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Public Act 91-0756
SB1657 Enrolled LRB9110302MWgc
AN ACT to amend the Illinois Health Finance Reform Act by
changing Sections 2-1, 4-1, 4-2, 4-3, and 4-5.
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 Sections 2-1, 4-1, 4-2, 4-3, and 4-5 as
follows:
(20 ILCS 2215/2-1) (from Ch. 111 1/2, par. 6502-1)
Sec. 2-1. Council Authorized. There is hereby created
the Illinois Health Care Cost Containment Council. It shall
consist of 13 11 members appointed by the Governor with the
advice and consent of the Senate as follows: 5 3 members to
represent providers as follows: 2 members to represent
Illinois hospitals at least one of which must represent a
small rural hospital, 2 members to represent physicians
licensed to practice medicine in all its branches, and 1
member to represent ambulatory surgical treatment centers; 3
members to represent consumers; 2 members to represent
insurance companies; and 3 members to represent businesses.
The members of the Council shall be appointed for 3-year
three year terms.
No more than 7 six members may be from the same political
party.
Members shall be appointed within 30 thirty days after
the effective date of this Act. The additional members
appointed under the amendatory Act of the 91st General
Assembly must be appointed within 30 days after the effective
date of this amendatory Act of the 91st General Assembly. The
members of the Council shall receive reimbursement of their
actual expenses incurred in connection with their service; in
addition, each member shall receive compensation of $150 a
day for each day served at regular or special meetings of the
Council, except that such compensation shall not exceed
$20,000 in any one year for any member. The Council shall
elect a Chairman from among its members, and shall have the
power to organize and appoint such other officers as it may
deem necessary.
All appointments shall be made in writing and filed with
the Secretary of State as a public record.
(Source: P.A. 83-1243.)
(20 ILCS 2215/4-1) (from Ch. 111 1/2, par. 6504-1)
Sec. 4-1. Illinois Health Finance Data Collection. The
General Assembly finds that accurate, comparable data on the
costs of health care are not currently available in Illinois.
Therefore, it is extremely difficult to make careful policy
choices for future health care cost management strategies.
Further, neither the public sector and nor private sector
purchasers of health care need health care cost and
utilization have available data to enable them to make
informed choices among health care providers in the market
place. While the gathering of health care cost data has
been attempted on a voluntary basis in the past, the lack of
a uniform system for the collection and analysis of data, and
the lack of full participation by providers and payors has
led to inadequate and unusable data. In order to remedy this
problem, The General Assembly finds it necessary to create a
mandated uniform system in Illinois for the collection,
analysis, and distribution of health care cost and
utilization data.
The purpose of this Article is to insure that data are
available to make valid comparisons among health care
providers hospitals of prices and utilization of for services
provided and to support ongoing analysis of the health care
delivery system so that the Council can fulfill its mandate.
(Source: P.A. 83-1243.)
(20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
Sec. 4-2. Powers and duties.
(a) The Illinois Health Care Cost Containment Council
may enter into any agreement with any corporation,
association or other entity it deems appropriate to undertake
the process described in this Article for the compilation and
analysis of data collected by the Council and to conduct or
contract for studies on health-related questions carried out
in pursuance of the purposes of this Article. The agreement
may provide for the corporation, association or entity to
prepare and distribute or make available data to health care
providers, health care subscribers, third-party payors,
government and the general public, in accordance with the
rules of confidentiality and review to be developed under
this Act.
(b) The input data collected by and furnished to the
Council or designated corporation, association or entity
pursuant to this Section shall not be a public record under
the Illinois Freedom of Information Act. It is the intent of
this Act and of the regulations written pursuant to it to
protect the confidentiality of individual patient information
and the proprietary information of commercial insurance
carriers and health care providers hospitals. To accomplish
this, the data specified in subsection (c) shall be released
in the following manner. Total gross revenue, total
deductions from gross revenue and gross inpatient revenue
shall be reported to the Council and released by the Council
on a hospital specific basis. The remaining data elements in
subsection (c) shall not be released on a hospital-specific
basis except as needed by the executive, legislative, and
judicial branches of government for the performance of their
duties. Data specified in subsections subsection (e) and
(e-5) shall be released on a hospital specific and licensed
ambulatory surgical treatment center specific basis to
facilitate comparisons among hospitals and licensed
ambulatory surgical treatment centers by purchasers.
