Full Text of HB2684 99th General Assembly
HB2684ham001 99TH GENERAL ASSEMBLY | Rep. Greg Harris Filed: 3/23/2015
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| 1 | | AMENDMENT TO HOUSE BILL 2684
| 2 | | AMENDMENT NO. ______. Amend House Bill 2684 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | adding Section 5-30.2 as follows: | 6 | | (305 ILCS 5/5-30.2 new) | 7 | | Sec. 5-30.2. Data sharing among participating | 8 | | institutions. | 9 | | (a) As used in this Section: | 10 | | "Department" means the Department of Healthcare and | 11 | | Family Services. | 12 | | "HIPAA" means the Health Information Portability and | 13 | | Accountability Act of 1996, Public Law 104-191, as amended | 14 | | by the Health Information Technology for Economic and | 15 | | Clinical Health Act of 2009, Public Law 111-05, and any | 16 | | subsequent amendments thereto and any regulations |
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| 1 | | promulgated thereunder. | 2 | | "Participating institutions" means institutions that | 3 | | have an institutional review board or access to an | 4 | | institutional review board that is in compliance with the | 5 | | United States Department of Health and Human Services | 6 | | Office of Human Research Protections and are a State | 7 | | university, Tier I or Tier II academic medical center, an | 8 | | association incorporated in Illinois that (i) possesses a | 9 | | demonstrated research capacity and (ii) is determined by | 10 | | the Department to represent a broad number of providers who | 11 | | serve recipients of medical assistance under Article V of | 12 | | the Illinois Public Aid Code, and any other entity | 13 | | designated by the Department. | 14 | | "Research" means a systematic investigation, including | 15 | | research development, testing, and evaluation designed to | 16 | | develop or contribute to generalizable knowledge. | 17 | | "Tier I and Tier II academic medical centers" has the | 18 | | meaning given to those terms under Section 5-5e.2 of the | 19 | | Illinois Public Aid Code. | 20 | | (b) The General Assembly finds that the Illinois Medicaid | 21 | | program is undergoing a transition to managed care for Medicaid | 22 | | populations subject to the Medicaid Reform Act of 2011, the | 23 | | Save Medicaid Access Together Act of 2012, and other Acts | 24 | | affecting Medicaid populations and delivery systems. The | 25 | | General Assembly further finds that Illinois possesses an | 26 | | abundance of academic research entities with expertise in the |
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| 1 | | academic fields related to health care practices, health | 2 | | outcomes, special needs populations, and health care delivery | 3 | | design. To that end, the General Assembly additionally finds | 4 | | that: | 5 | | (1) A lawful and well-regulated dissemination of | 6 | | Medicaid data to qualified researchers is the best way to | 7 | | create accurate and creative unbiased analysis and | 8 | | information about the Illinois Medicaid Program that will | 9 | | lead to better health outcomes at a lower cost. | 10 | | (2) Accurate research findings should be made | 11 | | available to the Illinois General Assembly from a variety | 12 | | of independent qualified research entities. | 13 | | (3) As the Medicaid program transforms from a fee for | 14 | | service system to a system based on capitated contracts, | 15 | | there must be sufficient transparency in those contracts to | 16 | | allow for evaluation of their effectiveness by the | 17 | | legislature through receipt of data analysis performed by | 18 | | qualified independent research institutions. | 19 | | (c) Notwithstanding any other provisions of law to the | 20 | | contrary, the Department is hereby authorized and directed to | 21 | | provide the individual patient medical claims information, | 22 | | including individual data for services provided through | 23 | | capitated contracts, of medical assistance participants to | 24 | | participating institutions for the analysis purposes for which | 25 | | the State Funded Health Care Quality Assurance and Research | 26 | | Fund is created, as specified in Section 6z-101 of the State |
