Illinois General Assembly - Full Text of Public Act 094-0027
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Public Act 094-0027




Public Act 094-0027
HB2343 Enrolled LRB094 05025 BDD 39283 b

    AN ACT concerning State government.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Illinois Health Finance Reform Act is
amended by changing Section 4-2 as follows:
    (20 ILCS 2215/4-2)  (from Ch. 111 1/2, par. 6504-2)
    Sec. 4-2. Powers and duties.
    (a) (Blank).
    (b) (Blank).
    (c) (Blank).
    (d) Uniform Provider Utilization and Charge Information.
        (1) The Department of Public Health shall require that
    all hospitals and ambulatory surgical treatment centers
    licensed to operate in the State of Illinois adopt a
    uniform system for submitting patient claims and encounter
    data charges for payment from public and private payors.
    This system shall be based upon adoption of the uniform
    electronic hospital billing form pursuant to the Health
    Insurance Portability and Accountability Act.
        (2) (Blank).
        (3) The Department of Insurance shall require all
    third-party payors, including but not limited to, licensed
    insurers, medical and hospital service corporations,
    health maintenance organizations, and self-funded employee
    health plans, to accept the uniform billing form, without
    attachment as submitted by hospitals pursuant to paragraph
    (1) of subsection (d) above, effective January 1, 1985;
    provided, however, nothing shall prevent all such third
    party payors from requesting additional information
    necessary to determine eligibility for benefits or
    liability for reimbursement for services provided.
        (4) By no later than 60 days after the end of each
    calendar quarter, each Each hospital licensed in the State
    shall electronically submit to the Department inpatient
    and outpatient claims and encounter patient billing data
    related to surgical and invasive procedures collected
    under paragraph (5) for each patient.
        By no later than 60 days after the end of each calendar
    quarter, each ambulatory surgical treatment center
    licensed in the State shall electronically submit to the
    Department outpatient claims and encounter data collected
    under paragraph (5) for each patient, provided however,
    that, until July 1, 2006, ambulatory surgical treatment
    centers who cannot electronically submit data may submit
    data by computer diskette. conditions and procedures
    required for public disclosure pursuant to paragraph (6).
    For hospitals, the claims and encounter billing data to be
    reported shall include all inpatient surgical cases.
    Claims and encounter Billing data submitted under this Act
    shall not include a patient's name, address, or Social
    Security number.
        (5) By no later than January 1, 2006 January 1, 2005,
    the Department must collect and compile claims and
    encounter billing data related to surgical and invasive
    procedures required under paragraph (6) according to
    uniform electronic submission formats as required under
    the Health Insurance Portability and Accountability Act.
    By no later than January 1, 2006, the Department must
    collect and compile from ambulatory surgical treatment
    centers the claims and encounter data according to uniform
    electronic data element formats as required under the
    Health Insurance Portability and Accountability Act of
    1996 (HIPAA).
        (6) The Department shall make available on its website
    the "Consumer Guide to Health Care" by January 1, 2006. The
    "Consumer Guide to Health Care" shall include information
    on at least 30 inpatient conditions and procedures
    identified by the Department that demonstrate the highest
    degree of variation in patient charges and quality of care.
    By no later than January 1, 2007, the "Consumer Guide to
    Health Care" shall also include information on at least 30
    outpatient conditions and procedures identified by the
    Department that demonstrate the highest degree of
    variation in patient charges and quality care. As to each
    condition or procedure, the "Consumer Guide to Health Care"
    shall include up-to-date comparison information relating
    to volume of cases, average charges, risk-adjusted
    mortality rates, and nosocomial infection rates and, with
    respect to outpatient surgical and invasive procedures,
    shall include information regarding surgical infections,
    complications, and direct admissions of outpatient cases
    to hospitals for selected procedures, as determined by the
    Department, based on review by the Department of its own,
    local, or national studies. Information disclosed pursuant
    to this paragraph on mortality and infection rates shall be
    based upon information hospitals and ambulatory surgical
    treatment centers have either (i) previously submitted to
    the Department pursuant to their obligations to report
    health care information under this Act or other public
    health reporting laws and regulations outside of this Act
    or (ii) submitted to the Department under the provisions of
    the Hospital Report Card Act.
        (7) Publicly disclosed information must be provided in
    language that is easy to understand and accessible to
    consumers using an interactive query system. The guide
    shall include such additional information as is necessary
    to enhance decision making among consumer and health care
    purchasers, which shall include, at a minimum, appropriate
    guidance on how to interpret the data and an explanation of
    why the data may vary from provider to provider. The
    "Consumer Guide to Health Care" shall also cite standards
    that facilities meet under state and federal law and, if
    applicable, to achieve voluntary accreditation.