(c) The Council shall require the Departments of Public
Health and Public Aid and hospitals located in the State to
assist the Council in gathering and submitting the following
hospital-specific financial information, and the Council is
authorized to share this data with both Departments to reduce
the burden on hospitals by avoiding duplicate data
collection:
OPERATING REVENUES
(1) Net patient service revenue
(2) Other revenue
(3) Total operating revenue
OPERATING EXPENSES
(4) Bad debt expense
(5) Total operating expenses
NON-OPERATING GAINS/LOSSES
(6) Total non-operating gains
(7) Total non-operating losses
PATIENT CARE REVENUES
(8) Gross inpatient revenue
(9) Gross outpatient revenue
(10) Other Patient care revenue
(11) Total patient revenue
(12) Total gross patient care revenue
(13) Medicare gross revenue
(14) Medicaid gross revenue
(15) Total other gross revenue
DEDUCTIONS FROM REVENUE
(16) Charity care
(17) Medicare allowance
(18) Medicaid allowance
(19) Other contractual allowances
(20) Other allowances
(21) Total Deductions
ASSETS
(22) Operating cash and short-term investments
(23) Estimated patient accounts receivable
(24) Other current assets
(25) Total current assets
(26) Total other assets
(27) Total Assets
LIABILITIES AND FUND BALANCES
(28) Total current liabilities
(29) Long Term Debt
(30) Other liabilities
(31) Total liabilities
(32) Total liabilities and fund balances
In addition, each hospital shall annually submit to the
Council a duplicate copy of the hospital's Medicaid Cost
Report at the same time that the hospital submits the cost
report to the Illinois Department of Public Aid and any
settled cost report upon receipt by the hospital of a notice
of amount of program reimbursement.
On and after the effective date of this Act, such
information shall be annually submitted from each hospital in
the State of Illinois no later than 120 days after the close
of its fiscal year. The information submitted in the report
shall be based upon audited financial statements and shall be
attested to by the Chief Executive Officer of each hospital.
All financial data collected by the Council from publicly
available sources such as the HCFA Electronic Medicare
Reports is releasable by the Council on a hospital specific
basis when appropriate.
(d) Uniform Provider Utilization and Charge
Information. The Council shall require that:
(1) 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 hospital billing form
(UB-92) (UB-82/HCFA-1450) or its successor form developed
by the National Uniform Billing Committee.
(2) (Blank) The Illinois Department of Public Aid
accept the uniform billing form effective October 1,
1985. In addition, the Illinois Department of Public Aid
shall report the data listed in subsection (e) for the
period January 1, 1985 through October 1, 1985.
(3) The Department of Insurance 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.
(e) The Council, in cooperation with the State
Departments of Public Aid, Insurance, and Public Health,
shall establish a system for the collection of the following
information from hospitals utilizing the raw data available
on the uniform billing forms. Such data shall include the
following elements and other elements contained on the
uniform billing form or its successor form determined as
necessary by the Council:
(1) Patient date of birth
(2) Patient sex
(3) Patient zip code
(4) Third-party coverage
(5) Date of admission
(6) Source of admission
(7) Type of admission
(8) Discharge date
(9) Principal and up to 8 four other diagnoses
(10) Principal procedure and date
(11) Patient status
(12) Other procedures and dates
(13) Total charges and components of those charges
(14) Attending and consulting physician identification
numbers number
(15) Hospital identification number
(16) An alphanumeric number based on the information to
identify the payor
(17) Principal source of payment.
(e-5) The Council, in cooperation with the Department of
Public Aid, the Department of Insurance, and the Department
of Public Health, shall establish a system for the collection
of the following information for each outpatient surgery
performed at hospitals and licensed ambulatory surgical
treatment centers using the raw data available on outpatient
billing forms submitted by hospitals and licensed ambulatory
surgical treatment centers to payors. The data must include
the following elements, if available on the billing forms,
and other elements contained on the billing forms that the
Council determines are necessary:
(1) patient date of birth;
(2) patient sex;
(3) patient zip code;
(4) third-party coverage;
(5) date of admission;
(6) source of admission;
(7) type of admission;
(8) discharge date;
(9) principal diagnosis and up to 8 other
diagnoses;
(10) principal procedure and the date of the
procedure;
(11) patient status;
(12) other procedures and the dates of those
procedures;
(13) attending and consulting physician
identification numbers;
(14) hospital or licensed ambulatory surgical
treatment center identification number;
(15) an alphanumeric number based on the
information needed to identify the payor; and
(16) principal source of payment.
(f) Extracts of the UB-92 UB82 transactions shall be
prepared by hospitals according to regulations promulgated by
the Council and submitted in electronic magnetic tape format
to the Council or the corporation, association or entity
designated by the Council.
