Public Act 097-0171

HB1562 Enrolled LRB097 06679 KTG 46765 b

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,

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.

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

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.

(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

Department shall also make available on its website the

Hospital Report Card Act. The "Consumer Guide to Health

Care" and the Hospital Report Card Act were established to

educate and assist Illinois health care consumers as they

make health care choices for themselves, their families,

and their loved ones. Significant and useful information is

available through the "Consumer Guide to Health Care" and

the Hospital Report Card Act. The links to the "Consumer

Guide to Health Care" and the Hospital Report Card Act on

the Department's website shall include a brief description

of the information available in both. When the Department

creates new or updates existing consumer fact sheets and

other information or materials for the purpose of educating

the Illinois health care consumer, it shall reference the

web pages of the "Consumer Guide to Health Care" and the

Hospital Report Card Act when it is relevant and

appropriate. 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. 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

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

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

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

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

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.)