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| 1 | | Finance Act. The patient medical claims information shall only | 2 | | include the Medicaid recipient identification number in | 3 | | addition to other individual medical claims patient data that | 4 | | has been de-identified in accordance with HIPAA so as to | 5 | | qualify as a limited data set under HIPAA, and shall only be | 6 | | shared in accordance with HIPAA. Information identifying | 7 | | health plans and health care providers shall be made available | 8 | | only in the event the research study commissioned by the | 9 | | General Assembly through the Commission on Government | 10 | | Forecasting and Accountability or the Department requires that | 11 | | such information be analyzed. The Department, and | 12 | | participating institutions must enter into data sharing | 13 | | agreements and business associate agreements to ensure privacy | 14 | | protection, HIPAA compliance, and to safeguard the security and | 15 | | confidentiality of such records. The Department shall make as | 16 | | much data available as possible in order to promote | 17 | | transparency and unencumbered data analysis. | 18 | | The data shall be shared electronically with each | 19 | | participating entity on a State fiscal year basis once the data | 20 | | year is considered complete, and not longer than 8 months after | 21 | | the close of the State fiscal year. A complete State fiscal | 22 | | year data set will be based on dates of service during a State | 23 | | fiscal year and shall be considered complete when sufficient | 24 | | time after the fiscal year has occurred to process all claims | 25 | | and make corrections to improperly filed claims. Data for | 26 | | fiscal years prior to the passage of this amendatory Act of the |
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| 1 | | 99th General Assembly shall be made available if requested by | 2 | | the participating institution and the data are available to the | 3 | | Department. | 4 | | Participating institutions and entities may, at their own | 5 | | expense and consistent with rules adopted by the Department, | 6 | | produce research reports related to the purposes of this | 7 | | amendatory Act of the 99th General Assembly, provided that all | 8 | | patient medical claims information has been aggregated and | 9 | | de-identified. Participating institutions and entities may not | 10 | | use such medical claims information for commercial purposes or | 11 | | otherwise transfer any such medical claims information to any | 12 | | other entity. Nothing in this amendatory Act of the 99th | 13 | | General Assembly shall be construed as prohibiting a | 14 | | participating institution and entity from partnering with | 15 | | another entity, either voluntarily or by contract, to produce | 16 | | research reports, so long as no individually identifiable data | 17 | | is shared with the participating institution or entity. | 18 | | Any data received under this Section must be used solely | 19 | | for research purposes by the research entity and the | 20 | | confidentiality of any data provided to authorized individuals | 21 | | pursuant to this Section must be maintained in accordance with | 22 | | the provisions of this Section and other applicable laws. Any | 23 | | use of the data for commercial purposes in violation of this | 24 | | Section shall be subject to fines and penalties specified | 25 | | herein, including the loss of access to data. |
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| 1 | | Section 10. The State Finance Act is amended by adding | 2 | | Section 6z-101 as follows: | 3 | | (30 ILCS 105/6z-101 new) | 4 | | Sec. 6z-101. State Funded Health Care Quality Assurance and | 5 | | Research Fund. The State Funded Health Care Quality Assurance | 6 | | and Research Fund is created. The State Funded Health Care | 7 | | Quality Assurance and Research Fund shall consist of receipts | 8 | | from State fund transfers, including the Healthcare Provider | 9 | | Relief Fund, and contributions from participating | 10 | | institutions, as that term is defined under Section 5-30.2 of | 11 | | the Illinois Public Aid Code. Any receipts from the federal | 12 | | government related to expenditures from the State Funded Health | 13 | | Care Quality Assurance and Research Fund shall be deposited | 14 | | into the Healthcare Provider Relief Fund. All interest earned | 15 | | on moneys in the State Funded Health Care Quality Assurance and | 16 | | Research Fund shall be deposited in the State Funded Health | 17 | | Care Quality Assurance and Research Fund. | 18 | | The State Funded Health Care Quality Assurance and Research | 19 | | Fund shall be appropriated to the Department of Healthcare and | 20 | | Family Services. The purpose of the State Funded Health Care | 21 | | Quality Assurance and Research Fund is to provide the Illinois | 22 | | General Assembly and the Department with independent analysis | 23 | | of: | 24 | | (1) the efficacy of State managed care programs to | 25 | | improve the patient experience of health care, and the |
