  patient zip code;
SB1657 Enrolled             -8-                LRB9110302MWgc
 1             (4)  third-party coverage;
 2             (5)  date of admission;
 3             (6)  source of admission;
 4             (7)  type of admission;
 5             (8)  discharge date;
 6             (9)  principal  diagnosis  and   up   to   8   other
 7        diagnoses;
 8             (10)  principal   procedure  and  the  date  of  the
 9        procedure;
10             (11)  patient status;
11             (12)  other  procedures  and  the  dates  of   those
12        procedures;
13             (13)  attending     and     consulting     physician
14        identification numbers;
15             (14)  hospital   or   licensed  ambulatory  surgical
16        treatment center identification number;
17             (15)  an   alphanumeric   number   based   on    the
18        information needed to identify the payor; and
19             (16)  principal source of payment.
20        (f)  Extracts  of  the  UB-92  UB82 transactions shall be
21    prepared by hospitals according to regulations promulgated by
22    the Council and submitted in electronic magnetic tape  format
23    to  the  Council  or  the  corporation, association or entity
24    designated by the Council.
25        For hospitals unable to  submit  extracts  in  electronic
26    magnetic   tape   format,  the  Council  shall  determine  an
27    alternate method for electronic  submission  of  data.   Such
28    extract  reporting  systems  shall  be  in  operation  before
29    January   1,  1987;  however,  the  Council  may  grant  time
30    extensions to individual hospital.
31        (f-5)  Extracts of the billing forms shall be prepared by
32    licensed ambulatory surgical treatment centers  according  to
33    rules  adopted by the Council and submitted to the Council or
34    a corporation,  association,  or  entity  designated  by  the
SB1657 Enrolled             -9-                LRB9110302MWgc
 1    Council.  Electronic  submissions  shall  be encouraged.  For
 2    licensed ambulatory  surgical  treatment  centers  unable  to
 3    submit  extracts  in  an  electronic  format the Council must
 4    determine an alternate method for submission of data.
 5        (g)  Under no circumstances shall patient name and social
 6    security number appear on the extracts.
 7        (h)  Hospitals and licensed ambulatory surgical treatment
 8    centers shall be assigned a standard identification number by
 9    the Council to be used in the submission of all data.
10        (i)  The Council shall collect a  100%  inpatient  sample
11    from  hospitals  annually.  The  Council  shall  require each
12    hospital in the State to submit the UB-92 UB-82 data extracts
13    required in  subsection  (e)  to  the  Council,  except  that
14    hospitals  with  fewer  than  50  beds may be exempted by the
15    Council from the filing requirements if  they  prove  to  the
16    Council's  satisfaction  that  the  requirements would impose
17    undue economic hardship and if the  Council  determines  that
18    the  data submitted from these hospitals are not essential to
19    its data base and its concomitant health care cost comparison
20    efforts.
21        (i-5)  The Council shall collect up to a 100%  outpatient
22    sample   annually  from  hospitals  and  licensed  ambulatory
23    surgical treatment centers.  The Council shall  require  each
24    hospital and licensed ambulatory surgical treatment center in
25    the   State  to  submit  the  data  extracts  required  under
26    subsection (e-5) to the Council, except  that  hospitals  and
27    licensed   ambulatory   surgical  treatment  centers  may  be
28    exempted by the Council from the filing requirements  if  the
29    hospitals  or  licensed ambulatory surgical treatment centers
30    prove to the Council's  satisfaction  that  the  requirements
31    would  impose  undue  economic  hardship  and  if the Council
32    determines that the data submitted from those  hospitals  and
33    licensed   ambulatory  surgical  treatment  centers  are  not
34    essential to  the  Council's  database  and  its  concomitant
SB1657 Enrolled             -10-               LRB9110302MWgc
 1    health care comparison efforts.
 2        (i-10)  The  outpatient  data  shall  be collected by the
 3    Council on a phase-in and trial basis for a  one-year  period
 4    beginning  on  January  1, 2001.  The Council shall implement
 5    outpatient data collection for reporting  purposes  beginning
 6    on January 1, 2002.
 7        (j)  The information submitted to the Council pursuant to
 8    subsections  subsection  (e)  and (e-5) shall be reported for
 9    each primary payor category,  including  Medicare,  Medicaid,
10    other   government   programs,   private   insurance,  health
11    maintenance   organizations,   self-insured,   private    pay
12    patients,   and   others.   Preferred  provider  organization
13    reimbursement shall also be reported for each  primary  third
14    party payor category.
