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92_HB1824eng HB1824 Engrossed LRB9204832JMmb 1 AN ACT concerning the Health Care Cost Containment 2 Council. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Illinois Health Finance Reform Act is 6 amended by changing Sections 1-2, 2-1, 2-5, and 4-2 as 7 follows: 8 (20 ILCS 2215/1-2) (from Ch. 111 1/2, par. 6501-2) 9 Sec. 1-2. Purpose. The General Assembly finds and 10 declares that stabilizing the cost of hospitalization is a 11 vital concern to the people of this State. It is the 12 legislative intent, pursuant to this declared public concern, 13 to develop measures which will increase hospital productivity 14 and better control utilization, while continuing to provide 15 quality health care services to all sectors of the citizenry, 16 education and training of health care professionals, and 17 research and development of improved and cost effective 18 methods of treatment of ailments and management of facilities 19 and operations. These ends shall be accomplished through the 20 establishment of the Illinois Health Care Cost Containment 21 Council within the Department of Public Health to study, 22 recommend and implement measures to contain health costs. 23 Furthermore, it is the intent of the General Assembly to 24 encourage new and innovative methods of financing health 25 care. 26 The overall goal of this legislation is to limit the 27 increase in the cost of hospital care to no more than the 28 rate of increase in prices in the general economy. The 29 General Assembly finds and declares that this result may be 30 achieved through the introduction of competitive forces into 31 the organization, delivery and financing of health care HB1824 Engrossed -2- LRB9204832JMmb 1 services. 2 (Source: P.A. 83-1243.) 3 (20 ILCS 2215/2-1) (from Ch. 111 1/2, par. 6502-1) 4 Sec. 2-1. Council Authorized. There is hereby created 5 within the Department of Public Health the Illinois Health 6 Care Cost Containment Council. It shall consist of 13 7 members appointed by the Director of Public HealthGovernor8with the advice and consent of the Senateas follows: 5 9 members to represent providers as follows: 2 members to 10 represent Illinois hospitals at least one of which must 11 represent a small rural hospital, 2 members to represent 12 physicians licensed to practice medicine in all its branches, 13 and 1 member to represent ambulatory surgical treatment 14 centers; 3 members to represent consumers; 2 members to 15 represent insurance companies; and 3 members to represent 16 businesses. 17 The members of the Council shall be appointed for 3-year 18 terms, except that the terms of members serving on the 19 effective date of this amendatory Act of the 92nd General 20 Assembly shall conclude upon the appointment of their 21 successors by the Director of Public Health. 22 No more than 7 members may be from the same political 23 party. 24Members shall be appointed within 30 days after the25effective date of this Act. The additional members appointed26under the amendatory Act of the 91st General Assembly must be27appointed within 30 days after the effective date of this28amendatory Act of the 91st General Assembly.The members of 29 the Council shall receive reimbursement of their actual 30 expenses incurred in connection with their service; in 31 addition, each member shall receive compensation of $150 a 32 day for each day served at regular or special meetings of the 33 Council, except that such compensation shall not exceed HB1824 Engrossed -3- LRB9204832JMmb 1 $20,000 in any one year for any member. The Council shall 2 elect a Chairman from among its members, and shall have the 3 power to organize and appoint such other officers as it may 4 deem necessary. 5 All appointments shall be made in writing and filed with 6 the Secretary of State as a public record. In appointing 7 members to represent providers, the Director of Public Health 8 shall give due consideration to recommendations of statewide 9 organizations representing such providers. 10 (Source: P.A. 91-756, eff. 6-2-00.) 11 (20 ILCS 2215/2-5) (from Ch. 111 1/2, par. 6502-5) 12 Sec. 2-5. Employees, Professional Consultants, and 13 Funding. The Director of Public HealthCouncilmay employ 14 and fix the compensation of such employees, and may enter 15 into contractual agreements with technical and professional 16 consultants as the Directoritdeems necessary to expedite 17 the purpose of this Act. 18 (Source: P.A. 83-1243.) 19 (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2) 20 Sec. 4-2. Powers and duties. 