Full Text of HB1562 97th General Assembly
HB1562enr 97TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning State government.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Health 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 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.)
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