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91_SB1657
LRB9110302MWgc
1 AN ACT to amend the Illinois Health Finance Reform Act by
2 changing Sections 4-1, 4-2, 4-3, and 4-5.
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 4-1, 4-2, 4-3, and 4-5 as
7 follows:
8 (20 ILCS 2215/4-1) (from Ch. 111 1/2, par. 6504-1)
9 Sec. 4-1. Illinois Health Finance Data Collection. The
10 General Assembly finds that accurate, comparable data on the
11 costs of health care are not currently available in Illinois.
12 Therefore, it is extremely difficult to make careful policy
13 choices for future health care cost management strategies.
14 Further, neither the public sector and nor private sector
15 purchasers of health care need health care cost and
16 utilization have available data to enable them to make
17 informed choices among health care providers in the market
18 place. While the gathering of health care cost data has
19 been attempted on a voluntary basis in the past, the lack of
20 a uniform system for the collection and analysis of data, and
21 the lack of full participation by providers and payors has
22 led to inadequate and unusable data. In order to remedy this
23 problem, The General Assembly finds it necessary to create a
24 mandated uniform system in Illinois for the collection,
25 analysis, and distribution of health care cost and
26 utilization data.
27 The purpose of this Article is to insure that data are
28 available to make valid comparisons among health care
29 providers hospitals of prices and utilization of for services
30 provided and to support ongoing analysis of the health care
31 delivery system so that the Council can fulfill its mandate.
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1 (Source: P.A. 83-1243.)
2 (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
3 Sec. 4-2. Powers and duties.
4 (a) The Illinois Health Care Cost Containment Council
5 may enter into any agreement with any corporation,
6 association or other entity it deems appropriate to undertake
7 the process described in this Article for the compilation and
8 analysis of data collected by the Council and to conduct or
9 contract for studies on health-related questions carried out
10 in pursuance of the purposes of this Article. The agreement
11 may provide for the corporation, association or entity to
12 prepare and distribute or make available data to health care
13 providers, health care subscribers, third-party payors,
14 government and the general public, in accordance with the
15 rules of confidentiality and review to be developed under
16 this Act.
17 (b) The input data collected by and furnished to the
18 Council or designated corporation, association or entity
19 pursuant to this Section shall not be a public record under
20 the Illinois Freedom of Information Act. It is the intent of
21 this Act and of the regulations written pursuant to it to
22 protect the confidentiality of individual patient information
23 and the proprietary information of commercial insurance
24 carriers and health care providers hospitals. To accomplish
25 this, the data specified in subsection (c) shall be released
26 in the following manner. Total gross revenue, total
27 deductions from gross revenue and gross inpatient revenue
28 shall be reported to the Council and released by the Council
29 on a hospital specific basis. The remaining data elements in
30 subsection (c) shall not be released on a hospital-specific
31 basis except as needed by the executive, legislative, and
32 judicial branches of government for the performance of their
33 duties. Data specified in subsections subsection (e) and
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1 (e-5) shall be released on a hospital specific and licensed
2 ambulatory surgical treatment center specific basis to
3 facilitate comparisons among hospitals and licensed
4 ambulatory surgical treatment centers by purchasers.
5 (c) The Council shall require the Departments of Public
6 Health and Public Aid and hospitals located in the State to
7 assist the Council in gathering and submitting the following
8 hospital-specific financial information, and the Council is
9 authorized to share this data with both Departments to reduce
10 the burden on hospitals by avoiding duplicate data
11 collection:
12 OPERATING REVENUES
13 (1) Net patient service revenue
14 (2) Other revenue
15 (3) Total operating revenue
16 OPERATING EXPENSES
17 (4) Bad debt expense
18 (5) Total operating expenses
19 NON-OPERATING GAINS/LOSSES
20 (6) Total non-operating gains
21 (7) Total non-operating losses
22 PATIENT CARE REVENUES
23 (8) Gross inpatient revenue
24 (9) Gross outpatient revenue
25 (10) Other Patient care revenue
26 (11) Total patient revenue
27 (12) Total gross patient care revenue
28 (13) Medicare gross revenue
29 (14) Medicaid gross revenue
30 (15) Total other gross revenue
31 DEDUCTIONS FROM REVENUE
32 (16) Charity care
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1 (17) Medicare allowance
2 (18) Medicaid allowance
3 (19) Other contractual allowances
4 (20) Other allowances
5 (21) Total Deductions
6 ASSETS
7 (22) Operating cash and short-term investments
8 (23) Estimated patient accounts receivable
9 (24) Other current assets
10 (25) Total current assets
11 (26) Total other assets
12 (27) Total Assets
13 LIABILITIES AND FUND BALANCES
14 (28) Total current liabilities
15 (29) Long Term Debt
16 (30) Other liabilities
17 (31) Total liabilities
18 (32) Total liabilities and fund balances
19 In addition, each hospital shall annually submit to the
20 Council a duplicate copy of the hospital's Medicaid Cost
21 Report at the same time that the hospital submits the cost
22 report to the Illinois Department of Public Aid and any
23 settled cost report upon receipt by the hospital of a notice
24 of amount of program reimbursement.