15        (k)  The   Council   shall  require  and  the  designated
16    corporation, association  or  entity,  if  applicable,  shall
17    prepare  quarterly  basic  reports in the aggregate on health
18    care cost and utilization  costs  trends  in  Illinois.   The
19    Council  shall  provide  these  reports  to  the  public,  if
20    requested.   These  shall  include,  but  not  be limited to,
21    comparative  information  on  average  charges,   total   and
22    ancillary    charge     components,   length   of   stay   on
23    diagnosis-specific and procedure specific cases,  and  number
24    of discharges, compiled in aggregate by hospital and licensed
25    ambulatory  surgical  treatment  center, by diagnosis, and by
26    primary payor category.
27        (l)  The  Council  shall,  from   information   submitted
28    pursuant  to  subsection (e), prepare an annual report in the
29    aggregate by hospital containing the following:
30             (1)  the ratio of caesarean  section  deliveries  to
31        total deliveries;
32             (2)  the  average  length  of  stay for patients who
33        undergo caesarean sections;
34             (3)  the average total charges for patients who have
SB1657 Enrolled             -11-               LRB9110302MWgc
 1        normal deliveries without any significant complications;
 2             (4)  the average  total  charges  for  patients  who
 3        deliver by caesarean section.
 4    The  Council  shall  provide  this  report  to the public, if
 5    requested.
 6        (l-5)  (Blank) The Council, in cooperation with the State
 7    Departments of Public  Aid,  Insurance,  and  Public  Health,
 8    shall  establish  a  system  for the collection of outpatient
 9    surgical data from hospitals and licensed ambulatory surgical
10    treatment  centers  utilizing  raw  data  available   on   an
11    outpatient  uniform billing form that conforms with pertinent
12    State and federal standards.  Under no circumstances shall  a
13    patient's  name  or  social  security  number  appear  on the
14    abstract  of  the  billing  form  provided  to  the  Council.
15    Beginning July 1, 1996, the Council is authorized to  collect
16    ambulatory  surgery  information  from hospitals and licensed
17    freestanding surgery centers by means of surveys.   No  later
18    than  January  1, 1997, the Council shall begin a pilot study
19    that includes the collection of some  hospital  and  licensed
20    freestanding  ambulatory  surgery  data  from the same health
21    care markets.  No later than July 1, 1997, the Council  shall
22    begin  a field test of the ambulatory surgery data collection
23    system with the collection of all defined outpatient  surgery
24    data  from  a  sample  of  licensed  freestanding  ambulatory
25    surgical  treatment  centers and the hospitals that serve the
26    same health care markets.  No later than January 1, 1998, the
27    Council shall begin to collect comments  from  providers  and
28    consumers  and  from  advisory  groups  regarding  the  field
29    testing of a system for the collection of outpatient surgical
30    data.   The  Council  shall  report  its findings, summary of
31    comments received, conclusions and recommendations  regarding
32    the  collection  of  outpatient  surgical  data no later than
33    March 1, 1998 to the General Assembly.
34        The Council shall seek  authorization  from  the  General
SB1657 Enrolled             -12-               LRB9110302MWgc
 1    Assembly  prior  to  beginning  the collection of all defined
 2    outpatient  surgery  data  from  all  licensed   freestanding
 3    ambulatory surgical treatment centers and hospitals.
 4        Beginning  July  1,  1996,  the  Council is authorized to
 5    develop a process to use  existing  third  party  payers  and
 6    other  voluntarily available existing databases, surveys, and
 7    sampling  techniques  to   develop   cost   and   utilization
 8    information on outpatient care primarily for areas other than
 9    ambulatory surgery in Illinois.
10        To  ensure  both equity and data integrity, no ambulatory
11    survey data shall be released other than  to  the  individual
12    hospitals   and  licensed  freestanding  ambulatory  surgical
13    treatment centers that provided the data until  the  data  is
14    being  required  from  all facilities in the same health care
15    market and the Council determines the collection  program  is
16    effective.
17        (m)  Prior  to  the  release  or  dissemination  of these
18    reports, the Council  or  the  designated  corporation  shall
19    permit  providers  the  opportunity to verify the accuracy of
20    any information pertaining to the  provider.   The  providers
21    may  submit  to  the Council any corrections or errors in the
22    compilation of the data  with  any  supporting  evidence  and
23    documents   the   providers   may  submit.   The  Council  or
24    corporation shall correct data  found  to  be  in  error  and
25    include  additional  commentary  as requested by the provider
26    for major deviations in the charges from the average charges.
