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.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be referred to as the
5Medicaid Reform Research Act.
 
6    Section 5. Findings. Whereas Illinois' Medical Assistance
7program is undergoing a transition to managed care for Medicaid
8populations subject to the Medicaid Reform Act of 2011, the
9Save Medicaid Access Together (SMART) Act of 2012, and other
10Acts affecting Medicaid populations and delivery systems; and
11    Whereas Illinois possesses an abundance of academic
12research entities with expertise in the academic fields related
13to health care practices, health outcomes, special needs
14populations, and health care delivery design, the General
15Assembly finds that:
16        (1) A lawful and well-regulated dissemination of
17    Medicaid data to qualified researchers is the best way to
18    create accurate and creative unbiased analysis and
19    information about Illinois' Medical Assistance Program
20    that will lead to better health outcomes at a lower cost.
21        (2) Accurate research findings should be made
22    available to the General Assembly from a variety of
23    independent qualified research entities.

 

 

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1        (3) As Illinois' Medical Assistance Program transforms
2    from a fee-for-service system to a system based on
3    capitated contracts, there must be sufficient transparency
4    in those contracts to allow for evaluation of their
5    effectiveness by the General Assembly through receipt of
6    data analysis performed by qualified independent research
7    institutions.
8        (4) Any data received under this Act must be used
9    solely for research purposes by the research entity; and
10    the confidentiality of any data provided to authorized
11    individuals pursuant to this Act must be maintained in
12    accordance with the provisions of this Act and other
13    applicable laws.
14        (5) Any use of the data for commercial purposes in
15    violation of this Act shall be subject to the fines and
16    penalties specified in the State Finance Act, including the
17    loss of access to data.
 
18    Section 10. The Commission on Government Forecasting and
19Accountability Act is amended by changing Section 3 as follows:
 
20    (25 ILCS 155/3)  (from Ch. 63, par. 343)
21    Sec. 3.
22    (a) The Commission shall:
23        (1) Study from time to time and report to the General
24    Assembly on economic development and trends in the State.

 

 

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1        (2) Make such special economic and fiscal studies as it
2    deems appropriate or desirable or as the General Assembly
3    may request.
4        (3) Based on its studies, recommend such State fiscal
5    and economic policies as it deems appropriate or desirable
6    to improve the functioning of State government and the
7    economy of the various regions within the State.
8        (4) Prepare annually a State economic report.
9        (5) Provide information for all appropriate
10    legislative organizations and personnel on economic trends
11    in relation to long range planning and budgeting.
12        (6) Study and make such recommendations as it deems
13    appropriate to the General Assembly on local and regional
14    economic and fiscal policy and on federal fiscal policy as
15    it may affect Illinois.
16        (7) Review capital expenditures, appropriations and
17    authorizations for both the State's general obligation and
18    revenue bonding authorities. At the direction of the
19    Commission, specific reviews may include economic
20    feasibility reviews of existing or proposed revenue bond
21    projects to determine the accuracy of the original estimate
22    of useful life of the projects, maintenance requirements
23    and ability to meet debt service requirements through their
24    operating expenses.
25        (8) Receive and review all executive agency and revenue
26    bonding authority annual and 3 year plans. The Commission

 

 

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1    shall prepare a consolidated review of these plans, an
2    updated assessment of current State agency capital plans, a
3    report on the outstanding and unissued bond
4    authorizations, an evaluation of the State's ability to
5    market further bond issues and shall submit them as the
6    "Legislative Capital Plan Analysis" to the House and Senate
7    Appropriations Committees at least once a year. The
8    Commission shall annually submit to the General Assembly on
9    the first Wednesday of April a report on the State's
10    long-term capital needs, with particular emphasis upon and
11    detail of the 5-year period in the immediate future.
12        (9) Study and make recommendations it deems
13    appropriate to the General Assembly on State bond
14    financing, bondability guidelines, and debt management. At
15    the direction of the Commission, specific studies and
16    reviews may take into consideration short and long-run
17    implications of State bonding and debt management policy.
18        (10) Comply with the provisions of the "State Debt
19    Impact Note Act" as now or hereafter amended.
20        (11) Comply with the provisions of the Pension Impact
21    Note Act, as now or hereafter amended.
22        (12) By August 1st of each year, the Commission must
23    prepare and cause to be published a summary report of State
24    appropriations for the State fiscal year beginning the
25    previous July 1st. The summary report must discuss major
26    categories of appropriations, the issues the General

 

 

