Rep. Kay Hatcher

Filed: 3/14/2011

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 1562

2    AMENDMENT NO. ______. Amend House Bill 1562 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1    system shall be based upon adoption of the uniform
2    electronic billing form pursuant to the Health Insurance
3    Portability and Accountability Act.
4        (2) (Blank).
5        (3) The Department of Insurance shall require all
6    third-party payors, including but not limited to, licensed
7    insurers, medical and hospital service corporations,
8    health maintenance organizations, and self-funded employee
9    health plans, to accept the uniform billing form, without
10    attachment as submitted by hospitals pursuant to paragraph
11    (1) of subsection (d) above, effective January 1, 1985;
12    provided, however, nothing shall prevent all such third
13    party payors from requesting additional information
14    necessary to determine eligibility for benefits or
15    liability for reimbursement for services provided.
16        (4) By no later than 60 days after the end of each
17    calendar quarter, each hospital licensed in the State shall
18    electronically submit to the Department inpatient and
19    outpatient claims and encounter data related to surgical
20    and invasive procedures collected under paragraph (5) for
21    each patient.
22        By no later than 60 days after the end of each calendar
23    quarter, each ambulatory surgical treatment center
24    licensed in the State shall electronically submit to the
25    Department outpatient claims and encounter data collected
26    under paragraph (5) for each patient, provided however,

 

 

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1    that, until July 1, 2006, ambulatory surgical treatment
2    centers who cannot electronically submit data may submit
3    data by computer diskette. For hospitals, the claims and
4    encounter data to be reported shall include all inpatient
5    surgical cases. Claims and encounter data submitted under
6    this Act shall not include a patient's name, address, or
7    Social Security number.
8        (5) By no later than January 1, 2006, the Department
9    must collect and compile claims and encounter data related
10    to surgical and invasive procedures according to uniform
11    electronic submission formats as required under the Health
12    Insurance Portability and Accountability Act. By no later
13    than January 1, 2006, the Department must collect and
14    compile from ambulatory surgical treatment centers the
15    claims and encounter data according to uniform electronic
16    data element formats as required under the Health Insurance
17    Portability and Accountability Act of 1996 (HIPAA).
18        (6) The Department shall make available on its website
19    the "Consumer Guide to Health Care" by January 1, 2006. The
20    Department shall also make available on its website the
21    Hospital Report Card Act. The "Consumer Guide to Health
22    Care" and the Hospital Report Card Act were established to
23    educate and assist Illinois health care consumers as they
24    make health care choices for themselves, their families,
25    and their loved ones. Significant and useful information is
26    available through the "Consumer Guide to Health Care" and

 

 

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1    the Hospital Report Card Act. The links to the "Consumer
2    Guide to Health Care" and the Hospital Report Card Act on
3    the Department's website shall include a brief description
4    of the information available in both. When the Department
5    creates new or updates existing consumer fact sheets and
6    other information or materials for the purpose of educating
7    the Illinois health care consumer, it shall reference the
8    web pages of the "Consumer Guide to Health Care" and the
9    Hospital Report Card Act when it is relevant and
10    appropriate. The "Consumer Guide to Health Care" shall
11    include information on at least 30 inpatient conditions and
12    procedures identified by the Department that demonstrate
13    the highest degree of variation in patient charges and
14    quality of care. By no later than January 1, 2007, the
15    "Consumer Guide to Health Care" shall also include
16    information on at least 30 outpatient conditions and
17    procedures identified by the Department that demonstrate
18    the highest degree of variation in patient charges and
19    quality care. As to each condition or procedure, the
20    "Consumer Guide to Health Care" shall include up-to-date
21    comparison information relating to volume of cases,
22    average charges, risk-adjusted mortality rates, and
23    nosocomial infection rates and, with respect to outpatient
24    surgical and invasive procedures, shall include
25    information regarding surgical infections, complications,
26    and direct admissions of outpatient cases to hospitals for

 

 

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1    selected procedures, as determined by the Department,
2    based on review by the Department of its own, local, or
3    national studies. Information disclosed pursuant to this
4    paragraph on mortality and infection rates shall be based
5    upon information hospitals and ambulatory surgical
6    treatment centers have either (i) previously submitted to
7    the Department pursuant to their obligations to report
8    health care information under this Act or other public
9    health reporting laws and regulations outside of this Act
10    or (ii) submitted to the Department under the provisions of
11    the Hospital Report Card Act.
12        (7) Publicly disclosed information must be provided in
13    language that is easy to understand and accessible to
14    consumers using an interactive query system. The guide
15    shall include such additional information as is necessary
16    to enhance decision making among consumer and health care
17    purchasers, which shall include, at a minimum, appropriate
18    guidance on how to interpret the data and an explanation of
19    why the data may vary from provider to provider. The
20    "Consumer Guide to Health Care" shall also cite standards
21    that facilities meet under state and federal law and, if
22    applicable, to achieve voluntary accreditation.
23        (8) None of the information the Department discloses to
24    the public under this subsection may be made available
25    unless the information has been reviewed, adjusted, and
26    validated according to the following process:

 

 

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1            (i) Hospitals, ambulatory surgical treatment
2        centers, and organizations representing hospitals,
3        ambulatory surgical treatment centers, purchasers,
4        consumer groups, and health plans are meaningfully
5        involved in providing advice and consultation to the
6        Department in the development of all aspects of the
7        Department's methodology for collecting, analyzing,
8        and disclosing the information collected under this
9        Act, including collection methods, formatting, and
10        methods and means for release and dissemination;
11            (ii) The entire methodology for collecting and
12        analyzing the data is disclosed to all relevant
13        organizations and to all providers that are the subject
14        of any information to be made available to the public
15        before any public disclosure of such information;
16            (iii) Data collection and analytical methodologies
17        are used that meet accepted standards of validity and
18        reliability before any information is made available
19        to the public;
20            (iv) The limitations of the data sources and
21        analytic methodologies used to develop comparative
22        provider information are clearly identified and
23        acknowledged, including, but not limited to,
24        appropriate and inappropriate uses of the data;
25            (v) To the greatest extent possible, comparative
26        hospital and ambulatory surgical treatment center

 

 

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1        information initiatives use standard-based norms
2        derived from widely accepted provider-developed
3        practice guidelines;
4            (vi) Comparative hospital and ambulatory surgical
5        treatment center information and other information
6        that the Department has compiled regarding hospitals
7        and ambulatory surgical treatment centers is shared
8        with the hospitals and ambulatory surgical treatment
9        centers under review prior to public dissemination of
10        the information and these providers have an
11        opportunity to make corrections and additions of
12        helpful explanatory comments about the information
13        before the publication;
14            (vii) Comparisons among hospitals and ambulatory
15        surgical treatment centers adjust for patient case mix
16        and other relevant risk factors and control for
17        provider peer groups, if applicable;
18            (viii) Effective safeguards to protect against the
19        unauthorized use or disclosure of hospital and
20        ambulatory surgical treatment center information are
21        developed and implemented;
22            (ix) Effective safeguards to protect against the
23        dissemination of inconsistent, incomplete, invalid,
24        inaccurate, or subjective provider data are developed
25        and implemented;
26            (x) The quality and accuracy of hospital and

 

 

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1        ambulatory surgical treatment center information
2        reported under this Act and its data collection,
3        analysis, and dissemination methodologies are
4        evaluated regularly; and
5            (xi) Only the most basic hospital or ambulatory
6        surgical treatment center identifying information from
7        mandatory reports is used. Information regarding a
8        hospital or ambulatory surgical center may be released
9        regardless of the number of employees or health care
10        professionals whose data are reflected in the data for
11        the hospital or ambulatory surgical treatment center
12        as long as no specific information identifying an
13        employee or a health care professional is released.
14        Further, patient identifiable information is not
15        released. The input data collected by the Department
16        shall not be a public record under the Illinois Freedom
17        of Information Act.
18        None of the information the Department discloses to the
19    public under this Act may be used to establish a standard
20    of care in a private civil action.
21        (9) The Department must develop and implement an
22    outreach campaign to educate the public regarding the
23    availability of the "Consumer Guide to Health Care".
24        (10) By January 1, 2006, the Department must study the
25    most effective methods for public disclosure of patient
26    claims and encounter data and health care quality

 

 

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1    information that will be useful to consumers in making
2    health care decisions and report its recommendations to the
3    Governor and to the General Assembly.
4        (11) The Department must undertake all steps necessary
5    under State and Federal law to protect patient
6    confidentiality in order to prevent the identification of
7    individual patient records.
8        (12) The Department must adopt rules for inpatient and
9    outpatient data collection and reporting no later than
10    January 1, 2006.
11        (13) In addition to the data products indicated above,
12    the Department shall respond to requests by government
13    agencies, academic research organizations, and private
14    sector organizations for purposes of clinical performance
15    measurements and analyses of data collected pursuant to
16    this Section.
17        (14) The Department, with the advice of and in
18    consultation with hospitals, ambulatory surgical treatment
19    centers, organizations representing hospitals,
20    organizations representing ambulatory treatment centers,
21    purchasers, consumer groups, and health plans, must
22    evaluate additional methods for comparing the performance
23    of hospitals and ambulatory surgical treatment centers,
24    including the value of disclosing additional measures that
25    are adopted by the National Quality Forum, The Joint
26    Commission on Accreditation of Healthcare Organizations,

 

 

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1    the Accreditation Association for Ambulatory Health Care,
2    the Centers for Medicare and Medicaid Services, or similar
3    national entities that establish standards to measure the
4    performance of health care providers. The Department shall
5    report its findings and recommendations on its Internet
6    website and to the Governor and General Assembly no later
7    than July 1, 2006.
8    (e) (Blank).
9(Source: P.A. 93-144, eff. 7-10-03; 94-27, eff. 6-14-05.)".