093_HB2202eng
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1 AN ACT in relation to health care.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Health Care 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
13 that all hospitals licensed to operate in the State of
14 Illinois adopt a uniform system for submitting patient
15 charges for payment from public and private payors
16 effective January 1, 1985. This system shall be based
17 upon adoption of the uniform electronic hospital billing
18 form pursuant to the Health Insurance Portability and
19 Accountability Act (UB-92) or its successor form
20 developed by the National Uniform Billing Committee.
21 (2) (Blank).
22 (3) The Department of Insurance shall require all
23 third-party payors, including but not limited to,
24 licensed insurers, medical and hospital service
25 corporations, health maintenance organizations, and
26 self-funded employee health plans, to accept the uniform
27 billing form, without attachment as submitted by
28 hospitals pursuant to paragraph (1) of subsection (d)
29 above, effective January 1, 1985; provided, however,
30 nothing shall prevent all such third party payors from
31 requesting additional information necessary to determine
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1 eligibility for benefits or liability for reimbursement
2 for services provided.
3 (4) Each hospital licensed in the State shall
4 electronically submit to the Department patient billing
5 data for conditions and procedures required for public
6 disclosure pursuant to paragraph (6). For hospitals, the
7 billing data to be reported shall include all inpatient
8 surgical cases. Billing data submitted under this Act
9 shall not include a patient's name, address, or Social
10 Security number.
11 (5) By no later than January 1, 2005, the
12 Department must collect and compile billing data required
13 under paragraph (6) according to uniform electronic
14 submission formats as required under the Health Insurance
15 Portability and Accountability Act.
16 (6) The Department shall make available on its
17 website the "Consumer Guide to Health Care" by January 1,
18 2006. The "Consumer Guide to Health Care" shall include
19 information on 30 conditions and procedures identified by
20 the Department that demonstrate the highest degree of
21 variation in patient charges and quality of care. As to
22 each condition or procedure, the "Consumer Guide to
23 Health Care" shall include up-to-date comparison
24 information relating to volume of cases, average charges,
25 risk-adjusted mortality rates, and nosocomial infection
26 rates. Information disclosed pursuant to this paragraph
27 on mortality and infection rates shall be based upon
28 information hospitals have previously submitted to the
29 Department pursuant to their obligations to report health
30 care information under other public health reporting laws
31 and regulations outside of this Act.
32 (7) Publicly disclosed information must be provided
33 in language that is easy to understand and accessible to
34 consumers using an interactive query system.
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1 (8) None of the information the Department
2 discloses to the public under this subsection may be made
3 available unless the information has been reviewed,
4 adjusted, and validated according to the following
5 process:
6 (i) Hospitals and organizations representing
7 hospitals are meaningfully involved in the
8 development of all aspects of the Department's
9 methodology for collecting, analyzing, and
10 disclosing the information collected under this Act,
11 including collection methods, formatting, and
12 methods and means for release and dissemination;
13 (ii) The entire methodology for collection and
14 analyzing the data is disclosed to all relevant
15 organizations and to all providers that are the
16 subject of any information to be made available to
17 the public before any public disclosure of such
18 information;
19 (iii) Data collection and analytical
20 methodologies are used that meet accepted standards
21 of validity and reliability before any information
22 is made available to the public;
23 (iv) The limitations of the data sources and
24 analytic methodologies used to develop comparative
25 provider information are clearly identified and
26 acknowledged, including, but not limited to,
27 appropriate and inappropriate uses of the data;
28 (v) To the greatest extent possible,
29 comparative hospital information initiatives use
30 standard-based norms derived from widely accepted
31 provider-developed practice guidelines;
32 (vi) Comparative hospital information and
33 other information that the Department has compiled
34 regarding hospitals is shared with the hospitals
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1 under review prior to public dissemination of the
2 information and these providers have an opportunity
3 to make corrections and additions of helpful
4 explanatory comments about the information before
5 the publication;
6 (vii) Comparisons among hospitals adjust for
7 patient case mix and other relevant risk factors and
8 control for provider peer groups;
9 (viii) Effective safeguards to protect against
10 the unauthorized use or disclosure of hospital
11 information are developed and implemented;
12 (ix) Effective safeguards to protect against
13 the dissemination of inconsistent, incomplete,
14 invalid, inaccurate, or subjective provider data are
15 developed and implemented;
16 (x) The quality and accuracy of hospital
17 information reported under this Act and its data
18 collection, analysis, and dissemination
19 methodologies are evaluated regularly; and
20 (xi) Only the most basic identifying
21 information from mandatory reports is used, and
22 patient identifiable information is not released.
23 The input data collected by the Department shall not
24 be a public record under the Illinois Freedom of
25 Information Act.
26 None of the information the Department discloses to
27 the public under this Act may be used to establish a
28 standard of care in a private civil action.
29 (9) The Department must develop and implement an
30 outreach campaign to educate the public regarding the
31 availability of the "Consumer Guide to Health Care".
32 (10) Within 12 months after the effective date of
33 this amendatory Act of the 93rd General Assembly, the
34 Department must study the most effective methods for
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1 public disclosure of patient charge data and health care
2 quality information that will be useful to consumers in
3 making health care decisions and report its
4 recommendations to the Governor and to the General
5 Assembly.
6 (11) The Department must undertake all steps
7 necessary under State and Federal law to protect patient
8 confidentiality in order to prevent the identification of
9 individual patient records.
10 (e) (Blank).
11 (Source: P.A. 91-756, eff. 6-2-00; 92-597, eff. 7-1-02.)
12 Section 99. Effective date. This Act takes effect upon
13 becoming law.