SB1282 EnrolledLRB097 05293 KTG 45347 b


  
1    AN ACT concerning State government.
  
 
2    Be it enacted by the People of the State of Illinois,
 
3represented in the General Assembly:
  
 
 
4    Section 5. The Illinois Health Finance Reform Act is 
5amended  by changing Section 4-2 as follows:
 



6    (20 ILCS 2215/4-2)  (from Ch. 111 1/2, par. 6504-2)



7    Sec. 4-2. Powers and duties. 

8    (a) (Blank).

9    (b) (Blank).

10    (c) (Blank).

11    (d) Uniform Provider Utilization and Charge Information.


12        (1) The Department of Public Health shall require that 
13    all hospitals and ambulatory surgical treatment centers

14    licensed to operate in the State of Illinois adopt a 
15    uniform system for
submitting patient claims and encounter 
16    data

for payment from public and private payors.  This 
17    system shall be based upon adoption of the uniform

18    electronic billing form pursuant to the Health Insurance

19    Portability and Accountability Act.


20        (2) (Blank).


21        (3) The Department of Insurance shall require all 
22    third-party payors,
including but not limited to, licensed 
23    insurers, medical and hospital service
corporations, 
 
 
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1    health maintenance organizations, and self-funded employee

2    health plans, to accept the uniform billing form, without 
3    attachment as
submitted by hospitals pursuant to paragraph 
4    (1) of subsection (d) above,
effective January 1, 1985; 
5    provided, however, nothing shall prevent all
such third 
6    party payors from requesting additional information 
7    necessary to
determine eligibility for benefits or 
8    liability for reimbursement for
services provided.


9        (4) By no later than 60 days after the end of each 
10    calendar quarter, each hospital
licensed in the State shall 
11    electronically submit to
the Department inpatient and 
12    outpatient claims and encounter data related to surgical 
13    and invasive procedures collected under paragraph (5) for 
14    each patient.
15        By no later than 60 days after the end of each calendar 
16    quarter, each ambulatory surgical treatment center 
17    licensed in the State shall electronically submit to the 
18    Department outpatient claims and encounter data collected 
19    under paragraph (5) for each patient, provided however, 
20    that, until July 1, 2006, ambulatory surgical treatment 
21    centers who cannot electronically submit data may submit 
22    data by computer diskette.


For hospitals, the claims and 
23    encounter

data to be
reported shall include all inpatient 
24    surgical
cases.
Claims and encounter data submitted under 
25    this Act
shall not include a patient's name,
address,
or

26    Social Security number; provided, however, that the 
 
 
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1    Department may require, by rule, the inclusion of a unique 
2    patient identifier that may be based upon the last four 
3    digits of the patient's Social Security number.  The 
4    Department shall promulgate regulations to protect the 
5    patient's rights of confidentiality and privacy. The 
6    regulations shall ensure that patient names, addresses, 
7    Social Security numbers, or any other data that the 
8    Department believes could be used to determine the identity 
9    of an individual patient shall be stored and processed in 
10    the most secure manner possible.


11        (5) By no later than January 1, 2006, the Department 
12    must collect and
compile
claims and encounter data related 
13    to surgical and invasive procedures according to uniform 
14    electronic
submission formats as required under the Health 
15    Insurance Portability and
Accountability Act. By no later 
16    than January 1, 2006, the Department must collect and 
17    compile from ambulatory surgical treatment centers the 
18    claims and encounter data according to uniform electronic 
19    data element formats as required under the Health Insurance 
20    Portability and Accountability Act of 1996 (HIPAA).



21        (6) The Department shall make available on its website 
22    the
"Consumer Guide to Health Care" by January 1, 2006. The 
23    "Consumer
Guide to Health Care" shall include information 
24    on at least 30 inpatient conditions and
procedures 
25    identified by the Department that demonstrate the highest

26    degree of variation in patient charges and quality of care. 
 
 
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1    By no later than January 1, 2007, the "Consumer Guide to 
2    Health Care" shall also include information on at least 30 
3    outpatient conditions and procedures identified by the 
4    Department that demonstrate the highest degree of 
5    variation in patient charges and quality care. As to each

6    condition or procedure, the "Consumer Guide to Health Care" 
7    shall include
up-to-date comparison information relating 
8    to volume of cases, average
charges, risk-adjusted 
9    mortality rates, and nosocomial infection rates and, with 
10    respect to outpatient surgical and invasive procedures, 
11    shall include information regarding surgical infections, 
12    complications, and direct admissions of outpatient cases 
13    to hospitals for selected procedures, as determined by the 
14    Department, based on review by the Department of its own, 
15    local, or national studies.
Information disclosed pursuant 
16    to this paragraph on
mortality and infection rates shall be 
17    based upon information hospitals
and ambulatory surgical 
18    treatment centers have either (i)
previously submitted to 
19    the Department pursuant to their obligations
to report 
20    health care information under this Act or other public 
21    health reporting laws
and regulations outside of this Act 
22    or (ii) submitted to the Department under the provisions of 
23    the Hospital Report Card Act.


24        (7) Publicly disclosed information must be provided in 
25    language
that is easy to understand and accessible to 
26    consumers using an
interactive query system. The guide 
 
 
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1    shall include such additional information as is necessary 
2    to enhance decision making among consumer and health care 
3    purchasers, which shall include, at a minimum, appropriate 
4    guidance on how to interpret the data and an explanation of 
5    why the data may vary from provider to provider. The 
6    "Consumer Guide to Health Care" shall also cite standards 
7    that facilities meet under state and federal law and, if 
8    applicable, to achieve voluntary accreditation.



