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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 5. The Illinois Health Finance Reform Act is
5amended 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 that
13    all hospitals and ambulatory surgical treatment centers
14    licensed to operate in the State of Illinois adopt a
15    uniform system for submitting patient claims and encounter
16    data for payment from public and private payors. This
17    system shall be based upon adoption of the uniform
18    electronic billing form pursuant to the Health Insurance
19    Portability and Accountability Act.
20        (2) (Blank).
21        (3) The Department of Insurance shall require all
22    third-party payors, including but not limited to, licensed
23    insurers, medical and hospital service corporations,

 

 

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1    health maintenance organizations, and self-funded employee
2    health plans, to accept the uniform billing form, without
3    attachment as submitted by hospitals pursuant to paragraph
4    (1) of subsection (d) above, effective January 1, 1985;
5    provided, however, nothing shall prevent all such third
6    party payors from requesting additional information
7    necessary to determine eligibility for benefits or
8    liability for reimbursement for services provided.
9        (4) By no later than 60 days after the end of each
10    calendar quarter, each hospital licensed in the State shall
11    electronically submit to the Department inpatient and
12    outpatient claims and encounter data related to surgical
13    and invasive procedures collected under paragraph (5) for
14    each patient.
15        By no later than 60 days after the end of each calendar
16    quarter, each ambulatory surgical treatment center
17    licensed in the State shall electronically submit to the
18    Department outpatient claims and encounter data collected
19    under paragraph (5) for each patient, provided however,
20    that, until July 1, 2006, ambulatory surgical treatment
21    centers who cannot electronically submit data may submit
22    data by computer diskette. For hospitals, the claims and
23    encounter data to be reported shall include all inpatient
24    surgical cases. Claims and encounter data submitted under
25    this Act shall not include a patient's name, address, or
26    Social Security number.

 

 

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1        (5) By no later than January 1, 2006, the Department
2    must collect and compile claims and encounter data related
3    to surgical and invasive procedures according to uniform
4    electronic submission formats as required under the Health
5    Insurance Portability and Accountability Act. By no later
6    than January 1, 2006, the Department must collect and
7    compile from ambulatory surgical treatment centers the
8    claims and encounter data according to uniform electronic
9    data element formats as required under the Health Insurance
10    Portability and Accountability Act of 1996 (HIPAA).
11        (6) The Department shall make available on its website
12    the "Consumer Guide to Health Care" by January 1, 2006. The
13    Department shall also make available on its website the
14    Hospital Report Card Act. The "Consumer Guide to Health
15    Care" and the Hospital Report Card Act were established to
16    educate and assist Illinois health care consumers as they
17    make health care choices for themselves, their families,
18    and their loved ones. Significant and useful information is
19    available through the "Consumer Guide to Health Care" and
20    the Hospital Report Card Act. The links to the "Consumer
21    Guide to Health Care" and the Hospital Report Card Act on
22    the Department's website shall include a brief description
23    of the information available in both. When the Department
24    creates new or updates existing consumer fact sheets and
25    other information or materials for the purpose of educating
26    the Illinois health care consumer, it shall reference the

 

 

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1    web pages of the "Consumer Guide to Health Care" and the
2    Hospital Report Card Act when it is relevant and
3    appropriate. The "Consumer Guide to Health Care" shall
4    include information on at least 30 inpatient conditions and
5    procedures identified by the Department that demonstrate
6    the highest degree of variation in patient charges and
7    quality of care. By no later than January 1, 2007, the
8    "Consumer Guide to Health Care" shall also include
9    information on at least 30 outpatient conditions and
10    procedures identified by the Department that demonstrate
11    the highest degree of variation in patient charges and
12    quality care. As to each condition or procedure, the
13    "Consumer Guide to Health Care" shall include up-to-date
14    comparison information relating to volume of cases,
15    average charges, risk-adjusted mortality rates, and
16    nosocomial infection rates and, with respect to outpatient
17    surgical and invasive procedures, shall include
18    information regarding surgical infections, complications,
19    and direct admissions of outpatient cases to hospitals for
20    selected procedures, as determined by the Department,
21    based on review by the Department of its own, local, or
22    national studies. Information disclosed pursuant to this
23    paragraph on mortality and infection rates shall be based
24    upon information hospitals and ambulatory surgical
25    treatment centers have either (i) previously submitted to
26    the Department pursuant to their obligations to report

 

 

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1    health care information under this Act or other public
2    health reporting laws and regulations outside of this Act
3    or (ii) submitted to the Department under the provisions of
4    the Hospital Report Card Act.
5        (7) Publicly disclosed information must be provided in
6    language that is easy to understand and accessible to
7    consumers using an interactive query system. The guide
8    shall include such additional information as is necessary
9    to enhance decision making among consumer and health care
10    purchasers, which shall include, at a minimum, appropriate
11    guidance on how to interpret the data and an explanation of
12    why the data may vary from provider to provider. The
13    "Consumer Guide to Health Care" shall also cite standards
14    that facilities meet under state and federal law and, if
15    applicable, to achieve voluntary accreditation.
16        (8) None of the information the Department discloses to
17    the public under this subsection may be made available
18    unless the information has been reviewed, adjusted, and
19    validated according to the following process:
20            (i) Hospitals, ambulatory surgical treatment
21        centers, and organizations representing hospitals,
22        ambulatory surgical treatment centers, purchasers,
23        consumer groups, and health plans are meaningfully
24        involved in providing advice and consultation to the
25        Department in the development of all aspects of the
26        Department's methodology for collecting, analyzing,

