Rep. Julie Hamos
Filed: 3/30/2004
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1 | AMENDMENT TO HOUSE BILL 4953
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2 | AMENDMENT NO. ______. Amend House Bill 4953 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Health Finance Reform Act is | ||||||
5 | amended by changing Section 4-2 as follows:
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6 | (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
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7 | Sec. 4-2. Powers and duties.
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8 | (a) (Blank).
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9 | (b) (Blank).
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10 | (c) (Blank).
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11 | (d) Uniform Provider Utilization and Charge Information.
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12 | (1) The Department of Public Health shall require that | ||||||
13 | all hospitals and ambulatory surgical treatment centers
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14 | licensed to operate in the State of Illinois adopt a | ||||||
15 | uniform system for
submitting patient claims or encounter | ||||||
16 | data
charges
for payment from public and private payors. | ||||||
17 | This system shall be based upon adoption of the uniform
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18 | electronic hospital billing form pursuant to the Health | ||||||
19 | Insurance
Portability and Accountability Act.
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20 | (2) (Blank).
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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, | ||||||
24 | health maintenance organizations, and self-funded employee
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1 | health plans, to accept the uniform billing form, without | ||||||
2 | attachment as
submitted by hospitals pursuant to paragraph | ||||||
3 | (1) of subsection (d) above,
effective January 1, 1985; | ||||||
4 | provided, however, nothing shall prevent all
such third | ||||||
5 | party payors from requesting additional information | ||||||
6 | necessary to
determine eligibility for benefits or | ||||||
7 | liability for reimbursement for
services provided.
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8 | (4) Pursuant to implementation dates, each hospital | ||||||
9 | and ambulatory surgical treatment center
Each hospital
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10 | licensed in the State shall electronically submit to
the | ||||||
11 | Department patient claims or encounter
billing data for | ||||||
12 | conditions and procedures required
for public disclosure | ||||||
13 | pursuant to paragraph (6).
Claims or encounter
For | ||||||
14 | hospitals, the billing
data to be
reported shall include | ||||||
15 | all inpatient surgical
cases.
Billing data submitted under | ||||||
16 | this Act
shall not include a patient's unique identifier, | ||||||
17 | race, ethnicity, and environmental coding under the | ||||||
18 | International Classification of Diseases, version 10, when | ||||||
19 | adopted and implemented by the United States Department of | ||||||
20 | Health and Human Services as Health Insurance Portability | ||||||
21 | and Accountability Act of 1996 (HIPAA) standards for | ||||||
22 | national implementation. Dissemination of this information | ||||||
23 | is subject to HIPAA and any other State and federal | ||||||
24 | confidentiality laws name,
address,
or
Social Security | ||||||
25 | number .
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26 | (5) By no later than January 1, 2005, the Department | ||||||
27 | must collect and
compile
claims or encounter
billing data | ||||||
28 | required under paragraph (6) according to uniform | ||||||
29 | electronic
submission formats as required under the Health | ||||||
30 | Insurance Portability and
Accountability Act. By no later | ||||||
31 | than January 1, 2006, the Department must collect and | ||||||
32 | compile from ambulatory surgical treatment centers the | ||||||
33 | claims or encounter data required under paragraph (6) | ||||||
34 | according to uniform electronic submission formats as |
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1 | required under the Health Insurance Portability and | ||||||
2 | Accountability Act.
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3 | (6) The Department shall make available on its website | ||||||
4 | the
"Consumer Guide to Health Care" by January 1, 2006. The | ||||||
5 | "Consumer
Guide to Health Care" shall include information | ||||||
6 | on at least 30 inpatient conditions and
procedures | ||||||
7 | identified by the Department that demonstrate the highest
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8 | degree of variation in patient charges and quality of care | ||||||
9 | and no more than 30 outpatient surgical procedures. By no | ||||||
10 | later than January 1, 2007, the "Consumer Guide to Health | ||||||
11 | Care" shall include information for both inpatient and | ||||||
12 | outpatient conditions and procedures . As to each
condition | ||||||
13 | or procedure, the "Consumer Guide to Health Care" shall | ||||||
14 | include
up-to-date comparison information relating to | ||||||
15 | volume of cases, average
charges, risk-adjusted mortality | ||||||
16 | rates, and nosocomial infection rates.