25 On and after the effective date of this Act, such
26 information shall be annually submitted from each hospital in
27 the State of Illinois no later than 120 days after the close
28 of its fiscal year. The information submitted in the report
29 shall be based upon audited financial statements and shall be
30 attested to by the Chief Executive Officer of each hospital.
31 All financial data collected by the Council from publicly
32 available sources such as the HCFA Electronic Medicare
33 Reports is releasable by the Council on a hospital specific
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1 basis when appropriate.
2 (d) Uniform Provider Utilization and Charge
3 Information. The Council shall require that:
4 (1) Hospitals licensed to operate in the State of
5 Illinois adopt a uniform system for submitting patient
6 charges for payment from public and private payors
7 effective January 1, 1985. This system shall be based
8 upon adoption of the uniform hospital billing form
9 (UB-92) (UB-82/HCFA-1450) or its successor form developed
10 by the National Uniform Billing Committee.
11 (2) (Blank) The Illinois Department of Public Aid
12 accept the uniform billing form effective October 1,
13 1985. In addition, the Illinois Department of Public Aid
14 shall report the data listed in subsection (e) for the
15 period January 1, 1985 through October 1, 1985.
16 (3) The Department of Insurance require all
17 third-party payors, including but not limited to,
18 licensed insurers, medical and hospital service
19 corporations, health maintenance organizations, and
20 self-funded employee health plans, to accept the uniform
21 billing form, without attachment as submitted by
22 hospitals pursuant to paragraph (1) of subsection (d)
23 above, effective January 1, 1985; provided, however,
24 nothing shall prevent all such third party payors from
25 requesting additional information necessary to determine
26 eligibility for benefits or liability for reimbursement
27 for services provided.
28 (e) The Council, in cooperation with the State
29 Departments of Public Aid, Insurance, and Public Health,
30 shall establish a system for the collection of the following
31 information from hospitals utilizing the raw data available
32 on the uniform billing forms. Such data shall include the
33 following elements and other elements contained on the
34 uniform billing form or its successor form determined as
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1 necessary by the Council:
2 (1) Patient date of birth
3 (2) Patient sex
4 (3) Patient zip code
5 (4) Third-party coverage
6 (5) Date of admission
7 (6) Source of admission
8 (7) Type of admission
9 (8) Discharge date
10 (9) Principal and up to 8 four other diagnoses
11 (10) Principal procedure and date
12 (11) Patient status
13 (12) Other procedures and dates
14 (13) Total charges and components of those charges
15 (14) Attending and consulting physician identification
16 numbers number
17 (15) Hospital identification number
18 (16) An alphanumeric number based on the information to
19 identify the payor
20 (17) Principal source of payment.
21 (e-5) The Council, in cooperation with the Department of
22 Public Aid, the Department of Insurance, and the Department
23 of Public Health, shall establish a system for the collection
24 of the following information for each outpatient surgery
25 performed at hospitals and licensed ambulatory surgical
26 treatment centers using the raw data available on outpatient
27 billing forms submitted by hospitals and licensed ambulatory
28 surgical treatment centers to payors. The data must include
29 the following elements, if available on the billing forms,
30 and other elements contained on the billing forms that the
31 Council determines are necessary:
32 (1) patient date of birth;
33 (2) patient sex;
34 (3) patient zip code;
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1 (4) third-party coverage;
2 (5) date of admission;
3 (6) source of admission;
4 (7) type of admission;
5 (8) discharge date;
6 (9) principal diagnosis and up to 8 other
7 diagnoses;
8 (10) principal procedure and to date of the
9 procedure;
10 (11) patient status;
11 (12) other procedures and the dates of those
12 procedures;
13 (13) attending and consulting physician
14 identification numbers;
15 (14) hospital or licensed ambulatory surgical
16 treatment center identification number;
17 (15) an alphanumeric number based on the
18 information needed to identify the payor; and
19 (16) principal source of payment.
20 (f) Extracts of the UB-92 UB82 transactions shall be
21 prepared by hospitals according to regulations promulgated by
22 the Council and submitted in electronic magnetic tape format
23 to the Council or the corporation, association or entity
24 designated by the Council.
