HB2684ham001 99TH GENERAL ASSEMBLY

Rep. Greg Harris

Filed: 3/23/2015

09900HB2684ham001 LRB099 09532 JLK 32737 a

AMENDMENT TO HOUSE BILL 2684

AMENDMENT NO. ______. Amend House Bill 2684 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Public Aid Code is amended by adding Section 5-30.2 as follows:

(305 ILCS 5/5-30.2 new)

Sec. 5-30.2. Data sharing among participating institutions.

(a) As used in this Section:

"Department" means the Department of Healthcare and Family Services.

"HIPAA" means the Health Information Portability and Accountability Act of 1996, Public Law 104-191, as amended by the Health Information Technology for Economic and Clinical Health Act of 2009, Public Law 111-05, and any subsequent amendments thereto and any regulations promulgated thereunder.

"Participating institutions" means institutions that have an institutional review board or access to an institutional review board that is in compliance with the United States Department of Health and Human Services Office of Human Research Protections and are a State university, Tier I or Tier II academic medical center, an association incorporated in Illinois that (i) possesses a demonstrated research capacity and (ii) is determined by the Department to represent a broad number of providers who serve recipients of medical assistance under Article V of the Illinois Public Aid Code, and any other entity designated by the Department.

"Research" means a systematic investigation, including research development, testing, and evaluation designed to develop or contribute to generalizable knowledge.

"Tier I and Tier II academic medical centers" has the meaning given to those terms under Section 5-5e.2 of the Illinois Public Aid Code.

(b) The General Assembly finds that the Illinois Medicaid program is undergoing a transition to managed care for Medicaid populations subject to the Medicaid Reform Act of 2011, the Save Medicaid Access Together Act of 2012, and other Acts affecting Medicaid populations and delivery systems. The General Assembly further finds that Illinois possesses an abundance of academic research entities with expertise in the academic fields related to health care practices, health outcomes, special needs populations, and health care delivery design. To that end, the General Assembly additionally finds that:

(1) 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 the Illinois Medicaid Program that will lead to better health outcomes at a lower cost.

(2) Accurate research findings should be made available to the Illinois General Assembly from a variety of independent qualified research entities.

(3) As the Medicaid program transforms from a fee for service system to a system based on capitated contracts, there must be sufficient transparency in those contracts to allow for evaluation of their effectiveness by the legislature through receipt of data analysis performed by qualified independent research institutions.

(c) Notwithstanding any other provisions of law to the contrary, the Department is hereby authorized and directed to provide the individual patient medical claims information, including individual data for services provided through capitated contracts, of medical assistance participants to participating institutions for the analysis purposes for which the State Funded Health Care Quality Assurance and Research Fund is created, as specified in Section 6z-101 of the State Finance Act. The patient medical claims information shall only include the Medicaid recipient identification number in addition to other individual medical claims patient data that has been de-identified in accordance with HIPAA so as to qualify as a limited data set under HIPAA, and shall only be shared in accordance with HIPAA. Information identifying health plans and health care providers shall be made available only in the event the research study commissioned by the General Assembly through the Commission on Government Forecasting and Accountability or the Department requires that such information be analyzed. The Department, and participating institutions must enter into data sharing agreements and business associate agreements to ensure privacy protection, HIPAA compliance, and to safeguard the security and confidentiality of such records. The Department shall make as much data available as possible in order to promote transparency and unencumbered data analysis.

The data shall be shared electronically with each participating entity on a State fiscal year basis once the data year is considered complete, and not longer than 8 months after the close of the State fiscal year. A complete State fiscal year data set will be based on dates of service during a State fiscal year and shall be considered complete when sufficient time after the fiscal year has occurred to process all claims and make corrections to improperly filed claims. Data for fiscal years prior to the passage of this amendatory Act of the 99th General Assembly shall be made available if requested by the participating institution and the data are available to the Department.

Participating institutions and entities may, at their own expense and consistent with rules adopted by the Department, produce research reports related to the purposes of this amendatory Act of the 99th General Assembly, provided that all patient medical claims information has been aggregated and de-identified. Participating institutions and entities may not use such medical claims information for commercial purposes or otherwise transfer any such medical claims information to any other entity. Nothing in this amendatory Act of the 99th General Assembly shall be construed as prohibiting a participating institution and entity from partnering with another entity, either voluntarily or by contract, to produce research reports, so long as no individually identifiable data is shared with the participating institution or entity.