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1    Assembly faced in allocating appropriations, comparisons
2    with appropriations for previous State fiscal years, and
3    other matters helpful in providing the citizens of Illinois
4    with an overall understanding of appropriations for that
5    fiscal year. The summary report must be written in plain
6    language and designed for readability. Publication must be
7    in newspapers of general circulation in the various areas
8    of the State to ensure distribution statewide. The summary
9    report must also be published on the General Assembly's web
10    site.
11        (13) Comply with the provisions of the State Facilities
12    Closure Act.
13        (14) For fiscal year 2012 and thereafter, develop a
14    3-year budget forecast for the State, including
15    opportunities and threats concerning anticipated revenues
16    and expenditures, with an appropriate level of detail.
17    (b) In addition to any other powers and duties, the
18Commission may, subject to appropriations, coordinate and
19enter into agreements with the Department of Healthcare and
20Family Services and State universities, Tier I and Tier II
21academic medical centers as defined in the Illinois Public Aid
22Code, or other entities as designated by the Department of
23Healthcare and Family Services for research on medical
24assistance managed care or other State medical assistance
25programs in accordance with the analysis purposes for which the
26State-Funded Health Care Quality Assurance and Research Fund is

 

 

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1created, as specified in Section 6z-101 of the State Finance
2Act. As used in this subsection, "research" means a systematic
3investigation, including research development, testing, and
4evaluation, that is designed to develop or contribute to
5generalizable knowledge.
6    Notwithstanding any other provisions of law to the
7contrary, subject to appropriations or funds made available by
8agreement through the Commission, the Department of Healthcare
9and Family Services is authorized and directed to provide the
10individual patient medical claims information, including
11individual data for services provided through capitated
12contracts, concerning recipients of medical assistance to the
13following institutions and entities for the analysis purposes
14for which the State-Funded Health Care Quality Assurance and
15Research Fund is created, as specified in Section 6z-101 of the
16State Finance Act:
17        (1) State universities.
18        (2) Tier I and Tier II academic medical centers as
19    defined in the Illinois Public Aid Code.
20        (3) Associations incorporated in Illinois that (i)
21    possess demonstrated research capacity and an
22    institutional review board that is in compliance with the
23    U.S. Health and Human Services' Office for Human Research
24    Protections and (ii) are determined by the Department of
25    Healthcare and Family Services to represent a broad number
26    of providers who serve recipients of medical assistance

 

 

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1    provided under Article V of the Illinois Public Aid Code.
2        (4) Other entities designated by the Department of
3    Healthcare and Family Services for the analysis purposes
4    for which the State-Funded Health Care Quality Assurance
5    and Research Fund is created, as specified in Section
6    6z-101 of the State Finance Act.
7    The patient medical claims information provided (i) shall
8include only the Medicaid recipient identification number,
9which shall not be de-identified, and any other individual
10medical patient data that has been de-identified in accordance
11with the federal Health Insurance Portability and
12Accountability Act of 1996 (HIPAA) so as to qualify as a
13"limited data set" and (ii) shall be shared only in accordance
14with HIPAA.
15    The Commission, the Department of Healthcare and Family
16Services, and the entities listed in paragraphs (1) through (4)
17of this subsection must enter into data sharing agreements and
18business associate agreements to ensure privacy protection and
19HIPAA compliance and to safeguard the security and
20confidentiality of the patient medical claims information
21provided by the Department. The Department of Healthcare and
22Family Services shall make as much data available as possible
23in order to promote transparency and unencumbered data
24analysis.
25    The data shall be shared electronically with each
26participating entity on a State fiscal year basis once the data

 

 

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1year is considered complete, and not longer than 8 months after
2the close of the State fiscal year. A complete State fiscal
3year data set shall be based on dates of service during a State
4fiscal year and shall be considered complete when sufficient
5time has occurred after the end of the State fiscal year to
6process all claims and make corrections to improperly filed
7claims.
8    Participating institutions and entities may, at their own
9expense and consistent with rules adopted by the Department of
10Healthcare and Family Services, produce research reports
11related to the purposes of this amendatory Act of the 99th
12General Assembly, provided that all patient medical claims
13information provided in any such report has been aggregated and
14de-identified. Participating institutions and entities may not
15use such patient medical claims information for commercial
16purposes or otherwise transfer such patient medical claims
17information to any other entity. Nothing in this amendatory Act
18of the 99th General Assembly shall be construed as prohibiting
19a participating institution or entity from partnering with
20another entity voluntarily or by contract to produce research
21reports, so long as no individually identifiable data is shared
22with the participating institution or entity.
23    The Commission shall report to the General Assembly the
24findings and recommendations resulting from the research and
25analyses conducted in accordance with Section 6z-101 of the
26State Finance Act.

