093_HB2202ham003











                                     LRB093 06053 MKM 14180 a

 1                    AMENDMENT TO HOUSE BILL 2202

 2        AMENDMENT NO.     .  Amend House Bill 2202,  AS  AMENDED,
 3    by  replacing  everything  after the enacting clause with the
 4    following:

 5        "Section 5. The Illinois Health Care Finance  Reform  Act
 6    is amended by changing Section 4-2 as follows:

 7        (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
 8        Sec. 4-2.  Powers and duties.
 9        (a)  (Blank).
10        (b)  (Blank).
11        (c)  (Blank).
12        (d)  Uniform Provider Utilization and Charge Information.
13             (1)  The  Department  of Public Health shall require
14        that all hospitals licensed to operate in  the  State  of
15        Illinois  adopt  a  uniform system for submitting patient
16        charges  for  payment  from  public  and  private  payors
17        effective January 1, 1985.  This system  shall  be  based
18        upon  adoption of the uniform electronic hospital billing
19        form pursuant to the  Health  Insurance  Portability  and
20        Accountability   Act   (UB-92)   or  its  successor  form
21        developed by the National Uniform Billing Committee.
22             (2)  (Blank).
 
                            -2-      LRB093 06053 MKM 14180 a
 1             (3)  The Department of Insurance shall  require  all
 2        third-party   payors,   including  but  not  limited  to,
 3        licensed   insurers,   medical   and   hospital   service
 4        corporations,  health  maintenance   organizations,   and
 5        self-funded  employee health plans, to accept the uniform
 6        billing  form,  without  attachment   as   submitted   by
 7        hospitals  pursuant  to  paragraph  (1) of subsection (d)
 8        above, effective  January  1,  1985;  provided,  however,
 9        nothing  shall  prevent  all such third party payors from
10        requesting additional information necessary to  determine
11        eligibility  for  benefits or liability for reimbursement
12        for services provided.
13             (4)  Each  hospital  licensed  in  the  State  shall
14        electronically submit to the Department  patient  billing
15        data  for  conditions  and procedures required for public
16        disclosure pursuant to paragraph (6). For hospitals,  the
17        billing  data  to be reported shall include all inpatient
18        surgical cases. Billing data  submitted  under  this  Act
19        shall  not  include  a patient's name, address, or Social
20        Security number.
21             (5)  By  no  later  than  January   1,   2005,   the
22        Department must collect and compile billing data required
23        under  paragraph  (6)  according  to  uniform  electronic
24        submission formats as required under the Health Insurance
25        Portability and Accountability Act.
26             (6)  The  Department  shall  make  available  on its
27        website the "Consumer Guide to Health Care" by January 1,
28        2006. The "Consumer Guide to Health Care"  shall  include
29        information on 30 conditions and procedures identified by
30        the  Department  that  demonstrate  the highest degree of
31        variation in patient charges and quality of care.  As  to
32        each  condition  or  procedure,  the  "Consumer  Guide to
33        Health  Care"   shall   include   up-to-date   comparison
34        information relating to volume of cases, average charges,
 
                            -3-      LRB093 06053 MKM 14180 a
 1        risk-adjusted  mortality  rates, and nosocomial infection
 2        rates. Information disclosed pursuant to  this  paragraph
 3        on  mortality  and  infection  rates  shall be based upon
 4        information hospitals have previously  submitted  to  the
 5        Department pursuant to their obligations to report health
 6        care information under other public health reporting laws
 7        and regulations outside of this Act.
 8             (7)  Publicly disclosed information must be provided
 9        in  language that is easy to understand and accessible to
10        consumers using an interactive query system.
11             (8)  None  of   the   information   the   Department
12        discloses to the public under this subsection may be made
13        available  unless  the  information  has  been  reviewed,
14        adjusted,   and  validated  according  to  the  following
15        process:
16                  (i)  Hospitals and  organizations  representing
17             hospitals   are   meaningfully   involved   in   the
18             development  of  all  aspects  of  the  Department's
19             methodology    for    collecting,   analyzing,   and
20             disclosing the information collected under this Act,
21             including  collection   methods,   formatting,   and
22             methods and means for release and dissemination;
23                  (ii)  The entire methodology for collection and
24             analyzing  the  data  is  disclosed  to all relevant
25             organizations and to  all  providers  that  are  the
26             subject  of  any information to be made available to
27             the public before  any  public  disclosure  of  such
28             information;
29                  (iii)  Data     collection    and    analytical
30             methodologies are used that meet accepted  standards
31             of  validity  and reliability before any information
32             is made available to the public;
33                  (iv)  The limitations of the data  sources  and
34             analytic  methodologies  used to develop comparative
 
                            -4-      LRB093 06053 MKM 14180 a
 1             provider  information  are  clearly  identified  and
 2             acknowledged,  including,  but   not   limited   to,
 3             appropriate and inappropriate uses of the data;
 4                  (v)  To    the    greatest   extent   possible,
 5             comparative  hospital  information  initiatives  use
 6             standard-based norms derived  from  widely  accepted
 7             provider-developed practice guidelines;
 8                  (vi)  Comparative   hospital   information  and
 9             other information that the Department  has  compiled
10             regarding  hospitals  is  shared  with the hospitals
11             under review prior to public  dissemination  of  the
12             information  and these providers have an opportunity
13             to  make  corrections  and  additions   of   helpful
14             explanatory  comments  about  the information before
15             the publication;
16                  (vii)  Comparisons among hospitals  adjust  for
17             patient case mix and other relevant risk factors and
18             control for provider peer groups;
19                  (viii)  Effective safeguards to protect against
20             the  unauthorized  use  or  disclosure  of  hospital
21             information are developed and implemented;
22                  (ix)  Effective  safeguards  to protect against
23             the  dissemination  of   inconsistent,   incomplete,
24             invalid, inaccurate, or subjective provider data are
25             developed and implemented;
26                  (x)  The   quality  and  accuracy  of  hospital
27             information reported under this  Act  and  its  data
28             collection,      analysis,     and     dissemination
29             methodologies are evaluated regularly; and
30                  (xi)  Only   the   most    basic    identifying
31             information  from  mandatory  reports  is  used, and
32             patient identifiable information  is  not  released.
33             The input data collected by the Department shall not
34             be  a  public  record  under the Illinois Freedom of
 
                            -5-      LRB093 06053 MKM 14180 a
 1             Information Act.
 2             None of the information the Department discloses  to
 3        the  public  under  this  Act  may be used to establish a
 4        standard of care in a private civil action.
 5             (9)  The Department must develop  and  implement  an
 6        outreach  campaign  to  educate  the public regarding the
 7        availability of the "Consumer Guide to Health Care".
 8             (10)  Within 12 months after the effective  date  of
 9        this  amendatory  Act  of  the 93rd General Assembly, the
10        Department must study  the  most  effective  methods  for
11        public  disclosure of patient charge data and health care
12        quality information that will be useful to  consumers  in
13        making    health    care   decisions   and   report   its
14        recommendations  to  the  Governor  and  to  the  General
15        Assembly.
16             (11)  The  Department  must  undertake   all   steps
17        necessary  under State and Federal law to protect patient
18        confidentiality in order to prevent the identification of
19        individual patient records.
20        (e)  (Blank).
21    (Source: P.A. 91-756, eff. 6-2-00; 92-597, eff. 7-1-02.)

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