State of Illinois
92nd General Assembly

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[ Introduced ][ House Amendment 001 ]


HB1824 Engrossed                               LRB9204832JMmb

 1        AN  ACT  concerning  the  Health  Care  Cost  Containment
 2    Council.

 3        Be it  enacted  by  the  People  of  the  State  of  Illinois,
 4    represented in the General Assembly:

 5        Section  5.   The  Illinois  Health Finance Reform Act is
 6    amended by changing  Sections  1-2,  2-1,  2-5,  and  4-2  as
 7    follows:

 8        (20 ILCS 2215/1-2) (from Ch. 111 1/2, par. 6501-2)
 9        Sec.  1-2.   Purpose.   The  General  Assembly  finds and
10    declares that stabilizing the cost of  hospitalization  is  a
11    vital  concern  to  the  people  of  this  State.   It is the
12    legislative intent, pursuant to this declared public concern,
13    to develop measures which will increase hospital productivity
14    and better control utilization, while continuing  to  provide
15    quality health care services to all sectors of the citizenry,
16    education  and  training  of  health  care professionals, and
17    research and  development  of  improved  and  cost  effective
18    methods of treatment of ailments and management of facilities
19    and operations.  These ends shall be accomplished through the
20    establishment  of  the  Illinois Health Care Cost Containment
21    Council within the Department  of  Public  Health  to  study,
22    recommend  and  implement  measures  to contain health costs.
23    Furthermore, it is the intent  of  the  General  Assembly  to
24    encourage  new  and  innovative  methods  of financing health
25    care.
26        The overall goal of this  legislation  is  to  limit  the
27    increase  in  the  cost  of hospital care to no more than the
28    rate of increase in  prices  in  the  general  economy.   The
29    General  Assembly  finds and declares that this result may be
30    achieved through the introduction of competitive forces  into
31    the  organization,  delivery  and  financing  of  health care
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 1    services.
 2    (Source: P.A. 83-1243.)

 3        (20 ILCS 2215/2-1) (from Ch. 111 1/2, par. 6502-1)
 4        Sec. 2-1.  Council Authorized.  There is  hereby  created
 5    within  the  Department  of Public Health the Illinois Health
 6    Care Cost  Containment  Council.   It  shall  consist  of  13
 7    members  appointed  by the Director of Public Health Governor
 8    with the advice and consent  of  the  Senate  as  follows:  5
 9    members  to  represent  providers  as  follows:  2 members to
10    represent Illinois hospitals  at  least  one  of  which  must
11    represent  a  small  rural  hospital,  2 members to represent
12    physicians licensed to practice medicine in all its branches,
13    and 1  member  to  represent  ambulatory  surgical  treatment
14    centers;  3  members  to  represent  consumers;  2 members to
15    represent insurance companies; and  3  members  to  represent
16    businesses.
17        The  members of the Council shall be appointed for 3-year
18    terms, except that  the  terms  of  members  serving  on  the
19    effective  date  of  this  amendatory Act of the 92nd General
20    Assembly  shall  conclude  upon  the  appointment  of   their
21    successors by the Director of Public Health.
22        No  more  than  7  members may be from the same political
23    party.
24        Members shall be  appointed  within  30  days  after  the
25    effective date of this Act.  The additional members appointed
26    under the amendatory Act of the 91st General Assembly must be
27    appointed  within  30  days  after the effective date of this
28    amendatory Act of the 91st General Assembly.  The members  of
29    the  Council  shall  receive  reimbursement  of  their actual
30    expenses  incurred  in  connection  with  their  service;  in
31    addition, each member shall receive compensation  of  $150  a
32    day for each day served at regular or special meetings of the
33    Council,  except  that  such  compensation  shall  not exceed
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 1    $20,000 in any one year for any member.   The  Council  shall
 2    elect  a  Chairman from among its members, and shall have the
 3    power to organize and appoint such other officers as  it  may
 4    deem necessary.
 5        All  appointments shall be made in writing and filed with
 6    the Secretary of State as  a  public  record.  In  appointing
 7    members to represent providers, the Director of Public Health
 8    shall  give due consideration to recommendations of statewide
 9    organizations representing such providers.
10    (Source: P.A. 91-756, eff. 6-2-00.)

11        (20 ILCS 2215/2-5) (from Ch. 111 1/2, par. 6502-5)
12        Sec.  2-5.   Employees,  Professional  Consultants,   and
13    Funding.   The  Director  of Public Health Council may employ
14    and fix the compensation of such  employees,  and  may  enter
15    into  contractual  agreements with technical and professional
16    consultants as the Director it deems  necessary  to  expedite
17    the purpose of this Act.
18    (Source: P.A. 83-1243.)