9        (8) None of the information the Department discloses to 
10    the public
under this subsection may be made available 
11    unless the information has
been reviewed, adjusted, and 
12    validated according to the following process:


13            (i) Hospitals, ambulatory surgical treatment 
14        centers,
and organizations
representing hospitals, 
15        ambulatory surgical treatment centers, purchasers, 
16        consumer groups, and health plans are
meaningfully 
17        involved in providing advice and consultation to the 
18        Department in the development of all aspects of
the 
19        Department's methodology for collecting, analyzing, 
20        and
disclosing the information collected under this 
21        Act, including
collection methods, formatting, and 
22        methods and means for
release and dissemination;


23            (ii) The entire methodology for collecting and

24        analyzing the data is disclosed to all relevant 
25        organizations
and to all providers that are the subject 
26        of any information to
be made available to the public 
 
 
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1        before any public disclosure
of such information;


2            (iii) Data collection and analytical methodologies 
3        are
used that meet accepted standards of validity and 
4        reliability
before any information is made available 
5        to the public;


6            (iv) The limitations of the data sources and 
7        analytic
methodologies used to develop comparative 
8        provider
information are clearly identified and 
9        acknowledged,
including, but not limited to, 
10        appropriate and inappropriate
uses of the data;


11            (v) To the greatest extent possible, comparative

12        hospital and ambulatory surgical treatment center

13        information initiatives use standard-based
norms 
14        derived from widely accepted provider-developed

15        practice guidelines;


16            (vi) Comparative hospital and ambulatory surgical 
17        treatment center information and other
information 
18        that the Department has compiled regarding
hospitals 
19        and ambulatory surgical treatment centers is shared 
20        with the hospitals and ambulatory surgical treatment 
21        centers under review prior to
public dissemination of 
22        the information and these providers
have an 
23        opportunity to make corrections and additions of

24        helpful explanatory comments about the information 
25        before
the publication;


26            (vii) Comparisons among hospitals and ambulatory 
 
 
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1        surgical treatment centers adjust for
patient case mix 
2        and other relevant risk factors and control
for 
3        provider peer groups, if applicable;


4            (viii) Effective safeguards to protect against the

5        unauthorized use or disclosure of hospital and 
6        ambulatory surgical treatment center information are

7        developed and implemented;


8            (ix) Effective safeguards to protect against the

9        dissemination of inconsistent, incomplete, invalid,

10        inaccurate, or subjective provider data are developed 
11        and
implemented;


12            (x) The quality and accuracy of hospital and 
13        ambulatory surgical treatment center information

14        reported under this Act and its data collection, 
15        analysis, and
dissemination methodologies are 
16        evaluated regularly; and


17            (xi) Only the most basic hospital or ambulatory 
18        surgical treatment center identifying information from 
19        mandatory reports is used. Information regarding a 
20        hospital or ambulatory surgical center may be released 
21        regardless of the number of employees or health care 
22        professionals whose data are reflected in the data for 
23        the hospital or ambulatory surgical treatment center 
24        as long as no specific information identifying an 
25        employee or a health care professional is released.


26        Further, patient identifiable
information is not 
 
 
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1        released. The input data collected
by the Department 
2        shall not be a public record under the
Illinois Freedom 
3        of Information Act.


4        None of the information
the Department discloses to the 
5    public under this Act may be
used to establish a standard 
6    of care in a private civil action.


7        (9) The Department must develop and implement an 
8    outreach
campaign to educate the public regarding the 
9    availability of the "Consumer
Guide to Health Care".


10        (10) By January 1, 2006, the Department must study the

11    most effective methods for public disclosure of patient 
12    claims and encounter data and
health care quality 
13    information that will be useful to consumers in making

14    health care decisions and report its recommendations to the

15    Governor and to the General Assembly.


16        (11) The Department must undertake all steps necessary 
17    under
State and Federal law to protect patient 
18    confidentiality in order to prevent
the identification of 
19    individual patient records.

20        (12) The Department must adopt rules for inpatient and 
21    outpatient data collection and reporting  no later than 
22    January 1, 2006.
23        (13) In addition to the data products indicated above, 
24    the Department shall respond to requests by government 
25    agencies, academic research organizations, and private 
26    sector organizations for purposes of clinical performance 
 
 
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1    measurements and analyses of data collected pursuant to 
2    this Section.
3        (14) The Department, with the advice of and in 
4    consultation with hospitals, ambulatory surgical treatment 
5    centers, organizations representing hospitals, 
6    organizations representing ambulatory treatment centers, 
7    purchasers, consumer groups, and health plans,  must 
8    evaluate additional methods for comparing the performance 
9    of hospitals and ambulatory surgical treatment centers, 
10    including the value of disclosing additional measures that 
11    are adopted by the National Quality Forum, The Joint 
12    Commission on Accreditation of Healthcare Organizations, 
13    the Accreditation Association for Ambulatory Health Care, 
14    the Centers for Medicare and Medicaid Services, or  similar 
15    national entities that establish standards to measure the 
16    performance of health care providers.  The Department shall 
17    report its findings and recommendations on its Internet 
18    website and to the Governor and General Assembly no later 
19    than July 1, 2006.

20    (e) (Blank).

21(Source: P.A. 93-144, eff. 7-10-03; 94-27, eff. 6-14-05.)