        (8) None of the information the Department discloses to
    the public under this subsection may be made available
    unless the information has been reviewed, adjusted, and
    validated according to the following process:
            (i) Hospitals, ambulatory surgical treatment
        centers, and organizations representing hospitals,
        ambulatory surgical treatment centers, purchasers,
        consumer groups, and health plans are meaningfully
        involved in providing advice and consultation to the
        Department in the development of all aspects of the
        Department's methodology for collecting, analyzing,
        and disclosing the information collected under this
        Act, including collection methods, formatting, and
        methods and means for release and dissemination;
            (ii) The entire methodology for collecting
        collection and analyzing the data is disclosed to all
        relevant organizations and to all providers that are
        the subject of any information to be made available to
        the public before any public disclosure of such
            (iii) Data collection and analytical methodologies
        are used that meet accepted standards of validity and
        reliability before any information is made available
        to the public;
            (iv) The limitations of the data sources and
        analytic methodologies used to develop comparative
        provider information are clearly identified and
        acknowledged, including, but not limited to,
        appropriate and inappropriate uses of the data;
            (v) To the greatest extent possible, comparative
        hospital and ambulatory surgical treatment center
        information initiatives use standard-based norms
        derived from widely accepted provider-developed
        practice guidelines;
            (vi) Comparative hospital and ambulatory surgical
        treatment center information and other information
        that the Department has compiled regarding hospitals
        and ambulatory surgical treatment centers is shared
        with the hospitals and ambulatory surgical treatment
        centers under review prior to public dissemination of
        the information and these providers have an
        opportunity to make corrections and additions of
        helpful explanatory comments about the information
        before the publication;
            (vii) Comparisons among hospitals and ambulatory
        surgical treatment centers adjust for patient case mix
        and other relevant risk factors and control for
        provider peer groups, if applicable;
            (viii) Effective safeguards to protect against the
        unauthorized use or disclosure of hospital and
        ambulatory surgical treatment center information are
        developed and implemented;
            (ix) Effective safeguards to protect against the
        dissemination of inconsistent, incomplete, invalid,
        inaccurate, or subjective provider data are developed
        and implemented;
            (x) The quality and accuracy of hospital and
        ambulatory surgical treatment center information
        reported under this Act and its data collection,
        analysis, and dissemination methodologies are
        evaluated regularly; and
            (xi) Only the most basic hospital or ambulatory
        surgical treatment center identifying information from
        mandatory reports is used. Information regarding a
        hospital or ambulatory surgical center may be released
        regardless of the number of employees or health care
        professionals whose data are reflected in the data for
        the hospital or ambulatory surgical treatment center
        as long as no specific information identifying an
        employee or a health care professional is released.
        identifying information from mandatory reports is
        used, and Further, patient identifiable information is
        not released. The input data collected by the
        Department shall not be a public record under the
        Illinois Freedom of Information Act.
        None of the information the Department discloses to the
    public under this Act may be used to establish a standard
    of care in a private civil action.
        (9) The Department must develop and implement an
    outreach campaign to educate the public regarding the
    availability of the "Consumer Guide to Health Care".
        (10) By January 1, 2006, Within 12 months after the
    effective date of this amendatory Act of the 93rd General
    Assembly, the Department must study the most effective
    methods for public disclosure of patient claims and
    encounter charge data and health care quality information
    that will be useful to consumers in making health care
    decisions and report its recommendations to the Governor
    and to the General Assembly.
        (11) The Department must undertake all steps necessary
    under State and Federal law to protect patient
    confidentiality in order to prevent the identification of
    individual patient records.
        (12) The Department must adopt rules for inpatient and
    outpatient data collection and reporting no later than
    January 1, 2006.
        (13) In addition to the data products indicated above,
    the Department shall respond to requests by government
    agencies, academic research organizations, and private
    sector organizations for purposes of clinical performance
    measurements and analyses of data collected pursuant to
    this Section.
        (14) The Department, with the advice of and in
    consultation with hospitals, ambulatory surgical treatment
    centers, organizations representing hospitals,
    organizations representing ambulatory treatment centers,
    purchasers, consumer groups, and health plans, must
    evaluate additional methods for comparing the performance
    of hospitals and ambulatory surgical treatment centers,
    including the value of disclosing additional measures that
    are adopted by the National Quality Forum, The Joint
    Commission on Accreditation of Healthcare Organizations,
    the Accreditation Association for Ambulatory Health Care,
    the Centers for Medicare and Medicaid Services, or similar
    national entities that establish standards to measure the
    performance of health care providers. The Department shall
    report its findings and recommendations on its Internet
    website and to the Governor and General Assembly no later
    than July 1, 2006.
    (e) (Blank).
(Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 6/14/2005