19        (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
20        Sec. 4-2.  Powers and duties.
21        (a)  The  Illinois  Health  Care Cost Containment Council
22    may  enter  into  any   agreement   with   any   corporation,
23    association or other entity it deems appropriate to undertake
24    the  process  described  in  this Article for the collection,
25    compilation, or and analysis of data collected by the Council
26    and to conduct or  contract  for  studies  on  health-related
27    questions  carried  out  in pursuance of the purposes of this
28    Article.  The agreement  may  provide  for  the  corporation,
29    association  or  entity  to  prepare  and  distribute or make
30    available  data  to  health  care  providers,   health   care
31    subscribers,  third-party  payors, government and the general
32    public, in accordance with the rules of  confidentiality  and
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 1    review to be developed under this Act.
 2        (a-5)  On  or  before December 31, 2001, the Council must
 3    complete an analysis of whether the functions of  collecting,
 4    compiling,  analyzing,  or reporting data as required by this
 5    Article IV could be performed more economically under one  or
 6    more agreements as authorized by subsection (a) then they can
 7    be  performed  internally  by  the  Council.   If the Council
 8    determines that one or  more  of  these  functions  could  be
 9    performed  more economically by an agreement as authorized by
10    subsection (a), the Council  must  enter  into  one  or  more
11    agreements  for  the  performance  of  such  functions.   The
12    Council  must periodically review any agreement entered under
13    subsection (a) to ensure that they remain the most economical
14    methods of performing the work that is  the  subject  of  the
15    agreement or agreements.
16        (b)  The  input  data  collected  by and furnished to the
17    Council or  designated  corporation,  association  or  entity
18    pursuant  to  this Section shall not be a public record under
19    the Illinois Freedom of Information Act.  It is the intent of
20    this Act and of the regulations written pursuant to  it    to
21    protect the confidentiality of individual patient information
22    and  the  proprietary  information  of  commercial  insurance
23    carriers  and  health  care  providers.   Data  specified  in
24    subsections  (e)  and  (e-5)  shall be released on a hospital
25    specific and licensed ambulatory  surgical  treatment  center
26    specific  basis to facilitate comparisons among hospitals and
27    licensed ambulatory surgical treatment centers by purchasers.
28        (c)  The Council shall require the Departments of  Public
29    Health  and  Public Aid and hospitals located in the State to
30    assist the Council in gathering and submitting the  following
31    hospital-specific  financial  information, and the Council is
32    authorized to share this data with both Departments to reduce
33    the  burden  on  hospitals   by   avoiding   duplicate   data
34    collection:
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 2        (1)  Net patient service revenue
 3        (2)  Other revenue
 4        (3)  Total operating revenue

 6        (4)  Bad debt expense
 7        (5)  Total operating expenses

 9        (6)  Total non-operating gains
10        (7)  Total non-operating losses

12        (8)  Gross inpatient revenue
13        (9)  Gross outpatient revenue
14        (10)  Other Patient care revenue
15        (11)  Total patient revenue
16        (12)  Total gross patient care revenue
17        (13)  Medicare gross revenue
18        (14)  Medicaid gross revenue
19        (15)  Total other gross revenue

21        (16)  Charity care
22        (17)  Medicare allowance
23        (18)  Medicaid allowance
24        (19)  Other contractual allowances
25        (20)  Other allowances
26        (21)  Total Deductions

27    ASSETS
28        (22)  Operating cash and short-term investments
29        (23)  Estimated patient accounts receivable
30        (24)  Other current assets
31        (25)  Total current assets
32        (26)  Total other assets
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 1        (27)  Total Assets