25 For hospitals unable to submit extracts in electronic
26 magnetic tape format, the Council shall determine an
27 alternate method for electronic submission of data. Such
28 extract reporting systems shall be in operation before
29 January 1, 1987; however, the Council may grant time
30 extensions to individual hospital.
31 (f-5) Extracts of the billing forms shall be prepared by
32 licensed ambulatory surgical treatment centers according to
33 rules adopted by the Council and submitted to the Council or
34 a corporation, association, or entity designated by the
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1 Council. Electronic submissions shall be encouraged. For
2 licensed ambulatory surgical treatment centers unable to
3 submit extracts in an electronic format the Council must
4 determine an alternate method for submission of data.
5 (g) Under no circumstances shall patient name and social
6 security number appear on the extracts.
7 (h) Hospitals and licensed ambulatory surgical treatment
8 centers shall be assigned a standard identification number by
9 the Council to be used in the submission of all data.
10 (i) The Council shall collect a 100% inpatient sample
11 from hospitals annually. The Council shall require each
12 hospital in the State to submit the UB-92 UB-82 data extracts
13 required in subsection (e) to the Council, except that
14 hospitals with fewer than 50 beds may be exempted by the
15 Council from the filing requirements if they prove to the
16 Council's satisfaction that the requirements would impose
17 undue economic hardship and if the Council determines that
18 the data submitted from these hospitals are not essential to
19 its data base and its concomitant health care cost comparison
20 efforts.
21 (i-5) The Council shall collect up to a 100% outpatient
22 sample annually from hospitals and licensed ambulatory
23 surgical treatment centers. The Council shall require each
24 hospital and licensed ambulatory surgical treatment center in
25 the State to submit the data extracts required under
26 subsection (e-5) to the Council, except that hospitals and
27 licensed ambulatory surgical treatment centers may be
28 exempted by the Council from the filing requirements if the
29 hospitals or licensed ambulatory surgical treatment centers
30 prove to the Council's satisfaction that the requirements
31 would impose undue economic hardship and if the Council
32 determines that the data submitted from those hospitals and
33 licensed ambulatory surgical treatment centers are not
34 essential to the Council's database and its concomitant
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1 health care comparison efforts.
2 (i-10) The outpatient data shall be collected by the
3 Council on a phase-in and trial basis for a one-year period
4 beginning on July 1, 2000. The Council shall implement
5 outpatient data collection for reporting purposes beginning
6 on July 1, 2001.
7 (j) The information submitted to the Council pursuant to
8 subsections subsection (e) and (e-5) shall be reported for
9 each primary payor category, including Medicare, Medicaid,
10 other government programs, private insurance, health
11 maintenance organizations, self-insured, private pay
12 patients, and others. Preferred provider organization
13 reimbursement shall also be reported for each primary third
14 party payor category.
15 (k) The Council shall require and the designated
16 corporation, association or entity, if applicable, shall
17 prepare quarterly basic reports in the aggregate on health
18 care cost and utilization costs trends in Illinois. The
19 Council shall provide these reports to the public, if
20 requested. These shall include, but not be limited to,
21 comparative information on average charges, total and
22 ancillary charge components, length of stay on
23 diagnosis-specific and procedure specific cases, and number
24 of discharges, compiled in aggregate by hospital and licensed
25 ambulatory surgical treatment center, by diagnosis, and by
26 primary payor category.
27 (l) The Council shall, from information submitted
28 pursuant to subsection (e), prepare an annual report in the
29 aggregate by hospital containing the following:
30 (1) the ratio of caesarean section deliveries to
31 total deliveries;
32 (2) the average length of stay for patients who
33 undergo caesarean sections;
34 (3) the average total charges for patients who have
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1 normal deliveries without any significant complications;
2 (4) the average total charges for patients who
3 deliver by caesarean section.
4 The Council shall provide this report to the public, if
5 requested.
6 (l-5) (Blank) The Council, in cooperation with the State
7 Departments of Public Aid, Insurance, and Public Health,
8 shall establish a system for the collection of outpatient
9 surgical data from hospitals and licensed ambulatory surgical
10 treatment centers utilizing raw data available on an
11 outpatient uniform billing form that conforms with pertinent
12 State and federal standards. Under no circumstances shall a
13 patient's name or social security number appear on the
14 abstract of the billing form provided to the Council.