21 (a) The Illinois Health Care Cost Containment Council 22 may enter into any agreement with any corporation, 23 association or other entity it deems appropriate to undertake 24 the process described in this Article for the collection, 25 compilation, orandanalysis of data collected by the Council 26 and to conduct or contract for studies on health-related 27 questions carried out in pursuance of the purposes of this 28 Article. The agreement may provide for the corporation, 29 association or entity to prepare and distribute or make 30 available data to health care providers, health care 31 subscribers, third-party payors, government and the general 32 public, in accordance with the rules of confidentiality and HB1824 Engrossed -4- LRB9204832JMmb 1 review to be developed under this Act. 2 (a-5) On or before December 31, 2001, the Council must 3 complete an analysis of whether the functions of collecting, 4 compiling, analyzing, or reporting data as required by this 5 Article IV could be performed more economically under one or 6 more agreements as authorized by subsection (a) then they can 7 be performed internally by the Council. If the Council 8 determines that one or more of these functions could be 9 performed more economically by an agreement as authorized by 10 subsection (a), the Council must enter into one or more 11 agreements for the performance of such functions. The 12 Council must periodically review any agreement entered under 13 subsection (a) to ensure that they remain the most economical 14 methods of performing the work that is the subject of the 15 agreement or agreements. 16 (b) The input data collected by and furnished to the 17 Council or designated corporation, association or entity 18 pursuant to this Section shall not be a public record under 19 the Illinois Freedom of Information Act. It is the intent of 20 this Act and of the regulations written pursuant to it to 21 protect the confidentiality of individual patient information 22 and the proprietary information of commercial insurance 23 carriers and health care providers. Data specified in 24 subsections (e) and (e-5) shall be released on a hospital 25 specific and licensed ambulatory surgical treatment center 26 specific basis to facilitate comparisons among hospitals and 27 licensed ambulatory surgical treatment centers by purchasers. 28 (c) The Council shall require the Departments of Public 29 Health and Public Aid and hospitals located in the State to 30 assist the Council in gathering and submitting the following 31 hospital-specific financial information, and the Council is 32 authorized to share this data with both Departments to reduce 33 the burden on hospitals by avoiding duplicate data 34 collection: HB1824 Engrossed -5- LRB9204832JMmb 1 OPERATING REVENUES 2 (1) Net patient service revenue 3 (2) Other revenue 4 (3) Total operating revenue 5 OPERATING EXPENSES 6 (4) Bad debt expense 7 (5) Total operating expenses 8 NON-OPERATING GAINS/LOSSES 9 (6) Total non-operating gains 10 (7) Total non-operating losses 11 PATIENT CARE REVENUES 12 (8) Gross inpatient revenue 13 (9) Gross outpatient revenue 14 (10) Other Patient care revenue 15 (11) Total patient revenue 16 (12) Total gross patient care revenue 17 (13) Medicare gross revenue 18 (14) Medicaid gross revenue 19 (15) Total other gross revenue 20 DEDUCTIONS FROM REVENUE 21 (16) Charity care 22 (17) Medicare allowance 23 (18) Medicaid allowance 24 (19) Other contractual allowances 25 (20) Other allowances 26 (21) Total Deductions 27 ASSETS 28 (22) Operating cash and short-term investments 29 (23) Estimated patient accounts receivable 30 (24) Other current assets 31 (25) Total current assets 32 (26) Total other assets HB1824 Engrossed -6- LRB9204832JMmb 1 (27) Total Assets 2 LIABILITIES AND FUND BALANCES 3 (28) Total current liabilities 4 (29) Long Term Debt 5 (30) Other liabilities 6 (31) Total liabilities 7 (32) Total liabilities and fund balances 8 All financial data collected by the Council from publicly 9 available sources such as the HCFA is releasable by the 10 Council on a hospital specific basis when appropriate. 11 (d) Uniform Provider Utilization and Charge 12 Information. The Council shall require that: 13 (1) 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 hospital billing form 18 (UB-92) or its successor form developed by the National 19 Uniform Billing Committee. 20 (2) (Blank). 21 (3) The Department of Insurance require all 22 third-party payors, including but not limited to, 23 licensed insurers, medical and hospital service 24 corporations, health maintenance organizations, and 25 self-funded employee health plans, to accept the uniform 26 billing form, without attachment as submitted by 27 hospitals pursuant to paragraph (1) of subsection (d) 28 above, effective January 1, 1985; provided, however, 29 nothing shall prevent all such third party payors from 30 requesting additional information necessary to determine 31 eligibility for benefits or liability for reimbursement 32 for services provided. 