 3        (28)  Total current liabilities
 4        (29)  Long Term Debt
 5        (30)  Other liabilities
 6        (31)  Total liabilities
 7        (32)  Total liabilities and fund balances
 8        All financial data collected by the Council from publicly
 9    available  sources  such  as  the  HCFA  is releasable by the
10    Council on a hospital specific basis when appropriate.
11        (d)  Uniform    Provider    Utilization    and     Charge
12    Information.  The Council shall require that:
13             (1)  Hospitals  licensed  to operate in the State of
14        Illinois adopt a uniform system  for  submitting  patient
15        charges  for  payment  from  public  and  private  payors
16        effective  January  1,  1985.  This system shall be based
17        upon  adoption  of  the  uniform  hospital  billing  form
18        (UB-92) or its successor form developed by  the  National
19        Uniform Billing Committee.
20             (2)  (Blank).
21             (3)  The   Department   of   Insurance  require  all
22        third-party  payors,  including  but  not   limited   to,
23        licensed   insurers,   medical   and   hospital   service
24        corporations,   health   maintenance  organizations,  and
25        self-funded employee health plans, to accept the  uniform
26        billing   form,   without   attachment  as  submitted  by
27        hospitals pursuant to paragraph  (1)  of  subsection  (d)
28        above,  effective  January  1,  1985;  provided, however,
29        nothing shall prevent all such third  party  payors  from
30        requesting  additional information necessary to determine
31        eligibility for benefits or liability  for  reimbursement
32        for services provided.
33        (e)  The   Council,   in   cooperation   with  the  State
34    Departments of Public  Aid,  Insurance,  and  Public  Health,
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 1    shall  establish a system for the collection of the following
 2    information from hospitals utilizing the raw  data  available
 3    on  the  uniform  billing forms.  Such data shall include the
 4    following  elements  and  other  elements  contained  on  the
 5    uniform billing form or  its  successor  form  determined  as
 6    necessary by the Council:
 7        (1)  Patient date of birth
 8        (2)  Patient sex
 9        (3)  Patient zip code
10        (4)  Third-party coverage
11        (5)  Date of admission
12        (6)  Source of admission
13        (7)  Type of admission
14        (8)  Discharge date
15        (9)  Principal and up to 8 other diagnoses
16        (10)  Principal procedure and date
17        (11)  Patient status
18        (12)  Other procedures and dates
19        (13)  Total charges and components of those charges
20        (14)  Attending  and  consulting physician identification
21    numbers
22        (15)  Hospital identification number
23        (16)  An alphanumeric number based on the information  to
24    identify the payor
25        (17)  Principal source of payment.
26        (e-5)  The Council, in cooperation with the Department of
27    Public  Aid,  the Department of Insurance, and the Department
28    of Public Health, shall establish a system for the collection
29    of the following  information  for  each  outpatient  surgery
30    performed  at  hospitals  and  licensed  ambulatory  surgical
31    treatment  centers using the raw data available on outpatient
32    billing forms submitted by hospitals and licensed  ambulatory
33    surgical  treatment centers to payors.  The data must include
34    the following elements, if available on  the  billing  forms,
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 1    and  other  elements  contained on the billing forms that the
 2    Council determines are necessary:
 3             (1)  patient date of birth;
 4             (2)  patient sex;
 5             (3)  patient zip code;
 6             (4)  third-party coverage;
 7             (5)  date of admission;
 8             (6)  source of admission;
 9             (7)  type of admission;
10             (8)  discharge date;
11             (9)  principal  diagnosis  and   up   to   8   other
12        diagnoses;
13             (10)  principal   procedure  and  the  date  of  the
14        procedure;
15             (11)  patient status;
16             (12)  other  procedures  and  the  dates  of   those
17        procedures;
18             (13)  attending     and     consulting     physician
19        identification numbers;
20             (14)  hospital   or   licensed  ambulatory  surgical
21        treatment center identification number;
22             (15)  an   alphanumeric   number   based   on    the
23        information needed to identify the payor; and
24             (16)  principal source of payment.
25        (f)  Extracts of the UB-92 transactions shall be prepared
26    by  hospitals  according  to  regulations  promulgated by the
27    Council and submitted in electronic format to the Council  or
28    the  corporation,  association  or  entity  designated by the
29    Council.
30        For hospitals unable to  submit  extracts  in  electronic
31    format,  the  Council shall determine an alternate method for
32    submission of data.  Such extract reporting systems shall  be
33    in operation before January 1, 1987; however, the Council may
34    grant time extensions to individual hospital.
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 1        (f-5)  Extracts of the billing forms shall be prepared by
 2    licensed  ambulatory  surgical treatment centers according to
 3    rules adopted by the Council and submitted to the Council  or
 4    a  corporation,  association,  or  entity  designated  by the
 5    Council. Electronic submissions  shall  be  encouraged.   For
 6    licensed  ambulatory  surgical  treatment  centers  unable to
 7    submit extracts in an  electronic  format  the  Council  must
 8    determine an alternate method for submission of data.
 9        (g)  Under no circumstances shall patient name and social
10    security number appear on the extracts.
11        (h)  Hospitals and licensed ambulatory surgical treatment
12    centers shall be assigned a standard identification number by
13    the Council to be used in the submission of all data.
14        (i)  The  Council  shall  collect a 100% inpatient sample
15    from hospitals  annually.  The  Council  shall  require  each
