093_HB2202enr

 
HB2202 Enrolled                      LRB093 06053 MKM 11084 b

 1        AN ACT in relation to health care.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section 5. The Illinois Health Care Finance Reform Act is
 5    amended 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
13        that all hospitals licensed to operate in  the  State  of
14        Illinois  adopt  a  uniform system for submitting patient
15        charges  for  payment  from  public  and  private  payors
16        effective January 1, 1985.  This system  shall  be  based
17        upon  adoption of the uniform electronic hospital billing
18        form pursuant to the  Health  Insurance  Portability  and
19        Accountability   Act   (UB-92)   or  its  successor  form
20        developed by the National Uniform Billing Committee.
21             (2)  (Blank).
22             (3)  The Department of Insurance shall  require  all
23        third-party   payors,   including  but  not  limited  to,
24        licensed   insurers,   medical   and   hospital   service
25        corporations,  health  maintenance   organizations,   and
26        self-funded  employee health plans, to accept the uniform
27        billing  form,  without  attachment   as   submitted   by
28        hospitals  pursuant  to  paragraph  (1) of subsection (d)
29        above, effective  January  1,  1985;  provided,  however,
30        nothing  shall  prevent  all such third party payors from
31        requesting additional information necessary to  determine
 
HB2202 Enrolled             -2-      LRB093 06053 MKM 11084 b
 1        eligibility  for  benefits or liability for reimbursement
 2        for services provided.
 3             (4)  Each  hospital  licensed  in  the  State  shall
 4        electronically submit to the Department  patient  billing
 5        data  for  conditions  and procedures required for public
 6        disclosure pursuant to paragraph (6). For hospitals,  the
 7        billing  data  to be reported shall include all inpatient
 8        surgical cases. Billing data  submitted  under  this  Act
 9        shall  not  include  a patient's name, address, or Social
10        Security number.
11             (5)  By  no  later  than  January   1,   2005,   the
12        Department must collect and compile billing data required
13        under  paragraph  (6)  according  to  uniform  electronic
14        submission formats as required under the Health Insurance
15        Portability and Accountability Act.
16             (6)  The  Department  shall  make  available  on its
17        website the "Consumer Guide to Health Care" by January 1,
18        2006. The "Consumer Guide to Health Care"  shall  include
19        information on 30 conditions and procedures identified by
20        the  Department  that  demonstrate  the highest degree of
21        variation in patient charges and quality of care.  As  to
22        each  condition  or  procedure,  the  "Consumer  Guide to
23        Health  Care"   shall   include   up-to-date   comparison
24        information relating to volume of cases, average charges,
25        risk-adjusted  mortality  rates, and nosocomial infection
26        rates. Information disclosed pursuant to  this  paragraph
27        on  mortality  and  infection  rates  shall be based upon
28        information hospitals have previously  submitted  to  the
29        Department pursuant to their obligations to report health
30        care information under other public health reporting laws
31        and regulations outside of this Act.
32             (7)  Publicly disclosed information must be provided
33        in  language that is easy to understand and accessible to
34        consumers using an interactive query system.
 
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 1             (8)  None  of   the   information   the   Department
 2        discloses to the public under this subsection may be made
 3        available  unless  the  information  has  been  reviewed,
 4        adjusted,   and  validated  according  to  the  following
 5        process:
 6                  (i)  Hospitals and  organizations  representing
 7             hospitals   are   meaningfully   involved   in   the
 8             development  of  all  aspects  of  the  Department's
 9             methodology    for    collecting,   analyzing,   and
10             disclosing the information collected under this Act,
11             including  collection   methods,   formatting,   and
12             methods and means for release and dissemination;
13                  (ii)  The entire methodology for collection and
14             analyzing  the  data  is  disclosed  to all relevant
15             organizations and to  all  providers  that  are  the
16             subject  of  any information to be made available to
17             the public before  any  public  disclosure  of  such
18             information;
19                  (iii)  Data     collection    and    analytical
20             methodologies are used that meet accepted  standards
21             of  validity  and reliability before any information
22             is made available to the public;
23                  (iv)  The limitations of the data  sources  and
24             analytic  methodologies  used to develop comparative
25             provider  information  are  clearly  identified  and
26             acknowledged,  including,  but   not   limited   to,
27             appropriate and inappropriate uses of the data;
28                  (v)  To    the    greatest   extent   possible,
29             comparative  hospital  information  initiatives  use
30             standard-based norms derived  from  widely  accepted
31             provider-developed practice guidelines;
32                  (vi)  Comparative   hospital   information  and
33             other information that the Department  has  compiled
34             regarding  hospitals  is  shared  with the hospitals
 
HB2202 Enrolled             -4-      LRB093 06053 MKM 11084 b
 1             under review prior to public  dissemination  of  the
 2             information  and these providers have an opportunity
 3             to  make  corrections  and  additions   of   helpful
 4             explanatory  comments  about  the information before
 5             the publication;
 6                  (vii)  Comparisons among hospitals  adjust  for
 7             patient case mix and other relevant risk factors and
 8             control for provider peer groups;
 9                  (viii)  Effective safeguards to protect against
10             the  unauthorized  use  or  disclosure  of  hospital
11             information are developed and implemented;
12                  (ix)  Effective  safeguards  to protect against
13             the  dissemination  of   inconsistent,   incomplete,
14             invalid, inaccurate, or subjective provider data are
15             developed and implemented;
16                  (x)  The   quality  and  accuracy  of  hospital
17             information reported under this  Act  and  its  data
18             collection,      analysis,     and     dissemination
19             methodologies are evaluated regularly; and
20                  (xi)  Only   the   most    basic    identifying
21             information  from  mandatory  reports  is  used, and
22             patient identifiable information  is  not  released.
23             The input data collected by the Department shall not
24             be  a  public  record  under the Illinois Freedom of
25             Information Act.
26             None of the information the Department discloses  to
27        the  public  under  this  Act  may be used to establish a
28        standard of care in a private civil action.
29             (9)  The Department must develop  and  implement  an
30        outreach  campaign  to  educate  the public regarding the
31        availability of the "Consumer Guide to Health Care".
32             (10)  Within 12 months after the effective  date  of
33        this  amendatory  Act  of  the 93rd General Assembly, the
34        Department must study  the  most  effective  methods  for
 
HB2202 Enrolled             -5-      LRB093 06053 MKM 11084 b
 1        public  disclosure of patient charge data and health care
 2        quality information that will be useful to  consumers  in
 3        making    health    care   decisions   and   report   its
 4        recommendations  to  the  Governor  and  to  the  General
 5        Assembly.
 6             (11)  The  Department  must  undertake   all   steps
 7        necessary  under State and Federal law to protect patient
 8        confidentiality in order to prevent the identification of
 9        individual patient records.
10        (e)  (Blank).
11    (Source: P.A. 91-756, eff. 6-2-00; 92-597, eff. 7-1-02.)

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