15 Beginning July 1, 1996, the Council is authorized to collect
16 ambulatory surgery information from hospitals and licensed
17 freestanding surgery centers by means of surveys. No later
18 than January 1, 1997, the Council shall begin a pilot study
19 that includes the collection of some hospital and licensed
20 freestanding ambulatory surgery data from the same health
21 care markets. No later than July 1, 1997, the Council shall
22 begin a field test of the ambulatory surgery data collection
23 system with the collection of all defined outpatient surgery
24 data from a sample of licensed freestanding ambulatory
25 surgical treatment centers and the hospitals that serve the
26 same health care markets. No later than January 1, 1998, the
27 Council shall begin to collect comments from providers and
28 consumers and from advisory groups regarding the field
29 testing of a system for the collection of outpatient surgical
30 data. The Council shall report its findings, summary of
31 comments received, conclusions and recommendations regarding
32 the collection of outpatient surgical data no later than
33 March 1, 1998 to the General Assembly.
34 The Council shall seek authorization from the General
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1 Assembly prior to beginning the collection of all defined
2 outpatient surgery data from all licensed freestanding
3 ambulatory surgical treatment centers and hospitals.
4 Beginning July 1, 1996, the Council is authorized to
5 develop a process to use existing third party payers and
6 other voluntarily available existing databases, surveys, and
7 sampling techniques to develop cost and utilization
8 information on outpatient care primarily for areas other than
9 ambulatory surgery in Illinois.
10 To ensure both equity and data integrity, no ambulatory
11 survey data shall be released other than to the individual
12 hospitals and licensed freestanding ambulatory surgical
13 treatment centers that provided the data until the data is
14 being required from all facilities in the same health care
15 market and the Council determines the collection program is
16 effective.
17 (m) Prior to the release or dissemination of these
18 reports, the Council or the designated corporation shall
19 permit providers the opportunity to verify the accuracy of
20 any information pertaining to the provider. The providers
21 may submit to the Council any corrections or errors in the
22 compilation of the data with any supporting evidence and
23 documents the providers may submit. The Council or
24 corporation shall correct data found to be in error and
25 include additional commentary as requested by the provider
26 for major deviations in the charges from the average charges.
27 For purposes of this subsection (m), "providers" includes
28 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
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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. 88-535; 89-554, eff. 7-26-96.)
12 (20 ILCS 2215/4-3) (from Ch. 111 1/2, par. 6504-3)
13 Sec. 4-3. Confidentiality.
14 (a) As indicated elsewhere in this Act, all steps
15 necessary under State and Federal law to protect patient
16 confidentiality shall be undertaken by the Council to prevent
17 the identification of individual patient records.
18 Regulations are to be written to assure the confidentiality
19 of patient records when gathering and submitting data to the
20 Council or designated corporation, association or entity.
21 (b) The information submitted to the Council, designated
22 corporation, association or entity by hospitals pursuant to
23 subsections (c), and (e), and (e-5) of Section 4-2 shall be
24 privileged and confidential, and shall not be disclosed in
25 any manner. The foregoing includes, but shall not be limited
26 to, disclosure, inspection or copying under the Freedom of
27 Information Act, the State Records Act, and paragraph (1) of
28 Section 404 of the Illinois Insurance Code. However, the
29 prohibitions stated in this subsection shall not apply to the
30 compilations of information assembled by the Council pursuant
31 to subsections (k) and (m) of Section 4-2.
32 (c) Any person or organization, including but not
33 limited to, hospitals, government agencies, associations,
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1 businesses, or researchers receiving data under an agreement
2 with the Council under the terms indicated in Section 6504-2
3 shall be required to adhere strictly to the terms of the
4 agreement, especially the terms that are related to
5 preserving patient confidentiality. The use of Council data
6 either alone or in combination with data from another source
7 or sources to identify specific patients is prohibited unless
8 such identification is specifically authorized by Illinois
9 Statute and agreed to in writing by the Council. An
10 intentional breach of patient confidentiality not authorized
11 by statute and the Council shall render the responsible
12 individual or organization liable to the penalties under
13 Section 5-2.
14 (Source: P.A. 91-357, eff. 7-29-99.)
15 (20 ILCS 2215/4-5) (from Ch. 111 1/2, par. 6504-5)
16 Sec. 4-5. Expenses. The Council or designated
17 corporation, association or entity shall establish a
18 procedure by which it will pay hospitals and licensed
19 ambulatory surgical treatment centers for submitting data
20 pursuant to subsections subsection (e) and (e-5) of Section
21 4-2. Operating expenses of the Council or the designated
22 corporation, association or entity for such payments, for the
23 conversion of hard copy reports to tape, and for the
24 compilation and analysis of basic reports shall be paid for
25 by appropriation of the General Assembly. Expenses for
26 additional reports shall be billed to those requesting the
27 reports.
28 (Source: P.A. 83-1243.)
29 Section 99. Effective date. This Act takes effect upon
30 becoming law.