16    hospital  in  the  State  to  submit  the UB-92 data extracts
17    required in  subsection  (e)  to  the  Council,  except  that
18    hospitals  with  fewer  than  50  beds may be exempted by the
19    Council from the filing requirements if  they  prove  to  the
20    Council's  satisfaction  that  the  requirements would impose
21    undue economic hardship and if the  Council  determines  that
22    the  data submitted from these hospitals are not essential to
23    its data base and its concomitant health care cost comparison
24    efforts.
25        (i-5)  The Council shall collect up to a 100%  outpatient
26    sample   annually  from  hospitals  and  licensed  ambulatory
27    surgical treatment centers.  The Council shall  require  each
28    hospital and licensed ambulatory surgical treatment center in
29    the   State  to  submit  the  data  extracts  required  under
30    subsection (e-5) to the Council, except  that  hospitals  and
31    licensed   ambulatory   surgical  treatment  centers  may  be
32    exempted by the Council from the filing requirements  if  the
33    hospitals  or  licensed ambulatory surgical treatment centers
34    prove to the Council's  satisfaction  that  the  requirements
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 1    would  impose  undue  economic  hardship  and  if the Council
 2    determines that the data submitted from those  hospitals  and
 3    licensed   ambulatory  surgical  treatment  centers  are  not
 4    essential to  the  Council's  database  and  its  concomitant
 5    health care comparison efforts.
 6        (i-10)  The  outpatient  data  shall  be collected by the
 7    Council on a phase-in and trial basis for a  one-year  period
 8    beginning  on  January  1, 2001.  The Council shall implement
 9    outpatient data collection for reporting  purposes  beginning
10    on January 1, 2002.
11        (j)  The information submitted to the Council pursuant to
12    subsections  (e) and (e-5) shall be reported for each primary
13    payor   category,   including   Medicare,   Medicaid,   other
14    government programs, private  insurance,  health  maintenance
15    organizations,   self-insured,   private  pay  patients,  and
16    others.  Preferred provider organization reimbursement  shall
17    also be reported for each primary third party payor category.
18        (k)  The   Council   shall  require  and  the  designated
19    corporation, association  or  entity,  if  applicable,  shall
20    prepare  quarterly  basic  reports in the aggregate on health
21    care cost and utilization trends in  Illinois.   The  Council
22    shall  provide  these  reports  to  the public, if requested.
23    These shall include,  but  not  be  limited  to,  comparative
24    information  on  average  charges, total and ancillary charge
25    components,  length  of  stay   on   diagnosis-specific   and
26    procedure  specific cases, and number of discharges, compiled
27    in aggregate by hospital  and  licensed  ambulatory  surgical
28    treatment   center,   by  diagnosis,  and  by  primary  payor
29    category.
30        (l)  The  Council  shall,  from   information   submitted
31    pursuant  to  subsection (e), prepare an annual report in the
32    aggregate by hospital containing the following:
33             (1)  the ratio of caesarean  section  deliveries  to
34        total deliveries;
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 1             (2)  the  average  length  of  stay for patients who
 2        undergo caesarean sections;
 3             (3)  the average total charges for patients who have
 4        normal deliveries without any significant complications;
 5             (4)  the average  total  charges  for  patients  who
 6        deliver by caesarean section.
 7    The  Council  shall  provide  this  report  to the public, if
 8    requested.
 9        (l-5)  (Blank).
10        (m)  Prior  to  the  release  or  dissemination  of   any
11    provider-specific  data for any purpose permitted by this Act
12    these reports, the  Council  or  the  designated  corporation
13    shall  notify  each  provider of the release or dissemination
14    and  permit  each  provider  a   reasonable   providers   the
15    opportunity   to  verify  the  accuracy  of  any  information
16    pertaining to the  provider.   The  Council  shall  give  any
17    requesting  provider,  or its designated agent, a copy of the
18    data to  be  released  or  disseminated  pertaining  to  that
19    provider.   The  providers,  or  their designated agents, may
20    submit to the  Council  any  corrections  or  errors  in  the
21    compilation  of  the  data  with  any supporting evidence and
22    documents the providers or agents may submit.  The Council or
23    corporation shall correct data  found  to  be  in  error  and
24    include additional commentary as requested by the provider or
25    agent  for  major  deviations in the charges from the average
26    charges. For purposes of  this  subsection  (m),  "providers"
27    includes  hospitals,  ambulatory  surgical treatment centers,
28    and physicians licensed to practice medicine in  all  of  its
29    branches.
30        (n)  In  addition  to  the  reports  indicated above, the
31    Council shall respond to requests by agencies  of  government
32    and  organizations  in  the private sector for data products,
33    special studies and analysis of data  collected  pursuant  to
34    this  Section.   Such reports shall be undertaken only by the
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 1    agreement of a majority of the members  of  the  Council  who
 2    shall  designate  the  form in which the information shall be
 3    made available.  The Council or the corporation,  association
 4    or  entity  in  consultation  with  the  Council  shall  also
 5    determine  a  fee  to  be charged to the requesting agency or
 6    private sector organization to cover the direct and  indirect
 7    costs  for producing such a report, and shall permit affected
 8    providers the rights to review the  accuracy  of  the  report
 9    before it is released.  Such reports  shall not be subject to
10    The Freedom of Information Act.
11    (Source: P.A. 91-756, eff. 6-2-00.)

12        Section  99.  Effective date.  This Act takes effect upon
13    becoming law.

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