For hospitals unable to submit extracts in electronic
magnetic tape format, the Council shall determine an
alternate method for electronic submission of data. Such
extract reporting systems shall be in operation before
January 1, 1987; however, the Council may grant time
extensions to individual hospital.
(f-5) Extracts of the billing forms shall be prepared by
licensed ambulatory surgical treatment centers according to
rules adopted by the Council and submitted to the Council or
a corporation, association, or entity designated by the
Council. Electronic submissions shall be encouraged. For
licensed ambulatory surgical treatment centers unable to
submit extracts in an electronic format the Council must
determine an alternate method for submission of data.
(g) Under no circumstances shall patient name and social
security number appear on the extracts.
(h) Hospitals and licensed ambulatory surgical treatment
centers shall be assigned a standard identification number by
the Council to be used in the submission of all data.
(i) The Council shall collect a 100% inpatient sample
from hospitals annually. The Council shall require each
hospital in the State to submit the UB-92 UB-82 data extracts
required in subsection (e) to the Council, except that
hospitals with fewer than 50 beds may be exempted by the
Council from the filing requirements if they prove to the
Council's satisfaction that the requirements would impose
undue economic hardship and if the Council determines that
the data submitted from these hospitals are not essential to
its data base and its concomitant health care cost comparison
efforts.
(i-5) The Council shall collect up to a 100% outpatient
sample annually from hospitals and licensed ambulatory
surgical treatment centers. The Council shall require each
hospital and licensed ambulatory surgical treatment center in
the State to submit the data extracts required under
subsection (e-5) to the Council, except that hospitals and
licensed ambulatory surgical treatment centers may be
exempted by the Council from the filing requirements if the
hospitals or licensed ambulatory surgical treatment centers
prove to the Council's satisfaction that the requirements
would impose undue economic hardship and if the Council
determines that the data submitted from those hospitals and
licensed ambulatory surgical treatment centers are not
essential to the Council's database and its concomitant
health care comparison efforts.
(i-10) The outpatient data shall be collected by the
Council on a phase-in and trial basis for a one-year period
beginning on January 1, 2001. The Council shall implement
outpatient data collection for reporting purposes beginning
on January 1, 2002.
(j) The information submitted to the Council pursuant to
subsections subsection (e) and (e-5) shall be reported for
each primary payor category, including Medicare, Medicaid,
other government programs, private insurance, health
maintenance organizations, self-insured, private pay
patients, and others. Preferred provider organization
reimbursement shall also be reported for each primary third
party payor category.
(k) The Council shall require and the designated
corporation, association or entity, if applicable, shall
prepare quarterly basic reports in the aggregate on health
care cost and utilization costs trends in Illinois. The
Council shall provide these reports to the public, if
requested. These shall include, but not be limited to,
comparative information on average charges, total and
ancillary charge components, length of stay on
diagnosis-specific and procedure specific cases, and number
of discharges, compiled in aggregate by hospital and licensed
ambulatory surgical treatment center, by diagnosis, and by
primary payor category.
(l) The Council shall, from information submitted
pursuant to subsection (e), prepare an annual report in the
aggregate by hospital containing the following:
(1) the ratio of caesarean section deliveries to
total deliveries;
(2) the average length of stay for patients who
undergo caesarean sections;
(3) the average total charges for patients who have
normal deliveries without any significant complications;
(4) the average total charges for patients who
deliver by caesarean section.
The Council shall provide this report to the public, if
requested.
(l-5) (Blank) The Council, in cooperation with the State
Departments of Public Aid, Insurance, and Public Health,
shall establish a system for the collection of outpatient
surgical data from hospitals and licensed ambulatory surgical
treatment centers utilizing raw data available on an
outpatient uniform billing form that conforms with pertinent
State and federal standards. Under no circumstances shall a
patient's name or social security number appear on the
abstract of the billing form provided to the Council.
Beginning July 1, 1996, the Council is authorized to collect
ambulatory surgery information from hospitals and licensed
freestanding surgery centers by means of surveys. No later
than January 1, 1997, the Council shall begin a pilot study
that includes the collection of some hospital and licensed
freestanding ambulatory surgery data from the same health
care markets. No later than July 1, 1997, the Council shall
begin a field test of the ambulatory surgery data collection
system with the collection of all defined outpatient surgery
data from a sample of licensed freestanding ambulatory
surgical treatment centers and the hospitals that serve the
same health care markets. No later than January 1, 1998, the
Council shall begin to collect comments from providers and
consumers and from advisory groups regarding the field
testing of a system for the collection of outpatient surgical
data. The Council shall report its findings, summary of
comments received, conclusions and recommendations regarding
the collection of outpatient surgical data no later than
March 1, 1998 to the General Assembly.
