Full Text of HB4953 93rd General Assembly
HB4953ham001 93RD GENERAL ASSEMBLY
|
Rep. Julie Hamos
Filed: 3/30/2004
|
|
09300HB4953ham001 |
|
LRB093 20871 MKM 49322 a |
|
| 1 |
| AMENDMENT TO HOUSE BILL 4953
| 2 |
| AMENDMENT NO. ______. Amend House Bill 4953 by replacing | 3 |
| everything after the enacting clause with the following:
| 4 |
| "Section 5. The Illinois Health Finance Reform Act is | 5 |
| amended by changing Section 4-2 as follows:
| 6 |
| (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
| 7 |
| Sec. 4-2. Powers and duties.
| 8 |
| (a) (Blank).
| 9 |
| (b) (Blank).
| 10 |
| (c) (Blank).
| 11 |
| (d) Uniform Provider Utilization and Charge Information.
| 12 |
| (1) The Department of Public Health shall require that | 13 |
| all hospitals and ambulatory surgical treatment centers
| 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
| 18 |
| electronic hospital billing form pursuant to the Health | 19 |
| Insurance
Portability and Accountability Act.
| 20 |
| (2) (Blank).
| 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
|
|
|
|
09300HB4953ham001 |
- 2 - |
LRB093 20871 MKM 49322 a |
|
| 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.
| 8 |
| (4) Pursuant to implementation dates, each hospital | 9 |
| and ambulatory surgical treatment center
Each hospital
| 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 .
| 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 |
|
|
|
09300HB4953ham001 |
- 3 - |
LRB093 20871 MKM 49322 a |
|
| 1 |
| required under the Health Insurance Portability and | 2 |
| Accountability Act.
| 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
| 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
| 19 |
| and ambulatory surgical treatment centers have either (i)
| 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 .
| 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.
| 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:
| 32 |
| (i) Hospitals , ambulatory surgical treatment | 33 |
| centers, and other entities
and organizations
| 34 |
| representing hospitals and ambulatory surgical |
|
|
|
09300HB4953ham001 |
- 4 - |
LRB093 20871 MKM 49322 a |
|
| 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
| 5 |
| collection methods, formatting, and methods and means | 6 |
| for
release and dissemination;
| 7 |
| (ii) The entire methodology for collecting
| 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;
| 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;
| 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;
| 22 |
| (v) To the greatest extent possible, comparative
| 23 |
| hospital and ambulatory surgical treatment center
| 24 |
| information initiatives use standard-based
norms | 25 |
| derived from widely accepted provider-developed
| 26 |
| practice guidelines;
| 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.
| 32 |
| (vi) Comparative hospital and ambulatory surgical | 33 |
| treatment center information and other
information | 34 |
| that the Department has compiled regarding
hospitals |
|
|
|
09300HB4953ham001 |
- 5 - |
LRB093 20871 MKM 49322 a |
|
| 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
| 6 |
| helpful explanatory comments about the information | 7 |
| before
the publication;
| 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;
| 12 |
| (viii) Effective safeguards to protect against the
| 13 |
| unauthorized use or disclosure of hospital and | 14 |
| ambulatory surgical treatment center information are
| 15 |
| developed and implemented;
| 16 |
| (ix) Effective safeguards to protect against the
| 17 |
| dissemination of inconsistent, incomplete, invalid,
| 18 |
| inaccurate, or subjective provider data are developed | 19 |
| and
implemented;
| 20 |
| (x) The quality and accuracy of hospital and | 21 |
| ambulatory surgical treatment center information
| 22 |
| reported under this Act and its data collection, | 23 |
| analysis, and
dissemination methodologies are | 24 |
| evaluated regularly; and
| 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.
| 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.
| 33 |
| (9) The Department must develop and implement an | 34 |
| outreach
campaign to educate the public regarding the |
|
|
|
09300HB4953ham001 |
- 6 - |
LRB093 20871 MKM 49322 a |
|
| 1 |
| availability of the "Consumer
Guide to Health Care".
| 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 .
| 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.
| 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 |
|
|
|
09300HB4953ham001 |
- 7 - |
LRB093 20871 MKM 49322 a |
|
| 1 |
| indirect costs of producing data products and for other | 2 |
| related purposes at the discretion of the Director.
| 3 |
| (e) (Blank).
| 4 |
| (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
| 5 |
| Section 10. The Hospital Report Card Act is amended by | 6 |
| changing Section 25 as follows:
| 7 |
| (210 ILCS 86/25)
| 8 |
| Sec. 25. Hospital reports.
| 9 |
| (a) Individual hospitals shall prepare a quarterly report | 10 |
| including all of
the
following:
| 11 |
| (1) Nursing hours per patient day, average daily | 12 |
| census, and average daily
hours worked
for each clinical | 13 |
| service area.
| 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:
| 17 |
| (A) Surgical
Class I surgical site infection , as | 18 |
| reviewed by the Advisory Committee .
| 19 |
| (B) Ventilator-associated pneumonia.
| 20 |
| (C) Central line-related bloodstream infections.
| 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
| 24 |
| Surveillance Program.
| 25 |
| (b) Individual hospitals shall prepare annual reports | 26 |
| including vacancy and
turnover rates
for licensed nurses per | 27 |
| clinical service area.
| 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
| 31 |
| according to the following process:
| 32 |
| (1) The Department shall organize an advisory |
|
|
|
09300HB4953ham001 |
- 8 - |
LRB093 20871 MKM 49322 a |
|
| 1 |
| committee, including
representatives
from the Department, | 2 |
| public and private hospitals, direct care nursing staff,
| 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
| 33 |
| prior to
public
dissemination of such information and these | 34 |
| hospitals have 30 days to make
corrections and
to add |
|
|
|
09300HB4953ham001 |
- 9 - |
LRB093 20871 MKM 49322 a |
|
| 1 |
| helpful explanatory comments about the information before | 2 |
| the
publication.
| 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.
| 33 |
| (e) If the hospital is a division or subsidiary of another | 34 |
| entity that owns
or
operates other
hospitals or related |
|
|
|
09300HB4953ham001 |
- 10 - |
LRB093 20871 MKM 49322 a |
|
| 1 |
| organizations, the annual public disclosure report shall
be for | 2 |
| the specific
division or subsidiary and not for the other | 3 |
| entity.
| 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
| 7 |
| Information Act provided that such information satisfies the | 8 |
| provisions of
subsection (c) of this Section.
| 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.
| 13 |
| (h) No hospital report or Department disclosure may contain | 14 |
| information
identifying a patient, employee, or licensed | 15 |
| professional.
| 16 |
| (Source: P.A. 93-563, eff. 1-1-04.)
| 17 |
| Section 90. The State Finance Act is amended by adding | 18 |
| Section
5.625 as follows:
| 19 |
| (30 ILCS 105/5.625 new)
| 20 |
| Sec. 5.625. The Public Health Special State Projects Fund.
| 21 |
| Section 99. Effective date. This Act takes effect January | 22 |
| 1, 2005.".
|
|