33 (e) The Council, in cooperation with the State 34 Departments of Public Aid, Insurance, and Public Health, HB1824 Engrossed -7- LRB9204832JMmb 1 shall establish a system for the collection of the following 2 information from hospitals utilizing the raw data available 3 on the uniform billing forms. Such data shall include the 4 following elements and other elements contained on the 5 uniform billing form or its successor form determined as 6 necessary by the Council: 7 (1) Patient date of birth 8 (2) Patient sex 9 (3) Patient zip code 10 (4) Third-party coverage 11 (5) Date of admission 12 (6) Source of admission 13 (7) Type of admission 14 (8) Discharge date 15 (9) Principal and up to 8 other diagnoses 16 (10) Principal procedure and date 17 (11) Patient status 18 (12) Other procedures and dates 19 (13) Total charges and components of those charges 20 (14) Attending and consulting physician identification 21 numbers 22 (15) Hospital identification number 23 (16) An alphanumeric number based on the information to 24 identify the payor 25 (17) Principal source of payment. 26 (e-5) The Council, in cooperation with the Department of 27 Public Aid, the Department of Insurance, and the Department 28 of Public Health, shall establish a system for the collection 29 of the following information for each outpatient surgery 30 performed at hospitals and licensed ambulatory surgical 31 treatment centers using the raw data available on outpatient 32 billing forms submitted by hospitals and licensed ambulatory 33 surgical treatment centers to payors. The data must include 34 the following elements, if available on the billing forms, HB1824 Engrossed -8- LRB9204832JMmb 1 and other elements contained on the billing forms that the 2 Council determines are necessary: 3 (1) patient date of birth; 4 (2) patient sex; 5 (3) patient zip code; 6 (4) third-party coverage; 7 (5) date of admission; 8 (6) source of admission; 9 (7) type of admission; 10 (8) discharge date; 11 (9) principal diagnosis and up to 8 other 12 diagnoses; 13 (10) principal procedure and the date of the 14 procedure; 15 (11) patient status; 16 (12) other procedures and the dates of those 17 procedures; 18 (13) attending and consulting physician 19 identification numbers; 20 (14) hospital or licensed ambulatory surgical 21 treatment center identification number; 22 (15) an alphanumeric number based on the 23 information needed to identify the payor; and 24 (16) principal source of payment. 25 (f) Extracts of the UB-92 transactions shall be prepared 26 by hospitals according to regulations promulgated by the 27 Council and submitted in electronic format to the Council or 28 the corporation, association or entity designated by the 29 Council. 30 For hospitals unable to submit extracts in electronic 31 format, the Council shall determine an alternate method for 32 submission of data. Such extract reporting systems shall be 33 in operation before January 1, 1987; however, the Council may 34 grant time extensions to individual hospital. HB1824 Engrossed -9- LRB9204832JMmb 1 (f-5) Extracts of the billing forms shall be prepared by 2 licensed ambulatory surgical treatment centers according to 3 rules adopted by the Council and submitted to the Council or 4 a corporation, association, or entity designated by the 5 Council. Electronic submissions shall be encouraged. For 6 licensed ambulatory surgical treatment centers unable to 7 submit extracts in an electronic format the Council must 8 determine an alternate method for submission of data. 9 (g) Under no circumstances shall patient name and social 10 security number appear on the extracts. 11 (h) Hospitals and licensed ambulatory surgical treatment 12 centers shall be assigned a standard identification number by 13 the Council to be used in the submission of all data. 14 (i) The Council shall collect a 100% inpatient sample 15 from hospitals annually. The Council shall require each 16 hospital in the State to submit the UB-92 data extracts 17 required in subsection (e) to the Council, except that 18 hospitals with fewer than 50 beds may be exempted by the 19 Council from the filing requirements if they prove to the 20 Council's satisfaction that the requirements would impose 21 undue economic hardship and if the Council determines that 22 the data submitted from these hospitals are not essential to 23 its data base and its concomitant health care cost comparison 24 efforts. 