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| 1 | | health of the population, and to reduce costs of health | 2 | | care; | 3 | | (2) the efficacy of the Department of Healthcare and | 4 | | Family Services in monitoring healthcare outcomes in | 5 | | managed care and other settings; | 6 | | (3) the efficacy of State managed care programs to | 7 | | improve continuity of care, ensure adequate provider | 8 | | participation, and maintain appropriate utilization of | 9 | | health services; | 10 | | (4) any possible gaps in healthcare for populations | 11 | | served by the State and recommendations on how to close | 12 | | them; | 13 | | (5) successful outcomes and best practices in | 14 | | improving the health of the population and the quality of | 15 | | care while reducing the cost; | 16 | | (6) in combination with other data sources, the impact | 17 | | of managed care on the social determinants of health as | 18 | | well as on non-clinical outcomes, such as employment and | 19 | | educational attainment; and | 20 | | (7) the degree to which appropriate mechanisms are in | 21 | | place to assess the Department of Healthcare and Family | 22 | | Services' internal quality assurance processes. | 23 | | Appropriations to the Commission on Government Forecasting | 24 | | and Accountability from the State Funded Health Care Quality | 25 | | Assurance and Research Fund may be made by the General Assembly | 26 | | through an appropriation from the Fund and either a law or a |
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| 1 | | resolution of either chamber authorizing the study, including | 2 | | the reasons for the study, the direction to the Commission on | 3 | | Government Forecasting and Accountability to contract for the | 4 | | study, the question or questions the study will answer, the | 5 | | requirement that the Department and other relevant State | 6 | | entities cooperate with the selected contractor, and the date | 7 | | the report is due. Appropriations from the State Funded Health | 8 | | Care Quality Assurance and Research Fund may also be used to | 9 | | pay for the costs to the Commission on Governmental Forecasting | 10 | | and Accountability of developing and reviewing contract | 11 | | proposals. Nothing in this amendatory Act of the 99th General | 12 | | Assembly requires that the Commission on Government | 13 | | Forecasting and Accountability award a contract to a | 14 | | participating institution. | 15 | | Each participating institution, as that term is defined | 16 | | under Section 5-30.2 of the Illinois Public Aid Code, may | 17 | | choose to participate in the State Funded Health Care Quality | 18 | | Assurance and Research Fund and the associated research by | 19 | | annually contributing up to $250,000 into the Healthcare | 20 | | Provider Relief Fund. Based upon the number of participants, | 21 | | the costs to the Department of Healthcare and Family Services, | 22 | | and the appropriations made to the Department of Healthcare and | 23 | | Family Services and the Commission on Forecasting and | 24 | | Governmental Accountability, the Department shall determine | 25 | | the contribution amount for participants. All participants | 26 | | shall pay the same amount. In the event that the research data |
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| 1 | | described in Section 3.1 of the Commission on Government | 2 | | Forecasting and Accountability Act is not provided to the | 3 | | participating entities or the research data or similar data is | 4 | | shared with an entity not identified in Section 3.1 free of | 5 | | charge, each entity shall be refunded the amount they each paid | 6 | | into the State Funded Health Care Quality Assurance and | 7 | | Research Fund. | 8 | | The State shall transfer into the State Funded Health Care | 9 | | Quality Assurance and Research Fund, from the Healthcare | 10 | | Provider Relief Fund, an amount equal to the contributions made | 11 | | by participating entities. | 12 | | Any use of the data for commercial purposes or for another | 13 | | purpose not authorized under Section 5-30.2 of the Illinois | 14 | | Public Aid Code shall result in loss of access to the data for | 15 | | a period of one year after the data year the last data set had | 16 | | been received, no refunding of the fees authorized under this | 17 | | Section, and a fine of $2,500 for each violation, which shall | 18 | | be deposited into the State Funded Health Care Quality | 19 | | Assurance and Research Fund.
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.".
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