Full Text of HB4953 93rd General Assembly
HB4953 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB4953
Introduced 02/05/04, by Julie Hamos SYNOPSIS AS INTRODUCED: |
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20 ILCS 2215/4-2 |
from Ch. 111 1/2, par. 6504-2 |
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Amends the Illinois Health Care Finance Reform Act. Requires the Department of Public Health to require all ambulatory surgical treatment centers licensed to operate in the State (now, the requirement applies only to hospitals licensed to operate in the State) to adopt a uniform system for submitting patient charges for payment from public and private payors and to electronically submit certain patient billing data to the Department for public disclosure. Makes corresponding changes in provisions concerning the process for review, adjustment, and validation of the publicly disclosed information. Requires the Department to collect and compile certain billing data from ambulatory surgical treatment centers according to certain standards by January 1, 2006 (or by January 1, 2007 for centers or physicians with fewer than 25 employees). Effective January 1, 2005.
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A BILL FOR
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HB4953 |
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LRB093 20871 MKM 46817 b |
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| AN ACT concerning health care.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Health Finance Reform Act is | 5 |
| amended by changing Section 4-2 as follows:
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| (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
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| Sec. 4-2. Powers and duties.
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| (a) (Blank).
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| (b) (Blank).
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| (c) (Blank).
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| (d) Uniform Provider Utilization and Charge Information.
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| (1) The Department of Public Health shall require that | 13 |
| all hospitals and ambulatory surgical treatment centers
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| licensed to operate in the State of Illinois adopt a | 15 |
| uniform system for
submitting patient charges for payment | 16 |
| from public and private payors. 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.
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| (2) (Blank).
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| (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, | 24 |
| health maintenance organizations, and self-funded employee
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| health plans, to accept the uniform billing form, without | 26 |
| attachment as
submitted by hospitals pursuant to paragraph | 27 |
| (1) of subsection (d) above,
effective January 1, 1985; | 28 |
| provided, however, nothing shall prevent all
such third | 29 |
| party payors from requesting additional information | 30 |
| necessary to
determine eligibility for benefits or | 31 |
| liability for reimbursement for
services provided.
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| (4) Each hospital licensed in the State shall |
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HB4953 |
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LRB093 20871 MKM 46817 b |
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| electronically submit to
the Department patient billing | 2 |
| data for conditions and procedures required
for public | 3 |
| disclosure pursuant to paragraph (6). For hospitals, the | 4 |
| billing
data to be
reported shall include all inpatient | 5 |
| surgical
cases.
Billing data submitted under this Act shall | 6 |
| not include a patient's name,
address, or Social Security | 7 |
| number.
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| (5) By no later than January 1, 2005, the Department | 9 |
| must collect and
compile
billing data required under | 10 |
| paragraph (6) according to uniform electronic
submission | 11 |
| formats as required under the Health Insurance Portability | 12 |
| and
Accountability Act. By no later than January 1, 2006, | 13 |
| the Department must collect and compile from ambulatory | 14 |
| surgical treatment centers the billing data required under | 15 |
| paragraph (6) according to uniform electronic submission | 16 |
| formats as required under the Health Insurance Portability | 17 |
| and Accountability Act.
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| (6) The Department shall make available on its website | 19 |
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"Consumer Guide to Health Care" by January 1, 2006. The | 20 |
| "Consumer
Guide to Health Care" shall include information | 21 |
| on 30 conditions and
procedures identified by the | 22 |
| Department that demonstrate the highest
degree of | 23 |
| variation in patient charges and quality of care. As to | 24 |
| each
condition or procedure, the "Consumer Guide to Health | 25 |
| Care" shall include
up-to-date comparison information | 26 |
| relating to volume of cases, average
charges, | 27 |
| risk-adjusted mortality rates, and nosocomial infection | 28 |
| rates.
Information disclosed pursuant to this paragraph on
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| mortality and infection rates shall be based upon | 30 |
| information hospitals
have previously submitted to the | 31 |
| Department pursuant to their obligations
to report health | 32 |
| care information under other public health reporting laws
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| and regulations outside of this Act.