25 (i-5) The Council shall collect up to a 100% outpatient 26 sample annually from hospitals and licensed ambulatory 27 surgical treatment centers. The Council shall require each 28 hospital and licensed ambulatory surgical treatment center in 29 the State to submit the data extracts required under 30 subsection (e-5) to the Council, except that hospitals and 31 licensed ambulatory surgical treatment centers may be 32 exempted by the Council from the filing requirements if the 33 hospitals or licensed ambulatory surgical treatment centers 34 prove to the Council's satisfaction that the requirements HB1824 Engrossed -10- LRB9204832JMmb 1 would impose undue economic hardship and if the Council 2 determines that the data submitted from those hospitals and 3 licensed ambulatory surgical treatment centers are not 4 essential to the Council's database and its concomitant 5 health care comparison efforts. 6 (i-10) The outpatient data shall be collected by the 7 Council on a phase-in and trial basis for a one-year period 8 beginning on January 1, 2001. The Council shall implement 9 outpatient data collection for reporting purposes beginning 10 on January 1, 2002. 11 (j) The information submitted to the Council pursuant to 12 subsections (e) and (e-5) shall be reported for each primary 13 payor category, including Medicare, Medicaid, other 14 government programs, private insurance, health maintenance 15 organizations, self-insured, private pay patients, and 16 others. Preferred provider organization reimbursement shall 17 also be reported for each primary third party payor category. 18 (k) The Council shall require and the designated 19 corporation, association or entity, if applicable, shall 20 prepare quarterly basic reports in the aggregate on health 21 care cost and utilization trends in Illinois. The Council 22 shall provide these reports to the public, if requested. 23 These shall include, but not be limited to, comparative 24 information on average charges, total and ancillary charge 25 components, length of stay on diagnosis-specific and 26 procedure specific cases, and number of discharges, compiled 27 in aggregate by hospital and licensed ambulatory surgical 28 treatment center, by diagnosis, and by primary payor 29 category. 30 (l) The Council shall, from information submitted 31 pursuant to subsection (e), prepare an annual report in the 32 aggregate by hospital containing the following: 33 (1) the ratio of caesarean section deliveries to 34 total deliveries; HB1824 Engrossed -11- LRB9204832JMmb 1 (2) the average length of stay for patients who 2 undergo caesarean sections; 3 (3) the average total charges for patients who have 4 normal deliveries without any significant complications; 5 (4) the average total charges for patients who 6 deliver by caesarean section. 7 The Council shall provide this report to the public, if 8 requested. 9 (l-5) (Blank). 10 (m) Prior to the release or dissemination of any 11 provider-specific data for any purpose permitted by this Act 12these reports, the Council or the designated corporation 13 shall notify each provider of the release or dissemination 14 and permit each provider a reasonableproviders the15 opportunity to verify the accuracy of any information 16 pertaining to the provider. The Council shall give any 17 requesting provider, or its designated agent, a copy of the 18 data to be released or disseminated pertaining to that 19 provider. The providers, or their designated agents, may 20 submit to the Council any corrections or errors in the 21 compilation of the data with any supporting evidence and 22 documents the providers or agents may submit. The Council or 23 corporation shall correct data found to be in error and 24 include additional commentary as requested by the provider or 25 agent for major deviations in the charges from the average 26 charges. For purposes of this subsection (m), "providers" 27 includes hospitals, ambulatory surgical treatment centers, 28 and physicians licensed to practice medicine in all of its 29 branches. 30 (n) In addition to the reports indicated above, the 31 Council shall respond to requests by agencies of government 32 and organizations in the private sector for data products, 33 special studies and analysis of data collected pursuant to 34 this Section. Such reports shall be undertaken only by the HB1824 Engrossed -12- LRB9204832JMmb 1 agreement of a majority of the members of the Council who 2 shall designate the form in which the information shall be 3 made available. The Council or the corporation, association 4 or entity in consultation with the Council shall also 5 determine a fee to be charged to the requesting agency or 6 private sector organization to cover the direct and indirect 7 costs for producing such a report, and shall permit affected 8 providers the rights to review the accuracy of the report 9 before it is released. Such reports shall not be subject to 10 The Freedom of Information Act. 11 (Source: P.A. 91-756, eff. 6-2-00.) 12 Section 99. Effective date. This Act takes effect upon 13 becoming law.