27    For purposes of this  subsection  (m),  "providers"  includes
28    physicians  licensed  to  practice  medicine  in  all  of its
29    branches.
30        (n)  In addition to  the  reports  indicated  above,  the
31    Council  shall  respond to requests by agencies of government
32    and organizations in the private sector  for  data  products,
33    special  studies  and  analysis of data collected pursuant to
34    this Section.  Such reports shall be undertaken only  by  the
SB1657 Enrolled             -13-               LRB9110302MWgc
 1    agreement  of  a  majority  of the members of the Council who
 2    shall designate the form in which the  information  shall  be
 3    made  available.  The Council or the corporation, association
 4    or  entity  in  consultation  with  the  Council  shall  also
 5    determine a fee to be charged to  the  requesting  agency  or
 6    private  sector organization to cover the direct and indirect
 7    costs for producing such a report, and shall permit  affected
 8    providers  the  rights  to  review the accuracy of the report
 9    before it is released.  Such reports  shall not be subject to
10    The Freedom of Information Act.
11    (Source: P.A. 88-535; 89-554, eff. 7-26-96.)

12        (20 ILCS 2215/4-3) (from Ch. 111 1/2, par. 6504-3)
13        Sec. 4-3.  Confidentiality.
14        (a)  As  indicated  elsewhere  in  this  Act,  all  steps
15    necessary under State and  Federal  law  to  protect  patient
16    confidentiality shall be undertaken by the Council to prevent
17    the    identification    of   individual   patient   records.
18    Regulations are to be written to assure  the  confidentiality
19    of  patient records when gathering and submitting data to the
20    Council or designated corporation, association or entity.
21        (b)  The information submitted to the Council, designated
22    corporation, association or entity by hospitals  pursuant  to
23    subsections  (c),  and (e), and (e-5) of Section 4-2 shall be
24    privileged and confidential, and shall not  be  disclosed  in
25    any manner.  The foregoing includes, but shall not be limited
26    to,  disclosure,  inspection  or copying under the Freedom of
27    Information Act, the State Records Act, and paragraph (1)  of
28    Section  404  of  the  Illinois Insurance Code.  However, the
29    prohibitions stated in this subsection shall not apply to the
30    compilations of information assembled by the Council pursuant
31    to subsections (k) and (m) of Section 4-2.
32        (c)  Any  person  or  organization,  including  but   not
33    limited  to,  hospitals,  government  agencies, associations,
SB1657 Enrolled             -14-               LRB9110302MWgc
 1    businesses, or researchers receiving data under an  agreement
 2    with  the Council under the terms indicated in Section 6504-2
 3    shall be required to adhere strictly  to  the  terms  of  the
 4    agreement,   especially   the   terms  that  are  related  to
 5    preserving patient confidentiality.  The use of Council  data
 6    either  alone or in combination with data from another source
 7    or sources to identify specific patients is prohibited unless
 8    such identification is specifically  authorized  by  Illinois
 9    Statute  and  agreed  to  in  writing  by  the  Council.   An
10    intentional  breach of patient confidentiality not authorized
11    by statute and  the  Council  shall  render  the  responsible
12    individual  or  organization  liable  to  the penalties under
13    Section 5-2.
14    (Source: P.A. 91-357, eff. 7-29-99.)

15        (20 ILCS 2215/4-5) (from Ch. 111 1/2, par. 6504-5)
16        Sec.   4-5.   Expenses.   The   Council   or   designated
17    corporation,  association  or  entity   shall   establish   a
18    procedure  by  which  it  will  pay  hospitals  and  licensed
19    ambulatory  surgical  treatment  centers  for submitting data
20    pursuant to subsections subsection (e) and (e-5)  of  Section
21    4-2.  Operating  expenses  of  the  Council or the designated
22    corporation, association or entity for such payments, for the
23    conversion  of  hard  copy  reports  to  tape,  and  for  the
24    compilation and analysis of basic reports shall be  paid  for
25    by  appropriation  of  the  General  Assembly.  Expenses  for
26    additional  reports  shall  be billed to those requesting the
27    reports.
28    (Source: P.A. 83-1243.)

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

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