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.)