Information | ||||||
17 | disclosed pursuant to this paragraph on
mortality and | ||||||
18 | infection rates shall be based upon information hospitals
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19 | and ambulatory surgical treatment centers have either (i)
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20 | previously submitted to the Department pursuant to their | ||||||
21 | obligations
to report health care information under other | ||||||
22 | public health reporting laws
and regulations outside of | ||||||
23 | this Act or (ii) submitted to the Department under the | ||||||
24 | provisions of the Hospital Report Card Act .
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25 | (7) Publicly disclosed information must be provided in | ||||||
26 | language
that is easy to understand and accessible to | ||||||
27 | consumers using an
interactive query system.
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28 | (8) None of the information the Department discloses to | ||||||
29 | the public
under this subsection may be made available | ||||||
30 | unless the information has
been reviewed, adjusted, and | ||||||
31 | validated according to the following process:
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32 | (i) Hospitals , ambulatory surgical treatment | ||||||
33 | centers, and other entities
and organizations
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34 | representing hospitals and ambulatory surgical |
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1 | treatment centers are
meaningfully involved in the | ||||||
2 | development of all aspects of
the Department's | ||||||
3 | methodology for collecting, analyzing, and
disclosing | ||||||
4 | the information collected under this Act, including
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5 | collection methods, formatting, and methods and means | ||||||
6 | for
release and dissemination;
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7 | (ii) The entire methodology for collecting
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8 | collection and
analyzing the data is disclosed to all | ||||||
9 | relevant organizations
and to all providers that are | ||||||
10 | the subject of any information to
be made available to | ||||||
11 | the public before any public disclosure
of such | ||||||
12 | information;
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13 | (iii) Data collection and analytical methodologies | ||||||
14 | are
used that meet accepted standards of validity and | ||||||
15 | reliability
before any information is made available | ||||||
16 | to the public;
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17 | (iv) The limitations of the data sources and | ||||||
18 | analytic
methodologies used to develop comparative | ||||||
19 | provider
information are clearly identified and | ||||||
20 | acknowledged,
including, but not limited to, | ||||||
21 | appropriate and inappropriate
uses of the data;
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22 | (v) To the greatest extent possible, comparative
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23 | hospital and ambulatory surgical treatment center
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24 | information initiatives use standard-based
norms | ||||||
25 | derived from widely accepted provider-developed
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26 | practice guidelines;
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27 | (v-5) For ambulatory services, information is | ||||||
28 | provided on surgical infections and mortality for | ||||||
29 | selected procedures, as determined by the Department, | ||||||
30 | based on review by the Department of its own, local, or | ||||||
31 | national studies.
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32 | (vi) Comparative hospital and ambulatory surgical | ||||||
33 | treatment center information and other
information | ||||||
34 | that the Department has compiled regarding
hospitals |
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1 | and ambulatory surgical treatment centers is shared | ||||||
2 | with the hospitals and ambulatory surgical treatment | ||||||
3 | centers under review prior to
public dissemination of | ||||||
4 | the information and these providers
have an | ||||||
5 | opportunity to make corrections and additions of
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6 | helpful explanatory comments about the information | ||||||
7 | before
the publication;
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8 | (vii) Comparisons among hospitals and ambulatory | ||||||
9 | surgical treatment centers adjust for
patient case mix | ||||||
10 | and other relevant risk factors and control
for | ||||||
11 | provider peer groups;
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12 | (viii) Effective safeguards to protect against the
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13 | unauthorized use or disclosure of hospital and | ||||||
14 | ambulatory surgical treatment center information are
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15 | developed and implemented;
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16 | (ix) Effective safeguards to protect against the
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17 | dissemination of inconsistent, incomplete, invalid,
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18 | inaccurate, or subjective provider data are developed | ||||||
19 | and
implemented;
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20 | (x) The quality and accuracy of hospital and | ||||||
21 | ambulatory surgical treatment center information
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22 | reported under this Act and its data collection, | ||||||
23 | analysis, and
dissemination methodologies are | ||||||
24 | evaluated regularly; and
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25 | (xi) Only the most basic identifying information | ||||||
26 | from
mandatory reports is used, and patient | ||||||
27 | identifiable
information is not released. The input | ||||||
28 | data collected
by the Department shall not be a public | ||||||
29 | record under the
Illinois Freedom of Information Act.
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30 | None of the information
the Department discloses to the | ||||||
31 | public under this Act may be
used to establish a standard | ||||||
32 | of care in a private civil action.
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33 | (9) The Department must develop and implement an | ||||||
34 | outreach
campaign to educate the public regarding the |
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1 | availability of the "Consumer
Guide to Health Care".