Any data received under this Section must be used solely for research purposes by the research entity and the confidentiality of any data provided to authorized individuals pursuant to this Section must be maintained in accordance with the provisions of this Section and other applicable laws. Any use of the data for commercial purposes in violation of this Section shall be subject to fines and penalties specified herein, including the loss of access to data.

Section 10. The State Finance Act is amended by adding Section 6z-101 as follows:

(30 ILCS 105/6z-101 new)

Sec. 6z-101. State Funded Health Care Quality Assurance and Research Fund. The State Funded Health Care Quality Assurance and Research Fund is created. The State Funded Health Care Quality Assurance and Research Fund shall consist of receipts from State fund transfers, including the Healthcare Provider Relief Fund, and contributions from participating institutions, as that term is defined under Section 5-30.2 of the Illinois Public Aid Code. Any receipts from the federal government related to expenditures from the State Funded Health Care Quality Assurance and Research Fund shall be deposited into the Healthcare Provider Relief Fund. All interest earned on moneys in the State Funded Health Care Quality Assurance and Research Fund shall be deposited in the State Funded Health Care Quality Assurance and Research Fund.

The State Funded Health Care Quality Assurance and Research Fund shall be appropriated to the Department of Healthcare and Family Services. The purpose of the State Funded Health Care Quality Assurance and Research Fund is to provide the Illinois General Assembly and the Department with independent analysis of:

(1) the efficacy of State managed care programs to improve the patient experience of health care, and the health of the population, and to reduce costs of health care;

(2) the efficacy of the Department of Healthcare and Family Services in monitoring healthcare outcomes in managed care and other settings;

(3) the efficacy of State managed care programs to improve continuity of care, ensure adequate provider participation, and maintain appropriate utilization of health services;

(4) any possible gaps in healthcare for populations served by the State and recommendations on how to close them;

(5) successful outcomes and best practices in improving the health of the population and the quality of care while reducing the cost;

(6) in combination with other data sources, the impact of managed care on the social determinants of health as well as on non-clinical outcomes, such as employment and educational attainment; and

(7) the degree to which appropriate mechanisms are in place to assess the Department of Healthcare and Family Services' internal quality assurance processes.

Appropriations to the Commission on Government Forecasting and Accountability from the State Funded Health Care Quality Assurance and Research Fund may be made by the General Assembly through an appropriation from the Fund and either a law or a resolution of either chamber authorizing the study, including the reasons for the study, the direction to the Commission on Government Forecasting and Accountability to contract for the study, the question or questions the study will answer, the requirement that the Department and other relevant State entities cooperate with the selected contractor, and the date the report is due. Appropriations from the State Funded Health Care Quality Assurance and Research Fund may also be used to pay for the costs to the Commission on Governmental Forecasting and Accountability of developing and reviewing contract proposals. Nothing in this amendatory Act of the 99th General Assembly requires that the Commission on Government Forecasting and Accountability award a contract to a participating institution.

Each participating institution, as that term is defined under Section 5-30.2 of the Illinois Public Aid Code, may choose to participate in the State Funded Health Care Quality Assurance and Research Fund and the associated research by annually contributing up to $250,000 into the Healthcare Provider Relief Fund. Based upon the number of participants, the costs to the Department of Healthcare and Family Services, and the appropriations made to the Department of Healthcare and Family Services and the Commission on Forecasting and Governmental Accountability, the Department shall determine the contribution amount for participants. All participants shall pay the same amount. In the event that the research data described in Section 3.1 of the Commission on Government Forecasting and Accountability Act is not provided to the participating entities or the research data or similar data is shared with an entity not identified in Section 3.1 free of charge, each entity shall be refunded the amount they each paid into the State Funded Health Care Quality Assurance and Research Fund.

The State shall transfer into the State Funded Health Care Quality Assurance and Research Fund, from the Healthcare Provider Relief Fund, an amount equal to the contributions made by participating entities.

Any use of the data for commercial purposes or for another purpose not authorized under Section 5-30.2 of the Illinois Public Aid Code shall result in loss of access to the data for a period of one year after the data year the last data set had been received, no refunding of the fees authorized under this Section, and a fine of $2,500 for each violation, which shall be deposited into the State Funded Health Care Quality Assurance and Research Fund.

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