The Council shall seek authorization from the General
Assembly prior to beginning the collection of all defined
outpatient surgery data from all licensed freestanding
ambulatory surgical treatment centers and hospitals.
Beginning July 1, 1996, the Council is authorized to
develop a process to use existing third party payers and
other voluntarily available existing databases, surveys, and
sampling techniques to develop cost and utilization
information on outpatient care primarily for areas other than
ambulatory surgery in Illinois.
To ensure both equity and data integrity, no ambulatory
survey data shall be released other than to the individual
hospitals and licensed freestanding ambulatory surgical
treatment centers that provided the data until the data is
being required from all facilities in the same health care
market and the Council determines the collection program is
effective.
(m) Prior to the release or dissemination of these
reports, the Council or the designated corporation shall
permit providers the opportunity to verify the accuracy of
any information pertaining to the provider. The providers
may submit to the Council any corrections or errors in the
compilation of the data with any supporting evidence and
documents the providers may submit. The Council or
corporation shall correct data found to be in error and
include additional commentary as requested by the provider
for major deviations in the charges from the average charges.
For purposes of this subsection (m), "providers" includes
physicians licensed to practice medicine in all of its
branches.
(n) In addition to the reports indicated above, the
Council shall respond to requests by agencies of government
and organizations in the private sector for data products,
special studies and analysis of data collected pursuant to
this Section. Such reports shall be undertaken only by the
agreement of a majority of the members of the Council who
shall designate the form in which the information shall be
made available. The Council or the corporation, association
or entity in consultation with the Council shall also
determine a fee to be charged to the requesting agency or
private sector organization to cover the direct and indirect
costs for producing such a report, and shall permit affected
providers the rights to review the accuracy of the report
before it is released. Such reports shall not be subject to
The Freedom of Information Act.
(Source: P.A. 88-535; 89-554, eff. 7-26-96.)
(20 ILCS 2215/4-3) (from Ch. 111 1/2, par. 6504-3)
Sec. 4-3. Confidentiality.
(a) As indicated elsewhere in this Act, all steps
necessary under State and Federal law to protect patient
confidentiality shall be undertaken by the Council to prevent
the identification of individual patient records.
Regulations are to be written to assure the confidentiality
of patient records when gathering and submitting data to the
Council or designated corporation, association or entity.
(b) The information submitted to the Council, designated
corporation, association or entity by hospitals pursuant to
subsections (c), and (e), and (e-5) of Section 4-2 shall be
privileged and confidential, and shall not be disclosed in
any manner. The foregoing includes, but shall not be limited
to, disclosure, inspection or copying under the Freedom of
Information Act, the State Records Act, and paragraph (1) of
Section 404 of the Illinois Insurance Code. However, the
prohibitions stated in this subsection shall not apply to the
compilations of information assembled by the Council pursuant
to subsections (k) and (m) of Section 4-2.
(c) Any person or organization, including but not
limited to, hospitals, government agencies, associations,
businesses, or researchers receiving data under an agreement
with the Council under the terms indicated in Section 6504-2
shall be required to adhere strictly to the terms of the
agreement, especially the terms that are related to
preserving patient confidentiality. The use of Council data
either alone or in combination with data from another source
or sources to identify specific patients is prohibited unless
such identification is specifically authorized by Illinois
Statute and agreed to in writing by the Council. An
intentional breach of patient confidentiality not authorized
by statute and the Council shall render the responsible
individual or organization liable to the penalties under
Section 5-2.
(Source: P.A. 91-357, eff. 7-29-99.)
(20 ILCS 2215/4-5) (from Ch. 111 1/2, par. 6504-5)
Sec. 4-5. Expenses. The Council or designated
corporation, association or entity shall establish a
procedure by which it will pay hospitals and licensed
ambulatory surgical treatment centers for submitting data
pursuant to subsections subsection (e) and (e-5) of Section
4-2. Operating expenses of the Council or the designated
corporation, association or entity for such payments, for the
conversion of hard copy reports to tape, and for the
compilation and analysis of basic reports shall be paid for
by appropriation of the General Assembly. Expenses for
additional reports shall be billed to those requesting the
reports.
(Source: P.A. 83-1243.)
Section 99. Effective date. This Act takes effect upon
becoming law.
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