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2 | (10) By January 1, 2005,
Within 12 months after the | ||||||
3 | effective date of this amendatory
Act of the 93rd General | ||||||
4 | Assembly, the Department must study the
most effective | ||||||
5 | methods for public disclosure of patient claims or | ||||||
6 | encounter
charge data and
health care quality information | ||||||
7 | that will be useful to consumers in making
health care | ||||||
8 | decisions and report its recommendations to the
Governor | ||||||
9 | and to the General Assembly and, by January 1, 2008, if the | ||||||
10 | Department has not used the data, collection of data | ||||||
11 | provided by ambulatory surgical treatment centers under | ||||||
12 | this Section shall be terminated .
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13 | (11) The Department must undertake all steps necessary | ||||||
14 | under
State and Federal law to protect patient | ||||||
15 | confidentiality in order to prevent
the identification of | ||||||
16 | individual patient records.
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17 | (12) The Department may establish rules for carrying | ||||||
18 | out, administering, and enforcing the provisions of this | ||||||
19 | Act. | ||||||
20 | (13) In addition to the data products indicated above, | ||||||
21 | the Department shall respond to requests by government | ||||||
22 | agencies, academic research organizations, and private | ||||||
23 | sector organizations for data products, special studies, | ||||||
24 | and analyses of data collected pursuant to this Section. | ||||||
25 | The Department shall determine the form in which the | ||||||
26 | information shall be made available and shall determine | ||||||
27 | reasonable fees to be charged to the agency or organization | ||||||
28 | requesting the data products. Use of the data must comply | ||||||
29 | with the Health Insurance Portability and Accountability | ||||||
30 | Act of 1996 (HIPAA). | ||||||
31 | (14) Fees collected for data products, as well as other | ||||||
32 | amounts that may be appropriated for the purposes of this | ||||||
33 | Act, shall be deposited into the Public Health Special | ||||||
34 | State Projects Fund, which may be used for the direct and |
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1 | indirect costs of producing data products and for other | ||||||
2 | related purposes at the discretion of the Director.
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3 | (e) (Blank).
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4 | (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
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5 | Section 10. The Hospital Report Card Act is amended by | ||||||
6 | changing Section 25 as follows:
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7 | (210 ILCS 86/25)
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8 | Sec. 25. Hospital reports.
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9 | (a) Individual hospitals shall prepare a quarterly report | ||||||
10 | including all of
the
following:
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11 | (1) Nursing hours per patient day, average daily | ||||||
12 | census, and average daily
hours worked
for each clinical | ||||||
13 | service area.
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14 | (2) Nosocomial infection rates for the facility for the | ||||||
15 | specific clinical
procedures
determined by the Department | ||||||
16 | by rule under the following categories:
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17 | (A) Surgical
Class I surgical site infection , as | ||||||
18 | reviewed by the Advisory Committee .
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19 | (B) Ventilator-associated pneumonia.
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20 | (C) Central line-related bloodstream infections.
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21 | The Department shall only disclose Illinois hospital | ||||||
22 | infection rate data
according to the
current benchmarks of the | ||||||
23 | Centers for Disease Control's National Nosocomial
Infection
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24 | Surveillance Program.
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25 | (b) Individual hospitals shall prepare annual reports | ||||||
26 | including vacancy and
turnover rates
for licensed nurses per | ||||||
27 | clinical service area.
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28 | (c) None of the information the Department discloses to the | ||||||
29 | public may be
made
available
in any form or fashion unless the | ||||||
30 | information has been reviewed, adjusted, and
validated
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31 | according to the following process:
| ||||||
32 | (1) The Department shall organize an advisory |
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1 | committee, including
representatives
from the Department, | ||||||
2 | public and private hospitals, direct care nursing staff,
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3 | physicians,
academic researchers, consumers, health | ||||||
4 | insurance companies, organized labor,
and
organizations | ||||||
5 | representing hospitals
and physicians. The advisory | ||||||
6 | committee
must be
meaningfully involved in the development | ||||||
7 | of all aspects of the Department's
methodology
for | ||||||
8 | collecting, analyzing, and disclosing the information | ||||||
9 | collected under this
Act, including
collection methods, | ||||||
10 | formatting, and methods and means for release and
| ||||||
11 | dissemination.
| ||||||
12 | (2) The entire methodology for collecting and | ||||||
13 | analyzing the data shall be
disclosed
to all
relevant | ||||||
14 | organizations and to all hospitals that are the subject of | ||||||
15 | any
information to be made
available to the public before | ||||||
16 | any public disclosure of such information.
