Bill Text: IL HB1562 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: Amends the Illinois Health Finance Reform Act. Provides that claims and encounter data required to be submitted by hospitals and ambulatory surgical treatment centers shall state the percentage of claims and encounter data that is attributable to administrative costs and provide an explanation of all assumptions and factors used to calculate such percentages.

Spectrum: Slight Partisan Bill (Republican 2-1)

Status: (Passed) 2011-07-22 - Public Act . . . . . . . . . 97-0171 [HB1562 Detail]

Download: Illinois-2011-HB1562-Introduced.html

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97TH GENERAL ASSEMBLY State of Illinois 2011 and 2012 HB1562 Introduced 2/15/2011, by Rep. Kay Hatcher SYNOPSIS AS INTRODUCED:
20 ILCS 2215/4-2 from Ch. 111 1/2, par. 6504-2
Amends the Illinois Health Finance Reform Act. Provides that claims and encounter data required to be submitted by hospitals and ambulatory surgical treatment centers shall state the percentage of claims and encounter data that is attributable to administrative costs and provide an explanation of all assumptions and factors used to calculate such percentages.
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A BILL FOR
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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,

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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. Claims and encounter data required to be
submitted under this Section shall state the percentage of
claims and encounter data that is attributable to
administrative costs and provide an explanation of all
assumptions and factors used to calculate such
percentages.
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

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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. Claims and encounter data required
to be submitted under this Section shall state the
percentage of claims and encounter data that is
attributable to administrative costs and provide an
explanation of all assumptions and factors used to
calculate such percentages.
(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
"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.

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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

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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

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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

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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

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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

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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.)