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.
Effective Date: 07/10/03