Public Act 93-0144

HB2202 Enrolled                      LRB093 06053 MKM 11084 b

    AN ACT in relation to health care.

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

    Section 5. The Illinois Health Care Finance Reform Act is
amended by changing Section 4-2 as follows:

    (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
    Sec. 4-2.  Powers and duties.
    (a)  (Blank).
    (b)  (Blank).
    (c)  (Blank).
    (d)  Uniform Provider Utilization and Charge Information.
         (1)  The  Department  of Public Health shall require
    that all hospitals licensed to operate in  the  State  of
    Illinois  adopt  a  uniform system for submitting patient
    charges  for  payment  from  public  and  private  payors
    effective January 1, 1985.  This system  shall  be  based
    upon  adoption of the uniform electronic hospital billing
    form pursuant to the  Health  Insurance  Portability  and
    Accountability   Act   (UB-92)   or  its  successor  form
    developed by the National Uniform Billing Committee.
         (2)  (Blank).
         (3)  The Department of Insurance shall  require  all
    third-party   payors,   including  but  not  limited  to,
    licensed   insurers,   medical   and   hospital   service
    corporations,  health  maintenance   organizations,   and
    self-funded  employee health plans, to accept the uniform
    billing  form,  without  attachment   as   submitted   by
    hospitals  pursuant  to  paragraph  (1) of subsection (d)
    above, effective  January  1,  1985;  provided,  however,
    nothing  shall  prevent  all such third party payors from
    requesting additional information necessary to  determine
    eligibility  for  benefits or liability for reimbursement
    for services provided.
         (4)  Each  hospital  licensed  in  the  State  shall
    electronically submit to the Department  patient  billing
    data  for  conditions  and procedures required for public
    disclosure pursuant to paragraph (6). For hospitals,  the
    billing  data  to be reported shall include all inpatient
    surgical cases. Billing data  submitted  under  this  Act
    shall  not  include  a patient's name, address, or Social
    Security number.
         (5)  By  no  later  than  January   1,   2005,   the
    Department must collect and compile billing data required
    under  paragraph  (6)  according  to  uniform  electronic
    submission formats as required under the Health Insurance
    Portability and Accountability Act.
         (6)  The  Department  shall  make  available  on its
    website the "Consumer Guide to Health Care" by January 1,
    2006. The "Consumer Guide to Health Care"  shall  include
    information on 30 conditions and procedures identified by
    the  Department  that  demonstrate  the highest degree of
    variation in patient charges and quality of care.  As  to
    each  condition  or  procedure,  the  "Consumer  Guide to
    Health  Care"   shall   include   up-to-date   comparison
    information relating to volume of cases, average charges,
    risk-adjusted  mortality  rates, and nosocomial infection
    rates. Information disclosed pursuant to  this  paragraph
    on  mortality  and  infection  rates  shall be based upon
    information hospitals have previously  submitted  to  the
    Department pursuant to their obligations to report health
    care information under other public health reporting laws
    and regulations outside of this Act.
         (7)  Publicly disclosed information must be provided
    in  language that is easy to understand and accessible to
    consumers using an interactive query system.
         (8)  None  of   the   information   the   Department
    discloses to the public under this subsection may be made
    available  unless  the  information  has  been  reviewed,
    adjusted,   and  validated  according  to  the  following
    process:
              (i)  Hospitals and  organizations  representing
         hospitals   are   meaningfully   involved   in   the
         development  of  all  aspects  of  the  Department's
         methodology    for    collecting,   analyzing,   and
         disclosing the information collected under this Act,
         including  collection   methods,   formatting,   and
         methods and means for release and dissemination;
              (ii)  The entire methodology for collection and
         analyzing  the  data  is  disclosed  to all relevant
         organizations and to  all  providers  that  are  the
         subject  of  any information to be made available to
         the public before  any  public  disclosure  of  such
         information;
              (iii)  Data     collection    and    analytical
         methodologies are used that meet accepted  standards
         of  validity  and reliability before any information
         is made available to the public;
              (iv)  The limitations of the data  sources  and
         analytic  methodologies  used to develop comparative
         provider  information  are  clearly  identified  and
         acknowledged,  including,  but   not   limited   to,
         appropriate and inappropriate uses of the data;
              (v)  To    the    greatest   extent   possible,
         comparative  hospital  information  initiatives  use
         standard-based norms derived  from  widely  accepted
         provider-developed practice guidelines;
              (vi)  Comparative   hospital   information  and
         other information that the Department  has  compiled
         regarding  hospitals  is  shared  with the hospitals
         under review prior to public  dissemination  of  the
         information  and these providers have an opportunity
         to  make  corrections  and  additions   of   helpful
         explanatory  comments  about  the information before
         the publication;
              (vii)  Comparisons among hospitals  adjust  for
         patient case mix and other relevant risk factors and
         control for provider peer groups;
              (viii)  Effective safeguards to protect against
         the  unauthorized  use  or  disclosure  of  hospital
         information are developed and implemented;
              (ix)  Effective  safeguards  to protect against
         the  dissemination  of   inconsistent,   incomplete,
         invalid, inaccurate, or subjective provider data are
         developed and implemented;
              (x)  The   quality  and  accuracy  of  hospital
         information reported under this  Act  and  its  data
         collection,      analysis,     and     dissemination
         methodologies are evaluated regularly; and
              (xi)  Only   the   most    basic    identifying
         information  from  mandatory  reports  is  used, and
         patient identifiable information  is  not  released.
         The input data collected by the Department shall not
         be  a  public  record  under the Illinois Freedom of
         Information Act.
         None of the information the Department discloses  to
    the  public  under  this  Act  may be used to establish a
    standard of care in a private civil action.
         (9)  The Department must develop  and  implement  an
    outreach  campaign  to  educate  the public regarding the
    availability of the "Consumer Guide to Health Care".
         (10)  Within 12 months after the effective  date  of
    this  amendatory  Act  of  the 93rd General Assembly, the
    Department must study  the  most  effective  methods  for
    public  disclosure of patient charge data and health care
    quality information that will be useful to  consumers  in
    making    health    care   decisions   and   report   its
    recommendations  to  the  Governor  and  to  the  General
    Assembly.
         (11)  The  Department  must  undertake   all   steps
    necessary  under State and Federal law to protect patient
    confidentiality in order to prevent the identification of
    individual patient records.
    (e)  (Blank).
(Source: P.A. 91-756, eff. 6-2-00; 92-597, eff. 7-1-02.)

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