99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB0302

 

Introduced , by Rep. William Davis

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 86/25

    Amends the Hospital Report Card Act. Requires hospitals to include in their quarterly reports additional infection measures mandated by the Centers for Medicare and Medicaid Services that are reported by hospitals to the Centers for Disease Control and Prevention's National Healthcare Safety Network surveillance system and deemed relevant to patient safety by the Department of Public Health. Provides that the Department may align the infection-related measures that are required to be reported by hospitals with the measures and methods developed by the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, the Joint Commission on Accreditation of Healthcare Organizations, and the National Quality Forum by adding and retiring reporting measures based on national health care strategies and measures deemed scientifically reliable and valid for public reporting.


LRB099 00335 RPS 20341 b

 

 

A BILL FOR

 

HB0302LRB099 00335 RPS 20341 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Hospital Report Card Act is amended by
5changing Section 25 as follows:
 
6    (210 ILCS 86/25)
7    Sec. 25. Hospital reports.
8    (a) Individual hospitals shall prepare a quarterly report
9including all of the following:
10        (1) Nursing hours per patient day, average daily
11    census, and average daily hours worked for each clinical
12    service area.
13        (2) Infection-related measures for the facility for
14    the specific clinical procedures and devices determined by
15    the Department by rule under 2 or more of the following
16    categories:
17            (A) Surgical procedure outcome measures.
18            (B) Surgical procedure infection control process
19        measures.
20            (C) Outcome or process measures related to
21        ventilator-associated pneumonia.
22            (D) Central vascular catheter-related bloodstream
23        infection rates in designated critical care units.

 

 

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1        (3) Information required under paragraph (4) of
2    Section 2310-312 of the Department of Public Health Powers
3    and Duties Law of the Civil Administrative Code of
4    Illinois.
5        (4) Additional infection measures mandated by the
6    Centers for Medicare and Medicaid Services that are
7    reported by hospitals to the Centers for Disease Control
8    and Prevention's National Healthcare Safety Network
9    surveillance system, or its successor, and deemed relevant
10    to patient safety by the Department.
11    The infection-related measures developed by the Department
12shall be based upon measures and methods developed by the
13Centers for Disease Control and Prevention, the Centers for
14Medicare and Medicaid Services, the Agency for Healthcare
15Research and Quality, the Joint Commission on Accreditation of
16Healthcare Organizations, or the National Quality Forum. The
17Department may align the infection-related measures with the
18measures and methods developed by the Centers for Disease
19Control and Prevention, the Centers for Medicare and Medicaid
20Services, the Agency for Healthcare Research and Quality, the
21Joint Commission on Accreditation of Healthcare Organizations,
22and the National Quality Forum by adding and retiring reporting
23measures based on national health care strategies and measures
24deemed scientifically reliable and valid for public reporting.
25    The Department shall include interpretive guidelines for
26infection-related indicators and, when available, shall

 

 

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1include relevant benchmark information published by national
2organizations.
3    (b) Individual hospitals shall prepare annual reports
4including vacancy and turnover rates for licensed nurses per
5clinical service area.
6    (c) None of the information the Department discloses to the
7public may be made available in any form or fashion unless the
8information has been reviewed, adjusted, and validated
9according to the following process:
10        (1) The Department shall organize an advisory
11    committee, including representatives from the Department,
12    public and private hospitals, direct care nursing staff,
13    physicians, academic researchers, consumers, health
14    insurance companies, organized labor, and organizations
15    representing hospitals and physicians. The advisory
16    committee must be meaningfully involved in the development
17    of all aspects of the Department's methodology for
18    collecting, analyzing, and disclosing the information
19    collected under this Act, including collection methods,
20    formatting, and methods and means for release and
21    dissemination.
22        (2) The entire methodology for collecting and
23    analyzing the data shall be disclosed to all relevant
24    organizations and to all hospitals that are the subject of
25    any information to be made available to the public before
26    any public disclosure of such information.

 

 

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1        (3) Data collection and analytical methodologies shall
2    be used that meet accepted standards of validity and
3    reliability before any information is made available to the
4    public.
5        (4) The limitations of the data sources and analytic
6    methodologies used to develop comparative hospital
7    information shall be clearly identified and acknowledged,
8    including but not limited to the appropriate and
9    inappropriate uses of the data.
10        (5) To the greatest extent possible, comparative
11    hospital information initiatives shall use standard-based
12    norms derived from widely accepted provider-developed
13    practice guidelines.
14        (6) Comparative hospital information and other
15    information that the Department has compiled regarding
16    hospitals shall be shared with the hospitals under review
17    prior to public dissemination of such information and these
18    hospitals have 30 days to make corrections and to add
19    helpful explanatory comments about the information before
20    the publication.
21        (7) Comparisons among hospitals shall adjust for
22    patient case mix and other relevant risk factors and
23    control for provider peer groups, when appropriate.
24        (8) Effective safeguards to protect against the
25    unauthorized use or disclosure of hospital information
26    shall be developed and implemented.

 

 

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1        (9) Effective safeguards to protect against the
2    dissemination of inconsistent, incomplete, invalid,
3    inaccurate, or subjective hospital data shall be developed
4    and implemented.
5        (10) The quality and accuracy of hospital information
6    reported under this Act and its data collection, analysis,
7    and dissemination methodologies shall be evaluated
8    regularly.
9        (11) Only the most basic identifying information from
10    mandatory reports shall be used, and information
11    identifying a patient, employee, or licensed professional
12    shall not be released. None of the information the
13    Department discloses to the public under this Act may be
14    used to establish a standard of care in a private civil
15    action.
16    (d) Quarterly reports shall be submitted, in a format set
17forth in rules adopted by the Department, to the Department by
18April 30, July 31, October 31, and January 31 each year for the
19previous quarter. Data in quarterly reports must cover a period
20ending not earlier than one month prior to submission of the
21report. Annual reports shall be submitted by December 31 in a
22format set forth in rules adopted by the Department to the
23Department. All reports shall be made available to the public
24on-site and through the Department.
25    (e) If the hospital is a division or subsidiary of another
26entity that owns or operates other hospitals or related

 

 

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1organizations, the annual public disclosure report shall be for
2the specific division or subsidiary and not for the other
3entity.
4    (f) The Department shall disclose information under this
5Section in accordance with provisions for inspection and
6copying of public records required by the Freedom of
7Information Act provided that such information satisfies the
8provisions of subsection (c) of this Section.
9    (g) Notwithstanding any other provision of law, under no
10circumstances shall the Department disclose information
11obtained from a hospital that is confidential under Part 21 of
12Article VIII of the Code of Civil Procedure.
13    (h) No hospital report or Department disclosure may contain
14information identifying a patient, employee, or licensed
15professional.
16(Source: P.A. 98-463, eff. 8-16-13.)