| ||||||
17 | (3) Data collection and analytical methodologies shall | ||||||
18 | be used that meet
accepted
standards of validity and | ||||||
19 | reliability before any information is made available
to the | ||||||
20 | public.
| ||||||
21 | (4) The limitations of the data sources and analytic | ||||||
22 | methodologies used to
develop
comparative hospital | ||||||
23 | information shall be clearly identified and acknowledged,
| ||||||
24 | including but not
limited to the appropriate and | ||||||
25 | inappropriate uses of the data.
| ||||||
26 | (5) To the greatest extent possible, comparative | ||||||
27 | hospital information
initiatives shall
use standard-based | ||||||
28 | norms derived from widely accepted provider-developed
| ||||||
29 | practice
guidelines.
| ||||||
30 | (6) Comparative hospital information and other | ||||||
31 | information that the
Department
has
compiled regarding | ||||||
32 | hospitals shall be shared with the hospitals under review
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33 | prior to
public
dissemination of such information and these | ||||||
34 | hospitals have 30 days to make
corrections and
to add |
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| |||||||
1 | helpful explanatory comments about the information before | ||||||
2 | the
publication.
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3 | (7) Comparisons among hospitals shall adjust for | ||||||
4 | patient case mix and
other
relevant
risk factors and | ||||||
5 | control for provider peer groups, when appropriate.
| ||||||
6 | (8) Effective safeguards to protect against the | ||||||
7 | unauthorized use or
disclosure
of
hospital information | ||||||
8 | shall be developed and implemented.
| ||||||
9 | (9) Effective safeguards to protect against the | ||||||
10 | dissemination of
inconsistent,
incomplete, invalid, | ||||||
11 | inaccurate, or subjective hospital data shall be developed
| ||||||
12 | and
implemented.
| ||||||
13 | (10) The quality and accuracy of hospital information | ||||||
14 | reported under this
Act
and its
data collection, analysis, | ||||||
15 | and dissemination methodologies shall be evaluated
| ||||||
16 | regularly.
| ||||||
17 | (11) Only the most basic identifying information from | ||||||
18 | mandatory reports
shall be
used, and
information | ||||||
19 | identifying a patient, employee, or licensed professional
| ||||||
20 | shall not be released.
None of the information the | ||||||
21 | Department discloses to the public under this Act
may be | ||||||
22 | used to
establish a standard of care in a private civil | ||||||
23 | action.
| ||||||
24 | (d) Quarterly reports shall be submitted, in a format set | ||||||
25 | forth in rules
adopted
by the
Department, to the Department by | ||||||
26 | April 30, July 31, October 31, and January 31
each year
for the | ||||||
27 | previous quarter. Data in quarterly reports must cover a period | ||||||
28 | ending
not earlier than
one month prior to submission of the | ||||||
29 | report. Annual reports shall be submitted
by December
31 in a | ||||||
30 | format set forth in rules adopted by the Department to the | ||||||
31 | Department.
All reports
shall be made available to the public | ||||||
32 | on-site and through the Department.
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33 | (e) If the hospital is a division or subsidiary of another | ||||||
34 | entity that owns
or
operates other
hospitals or related |
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1 | organizations, the annual public disclosure report shall
be for | ||||||
2 | the specific
division or subsidiary and not for the other | ||||||
3 | entity.
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4 | (f) The Department shall disclose information under this | ||||||
5 | Section in
accordance with provisions for inspection and | ||||||
6 | copying of public records
required by the Freedom of
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7 | Information Act provided that such information satisfies the | ||||||
8 | provisions of
subsection (c) of this Section.
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9 | (g) Notwithstanding any other provision of law, under no | ||||||
10 | circumstances shall
the
Department disclose information | ||||||
11 | obtained from a hospital that is confidential
under Part 21
of | ||||||
12 | Article 8 of the Code of Civil Procedure.
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13 | (h) No hospital report or Department disclosure may contain | ||||||
14 | information
identifying a patient, employee, or licensed | ||||||
15 | professional.
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16 | (Source: P.A. 93-563, eff. 1-1-04.)
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17 | Section 90. The State Finance Act is amended by adding | ||||||
18 | Section
5.625 as follows:
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19 | (30 ILCS 105/5.625 new)
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20 | Sec. 5.625. The Public Health Special State Projects Fund.
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21 | Section 99. Effective date. This Act takes effect January | ||||||
22 | 1, 2005.".
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