093_HB2202ham003
LRB093 06053 MKM 14180 a
1 AMENDMENT TO HOUSE BILL 2202
2 AMENDMENT NO. . Amend House Bill 2202, AS AMENDED,
3 by replacing everything after the enacting clause with the
4 following:
5 "Section 5. The Illinois Health Care Finance Reform Act
6 is amended by changing Section 4-2 as follows:
7 (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
8 Sec. 4-2. Powers and duties.
9 (a) (Blank).
10 (b) (Blank).
11 (c) (Blank).
12 (d) Uniform Provider Utilization and Charge Information.
13 (1) The Department of Public Health shall require
14 that all hospitals licensed to operate in the State of
15 Illinois adopt a uniform system for submitting patient
16 charges for payment from public and private payors
17 effective January 1, 1985. This system shall be based
18 upon adoption of the uniform electronic hospital billing
19 form pursuant to the Health Insurance Portability and
20 Accountability Act (UB-92) or its successor form
21 developed by the National Uniform Billing Committee.
22 (2) (Blank).
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1 (3) The Department of Insurance shall require all
2 third-party payors, including but not limited to,
3 licensed insurers, medical and hospital service
4 corporations, health maintenance organizations, and
5 self-funded employee health plans, to accept the uniform
6 billing form, without attachment as submitted by
7 hospitals pursuant to paragraph (1) of subsection (d)
8 above, effective January 1, 1985; provided, however,
9 nothing shall prevent all such third party payors from
10 requesting additional information necessary to determine
11 eligibility for benefits or liability for reimbursement
12 for services provided.
13 (4) Each hospital licensed in the State shall
14 electronically submit to the Department patient billing
15 data for conditions and procedures required for public
16 disclosure pursuant to paragraph (6). For hospitals, the
17 billing data to be reported shall include all inpatient
18 surgical cases. Billing data submitted under this Act
19 shall not include a patient's name, address, or Social
20 Security number.
21 (5) By no later than January 1, 2005, the
22 Department must collect and compile billing data required
23 under paragraph (6) according to uniform electronic
24 submission formats as required under the Health Insurance
25 Portability and Accountability Act.
26 (6) The Department shall make available on its
27 website the "Consumer Guide to Health Care" by January 1,
28 2006. The "Consumer Guide to Health Care" shall include
29 information on 30 conditions and procedures identified by
30 the Department that demonstrate the highest degree of
31 variation in patient charges and quality of care. As to
32 each condition or procedure, the "Consumer Guide to
33 Health Care" shall include up-to-date comparison
34 information relating to volume of cases, average charges,
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1 risk-adjusted mortality rates, and nosocomial infection
2 rates. Information disclosed pursuant to this paragraph
3 on mortality and infection rates shall be based upon
4 information hospitals have previously submitted to the
5 Department pursuant to their obligations to report health
6 care information under other public health reporting laws
7 and regulations outside of this Act.
8 (7) Publicly disclosed information must be provided
9 in language that is easy to understand and accessible to
10 consumers using an interactive query system.
11 (8) None of the information the Department
12 discloses to the public under this subsection may be made
13 available unless the information has been reviewed,
14 adjusted, and validated according to the following
15 process:
16 (i) Hospitals and organizations representing
17 hospitals are meaningfully involved in the
18 development of all aspects of the Department's
19 methodology for collecting, analyzing, and
20 disclosing the information collected under this Act,
21 including collection methods, formatting, and
22 methods and means for release and dissemination;
23 (ii) The entire methodology for collection and
24 analyzing the data is disclosed to all relevant
25 organizations and to all providers that are the
26 subject of any information to be made available to
27 the public before any public disclosure of such
28 information;
29 (iii) Data collection and analytical
30 methodologies are used that meet accepted standards
31 of validity and reliability before any information
32 is made available to the public;
33 (iv) The limitations of the data sources and
34 analytic methodologies used to develop comparative
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1 provider information are clearly identified and
2 acknowledged, including, but not limited to,
3 appropriate and inappropriate uses of the data;
4 (v) To the greatest extent possible,
5 comparative hospital information initiatives use
6 standard-based norms derived from widely accepted
7 provider-developed practice guidelines;
8 (vi) Comparative hospital information and
9 other information that the Department has compiled
10 regarding hospitals is shared with the hospitals
11 under review prior to public dissemination of the
12 information and these providers have an opportunity
13 to make corrections and additions of helpful
14 explanatory comments about the information before
15 the publication;
16 (vii) Comparisons among hospitals adjust for
17 patient case mix and other relevant risk factors and
18 control for provider peer groups;
19 (viii) Effective safeguards to protect against
20 the unauthorized use or disclosure of hospital
21 information are developed and implemented;
22 (ix) Effective safeguards to protect against
23 the dissemination of inconsistent, incomplete,
24 invalid, inaccurate, or subjective provider data are
25 developed and implemented;
26 (x) The quality and accuracy of hospital
27 information reported under this Act and its data
28 collection, analysis, and dissemination
29 methodologies are evaluated regularly; and
30 (xi) Only the most basic identifying
31 information from mandatory reports is used, and
32 patient identifiable information is not released.
33 The input data collected by the Department shall not
34 be a public record under the Illinois Freedom of
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1 Information Act.
2 None of the information the Department discloses to
3 the public under this Act may be used to establish a
4 standard of care in a private civil action.
5 (9) The Department must develop and implement an
6 outreach campaign to educate the public regarding the
7 availability of the "Consumer Guide to Health Care".
8 (10) Within 12 months after the effective date of
9 this amendatory Act of the 93rd General Assembly, the
10 Department must study the most effective methods for
11 public disclosure of patient charge data and health care
12 quality information that will be useful to consumers in
13 making health care decisions and report its
14 recommendations to the Governor and to the General
15 Assembly.
16 (11) The Department must undertake all steps
17 necessary under State and Federal law to protect patient
18 confidentiality in order to prevent the identification of
19 individual patient records.
20 (e) (Blank).
21 (Source: P.A. 91-756, eff. 6-2-00; 92-597, eff. 7-1-02.)
22 Section 99. Effective date. This Act takes effect upon
23 becoming law.".