 

 

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1    (c) The requirement for reporting to the General Assembly
2shall be satisfied by filing copies of the report with the
3Speaker, the Minority Leader and the Clerk of the House of
4Representatives and the President, the Minority Leader and the
5Secretary of the Senate and the Legislative Research Unit, as
6required by Section 3.1 of the General Assembly Organization
7Act, and filing such additional copies with the State
8Government Report Distribution Center for the General Assembly
9as is required under paragraph (t) of Section 7 of the State
10Library Act.
11(Source: P.A. 96-958, eff. 7-1-10.)
 
12    Section 15. The State Finance Act is amended by adding
13Section 6z-101 as follows:
 
14    (30 ILCS 105/6z-101 new)
15    Sec. 6z-101. State-Funded Health Care Quality Assurance
16and Research Fund.
17    (a) The State-Funded Health Care Quality Assurance and
18Research Fund is created. The Fund shall consist of:
19        (1) receipts from State fund transfers, including
20    transfers from the Healthcare Provider Relief Fund;
21        (2) contributions from participating institutions and
22    entities as provided in subsection (c); and
23        (3) any receipts from the federal government related to
24    expenditures from the Fund.

 

 

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1    All interest earned on moneys in the Fund shall be
2deposited into the Fund.
3    (b) The Fund shall be appropriated to the Commission on
4Government Forecasting and Accountability. The purpose of the
5Fund is to fund an independent analysis of each of the
6following:
7        (1) The efficacy of State managed care programs to
8    improve the patient's experience with healthcare, to
9    improve the health of Medicaid populations, and to reduce
10    healthcare costs.
11        (2) The efficacy of the Department of Healthcare and
12    Family Services in monitoring healthcare outcomes in
13    managed care and other healthcare settings.
14        (3) Any possible gaps in healthcare for Medicaid
15    populations served by the State and recommendations on how
16    to close them.
17        (4) Successful outcomes and best practices in
18    improving the health of Medicaid populations and the
19    quality of care while reducing the cost.
20        (5) The efficacy of State managed care programs to
21    improve continuity of care, ensure adequate provider
22    participation, and maintain appropriate utilization of
23    health services.
24        (6) In combination with other data sources, the impact
25    of managed care on the social determinants of health as
26    well as on non-clinical outcomes such as employment and

 

 

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1    educational attainment.
2        (7) The degree to which appropriate mechanisms are in
3    place to assess the internal quality assurance processes of
4    the Department of Healthcare and Family Services.
5    (c) The following institutions and entities may choose to
6participate in the Fund and the associated research by
7contributing not more than $250,000 into the Healthcare
8Provider Relief Fund annually:
9        (1) State universities.
10        (2) Tier I or Tier II academic medical centers as
11    defined in the Illinois Public Aid Code.
12        (3) Associations incorporated in Illinois that possess
13    demonstrated research capacity and an institutional
14    research board and that, as determined by the Department of
15    Healthcare and Family Services, represent a broad number of
16    providers who serve recipients of medical assistance
17    provided under Article V of the Illinois Public Aid Code.
18        (4) Other entities as designated by the Department of
19    Healthcare and Family Services.
20    Based upon the number of participants, the costs to the
21Department of Healthcare and Family Services, and the
22appropriations made to the Department of Healthcare and Family
23Services and the Commission on Forecasting and Governmental
24Accountability, the Department shall determine the
25contribution amount for participants. All participants shall
26pay the same amount. Each participant shall be refunded the

 

 

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1amount it paid into the Fund if (i) the research data described
2in subsection (b) of Section 3 of the Commission on Government
3Forecasting and Accountability Act is not provided to the
4participating entities free of charge or (ii) the research data
5or similar data is shared with an entity not identified in
6subsection (b) of Section 3 of the Commission on Government
7Forecasting and Accountability Act.
8    The State shall transfer into the Fund, from the Healthcare
9Provider Relief Fund, an amount equal to the contributions made
10by participating entities.
11    Any use of the data for commercial purposes or for another
12purpose not authorized under subsection (b) of Section 3 of the
13Commission on Government Forecasting and Accountability Act
14shall result in: (i) no access to the data for a period of one
15year after the data year the last data set had been received;
16(ii) no refund of the fees authorized under this Section; and
17(iii) a civil penalty of $2,500 for each violation, which shall
18be deposited into the State-Funded Quality Care and Research
19Fund.
 
20    Section 99. Effective date. This Act takes effect upon
21becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    25 ILCS 155/3from Ch. 63, par. 343
4    30 ILCS 105/6z-101 new