 

 

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1        and disclosing the information collected under this
2        Act, including collection methods, formatting, and
3        methods and means for release and dissemination;
4            (ii) The entire methodology for collecting and
5        analyzing the data is disclosed to all relevant
6        organizations and to all providers that are the subject
7        of any information to be made available to the public
8        before any public disclosure of such information;
9            (iii) Data collection and analytical methodologies
10        are used that meet accepted standards of validity and
11        reliability before any information is made available
12        to the public;
13            (iv) The limitations of the data sources and
14        analytic methodologies used to develop comparative
15        provider information are clearly identified and
16        acknowledged, including, but not limited to,
17        appropriate and inappropriate uses of the data;
18            (v) To the greatest extent possible, comparative
19        hospital and ambulatory surgical treatment center
20        information initiatives use standard-based norms
21        derived from widely accepted provider-developed
22        practice guidelines;
23            (vi) Comparative hospital and ambulatory surgical
24        treatment center information and other information
25        that the Department has compiled regarding hospitals
26        and ambulatory surgical treatment centers is shared

 

 

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1        with the hospitals and ambulatory surgical treatment
2        centers under review prior to public dissemination of
3        the information and these providers have an
4        opportunity to make corrections and additions of
5        helpful explanatory comments about the information
6        before the publication;
7            (vii) Comparisons among hospitals and ambulatory
8        surgical treatment centers adjust for patient case mix
9        and other relevant risk factors and control for
10        provider peer groups, if applicable;
11            (viii) Effective safeguards to protect against the
12        unauthorized use or disclosure of hospital and
13        ambulatory surgical treatment center information are
14        developed and implemented;
15            (ix) Effective safeguards to protect against the
16        dissemination of inconsistent, incomplete, invalid,
17        inaccurate, or subjective provider data are developed
18        and implemented;
19            (x) The quality and accuracy of hospital and
20        ambulatory surgical treatment center information
21        reported under this Act and its data collection,
22        analysis, and dissemination methodologies are
23        evaluated regularly; and
24            (xi) Only the most basic hospital or ambulatory
25        surgical treatment center identifying information from
26        mandatory reports is used. Information regarding a

 

 

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1        hospital or ambulatory surgical center may be released
2        regardless of the number of employees or health care
3        professionals whose data are reflected in the data for
4        the hospital or ambulatory surgical treatment center
5        as long as no specific information identifying an
6        employee or a health care professional is released.
7        Further, patient identifiable information is not
8        released. The input data collected by the Department
9        shall not be a public record under the Illinois Freedom
10        of Information Act.
11        None of the information the Department discloses to the
12    public under this Act may be used to establish a standard
13    of care in a private civil action.
14        (9) The Department must develop and implement an
15    outreach campaign to educate the public regarding the
16    availability of the "Consumer Guide to Health Care".
17        (10) By January 1, 2006, the Department must study the
18    most effective methods for public disclosure of patient
19    claims and encounter data and health care quality
20    information that will be useful to consumers in making
21    health care decisions and report its recommendations to the
22    Governor and to the General Assembly.
23        (11) The Department must undertake all steps necessary
24    under State and Federal law to protect patient
25    confidentiality in order to prevent the identification of
26    individual patient records.

 

 

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1        (12) The Department must adopt rules for inpatient and
2    outpatient data collection and reporting no later than
3    January 1, 2006.
4        (13) In addition to the data products indicated above,
5    the Department shall respond to requests by government
6    agencies, academic research organizations, and private
7    sector organizations for purposes of clinical performance
8    measurements and analyses of data collected pursuant to
9    this Section.
10        (14) The Department, with the advice of and in
11    consultation with hospitals, ambulatory surgical treatment
12    centers, organizations representing hospitals,
13    organizations representing ambulatory treatment centers,
14    purchasers, consumer groups, and health plans, must
15    evaluate additional methods for comparing the performance
16    of hospitals and ambulatory surgical treatment centers,
17    including the value of disclosing additional measures that
18    are adopted by the National Quality Forum, The Joint
19    Commission on Accreditation of Healthcare Organizations,
20    the Accreditation Association for Ambulatory Health Care,
21    the Centers for Medicare and Medicaid Services, or similar
22    national entities that establish standards to measure the
23    performance of health care providers. The Department shall
24    report its findings and recommendations on its Internet
25    website and to the Governor and General Assembly no later
26    than July 1, 2006.

 

 

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1    (e) (Blank).
2(Source: P.A. 93-144, eff. 7-10-03; 94-27, eff. 6-14-05.)