Public Act 097-0171
 
HB1562 EnrolledLRB097 06679 KTG 46765 b

    AN ACT concerning State government.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Health 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 and ambulatory surgical treatment centers
    licensed to operate in the State of Illinois adopt a
    uniform system for submitting patient claims and encounter
    data for payment from public and private payors. This
    system shall be based upon adoption of the uniform
    electronic billing form pursuant to the Health Insurance
    Portability and Accountability Act.
        (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) By no later than 60 days after the end of each
    calendar quarter, each hospital licensed in the State shall
    electronically submit to the Department inpatient and
    outpatient claims and encounter data related to surgical
    and invasive procedures collected under paragraph (5) for
    each patient.
        By no later than 60 days after the end of each calendar
    quarter, each ambulatory surgical treatment center
    licensed in the State shall electronically submit to the
    Department outpatient claims and encounter data collected
    under paragraph (5) for each patient, provided however,
    that, until July 1, 2006, ambulatory surgical treatment
    centers who cannot electronically submit data may submit
    data by computer diskette. For hospitals, the claims and
    encounter data to be reported shall include all inpatient
    surgical cases. Claims and encounter data submitted under
    this Act shall not include a patient's name, address, or
    Social Security number.
        (5) By no later than January 1, 2006, the Department
    must collect and compile claims and encounter data related
    to surgical and invasive procedures according to uniform
    electronic submission formats as required under the Health
    Insurance Portability and Accountability Act. By no later
    than January 1, 2006, the Department must collect and
    compile from ambulatory surgical treatment centers the
    claims and encounter data according to uniform electronic
    data element formats as required under the Health Insurance
    Portability and Accountability Act of 1996 (HIPAA).
        (6) The Department shall make available on its website
    the "Consumer Guide to Health Care" by January 1, 2006. The
    Department shall also make available on its website the
    Hospital Report Card Act. The "Consumer Guide to Health
    Care" and the Hospital Report Card Act were established to
    educate and assist Illinois health care consumers as they
    make health care choices for themselves, their families,
    and their loved ones. Significant and useful information is
    available through the "Consumer Guide to Health Care" and
    the Hospital Report Card Act. The links to the "Consumer
    Guide to Health Care" and the Hospital Report Card Act on
    the Department's website shall include a brief description
    of the information available in both. When the Department
    creates new or updates existing consumer fact sheets and
    other information or materials for the purpose of educating
    the Illinois health care consumer, it shall reference the
    web pages of the "Consumer Guide to Health Care" and the
    Hospital Report Card Act when it is relevant and
    appropriate. The "Consumer Guide to Health Care" shall
    include information on at least 30 inpatient conditions and
    procedures identified by the Department that demonstrate
    the highest degree of variation in patient charges and
    quality of care. By no later than January 1, 2007, the
    "Consumer Guide to Health Care" shall also include
    information on at least 30 outpatient conditions and
    procedures identified by the Department that demonstrate
    the highest degree of variation in patient charges and
    quality 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 and, with respect to outpatient
    surgical and invasive procedures, shall include
    information regarding surgical infections, complications,
    and direct admissions of outpatient cases to hospitals for
    selected procedures, as determined by the Department,
    based on review by the Department of its own, local, or
    national studies. Information disclosed pursuant to this
    paragraph on mortality and infection rates shall be based
    upon information hospitals and ambulatory surgical
    treatment centers have either (i) previously submitted to
    the Department pursuant to their obligations to report
    health care information under this Act or other public
    health reporting laws and regulations outside of this Act
    or (ii) submitted to the Department under the provisions of
    the Hospital Report Card Act.
        (7) Publicly disclosed information must be provided in
    language that is easy to understand and accessible to
    consumers using an interactive query system. The guide
    shall include such additional information as is necessary
    to enhance decision making among consumer and health care
    purchasers, which shall include, at a minimum, appropriate
    guidance on how to interpret the data and an explanation of
    why the data may vary from provider to provider. The
    "Consumer Guide to Health Care" shall also cite standards
    that facilities meet under state and federal law and, if
    applicable, to achieve voluntary accreditation.
        (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, ambulatory surgical treatment
        centers, and organizations representing hospitals,
        ambulatory surgical treatment centers, purchasers,
        consumer groups, and health plans are meaningfully
        involved in providing advice and consultation to the
        Department 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 collecting 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 and ambulatory surgical treatment center
        information initiatives use standard-based norms
        derived from widely accepted provider-developed
        practice guidelines;
            (vi) Comparative hospital and ambulatory surgical
        treatment center information and other information
        that the Department has compiled regarding hospitals
        and ambulatory surgical treatment centers is shared
        with the hospitals and ambulatory surgical treatment
        centers 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 and ambulatory
        surgical treatment centers adjust for patient case mix
        and other relevant risk factors and control for
        provider peer groups, if applicable;
            (viii) Effective safeguards to protect against the
        unauthorized use or disclosure of hospital and
        ambulatory surgical treatment center 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 and
        ambulatory surgical treatment center information
        reported under this Act and its data collection,
        analysis, and dissemination methodologies are
        evaluated regularly; and
            (xi) Only the most basic hospital or ambulatory
        surgical treatment center identifying information from
        mandatory reports is used. Information regarding a
        hospital or ambulatory surgical center may be released
        regardless of the number of employees or health care
        professionals whose data are reflected in the data for
        the hospital or ambulatory surgical treatment center
        as long as no specific information identifying an
        employee or a health care professional is released.
        Further, 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) By January 1, 2006, the Department must study the
    most effective methods for public disclosure of patient
    claims and encounter 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.
        (12) The Department must adopt rules for inpatient and
    outpatient data collection and reporting no later than
    January 1, 2006.
        (13) In addition to the data products indicated above,
    the Department shall respond to requests by government
    agencies, academic research organizations, and private
    sector organizations for purposes of clinical performance
    measurements and analyses of data collected pursuant to
    this Section.
        (14) The Department, with the advice of and in
    consultation with hospitals, ambulatory surgical treatment
    centers, organizations representing hospitals,
    organizations representing ambulatory treatment centers,
    purchasers, consumer groups, and health plans, must
    evaluate additional methods for comparing the performance
    of hospitals and ambulatory surgical treatment centers,
    including the value of disclosing additional measures that
    are adopted by the National Quality Forum, The Joint
    Commission on Accreditation of Healthcare Organizations,
    the Accreditation Association for Ambulatory Health Care,
    the Centers for Medicare and Medicaid Services, or similar
    national entities that establish standards to measure the
    performance of health care providers. The Department shall
    report its findings and recommendations on its Internet
    website and to the Governor and General Assembly no later
    than July 1, 2006.
    (e) (Blank).
(Source: P.A. 93-144, eff. 7-10-03; 94-27, eff. 6-14-05.)

Effective Date: 1/1/2012