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| (7) Publicly disclosed information must be provided in | 35 |
| language
that is easy to understand and accessible to | 36 |
| consumers using an
interactive query system.
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LRB093 20871 MKM 46817 b |
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| (8) None of the information the Department discloses to | 2 |
| the public
under this subsection may be made available | 3 |
| unless the information has
been reviewed, adjusted, and | 4 |
| validated according to the following process:
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| (i) Hospitals ambulatory surgical treatment | 6 |
| centers and organizations representing hospitals are
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| meaningfully involved in the development of all | 8 |
| aspects of
the Department's methodology for | 9 |
| collecting, analyzing, and
disclosing the information | 10 |
| collected under this Act, including
collection | 11 |
| methods, formatting, and methods and means for
release | 12 |
| and dissemination;
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| (ii) The entire methodology for collection and
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| analyzing the data is disclosed to all relevant | 15 |
| organizations
and to all providers that are the subject | 16 |
| of any information to
be made available to the public | 17 |
| before any public disclosure
of such information;
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| (iii) Data collection and analytical methodologies | 19 |
| are
used that meet accepted standards of validity and | 20 |
| reliability
before any information is made available | 21 |
| to the public;
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| (iv) The limitations of the data sources and | 23 |
| analytic
methodologies used to develop comparative | 24 |
| provider
information are clearly identified and | 25 |
| acknowledged,
including, but not limited to, | 26 |
| appropriate and inappropriate
uses of the data;
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| (v) To the greatest extent possible, comparative
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| hospital and ambulatory surgical treatment center | 29 |
| information initiatives use standard-based
norms | 30 |
| derived from widely accepted provider-developed
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| practice guidelines;
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| (vi) Comparative hospital information and other
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| information that the Department has compiled regarding
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| hospitals is shared with the hospitals and ambulatory | 35 |
| surgical treatment centers under review prior to
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| public dissemination of the information and these |
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| providers
have an opportunity to make corrections and | 2 |
| additions of
helpful explanatory comments about the | 3 |
| information before
the publication;
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| (vii) Comparisons among hospitals and ambulatory | 5 |
| surgical treatment centers adjust for
patient case mix | 6 |
| and other relevant risk factors and control
for | 7 |
| provider peer groups;
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| (viii) Effective safeguards to protect against the
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| unauthorized use or disclosure of hospital and | 10 |
| ambulatory surgical treatment center information are
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| developed and implemented;
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| (ix) Effective safeguards to protect against the
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| dissemination of inconsistent, incomplete, invalid,
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| inaccurate, or subjective provider data are developed | 15 |
| and
implemented;
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| (x) The quality and accuracy of hospital and | 17 |
| ambulatory surgical treatment center information
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| reported under this Act and its data collection, | 19 |
| analysis, and
dissemination methodologies are | 20 |
| evaluated regularly; and
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| (xi) Only the most basic identifying information | 22 |
| from
mandatory reports is used, and patient | 23 |
| identifiable
information is not released. The input | 24 |
| data collected
by the Department shall not be a public | 25 |
| record under the
Illinois Freedom of Information Act.
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| None of the information
the Department discloses to the | 27 |
| public under this Act may be
used to establish a standard | 28 |
| of care in a private civil action.
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| (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".
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| (10) Within 12 months after the effective date of this | 33 |
| amendatory
Act of the 93rd General Assembly, the Department | 34 |
| must study the
most effective methods for public disclosure | 35 |
| of patient charge data and
health care quality information | 36 |
| that will be useful to consumers in making
health care |
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| decisions and report its recommendations to the
Governor | 2 |
| and to the General Assembly.
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| (11) The Department must undertake all steps necessary | 4 |
| under
State and Federal law to protect patient | 5 |
| confidentiality in order to prevent
the identification of | 6 |
| individual patient records.
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| (e) (Blank).
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| (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
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| Section 99. Effective date. This Act takes effect January | 10 |
| 1, 2005.
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