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| Public Act 097-0171
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| HB1562 Enrolled | LRB097 06679 KTG 46765 b |
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AN ACT concerning State government.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Health Finance Reform Act is |
amended by changing Section 4-2 as follows:
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(20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
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Sec. 4-2. Powers and duties.
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(a) (Blank).
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(b) (Blank).
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(c) (Blank).
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(d) Uniform Provider Utilization and Charge Information.
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(1) The Department of Public Health shall require that |
all hospitals and ambulatory surgical treatment centers
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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
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electronic billing form pursuant to the Health Insurance
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Portability and Accountability Act.
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(2) (Blank).
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(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
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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.
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(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
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Social Security number.
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(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).
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(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 |
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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
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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 |
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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.
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(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.
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(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:
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(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, |
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and
disclosing the information collected under this |
Act, including
collection methods, formatting, and |
methods and means for
release and dissemination;
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(ii) The entire methodology for collecting and
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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;
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(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;
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(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;
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(v) To the greatest extent possible, comparative
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hospital and ambulatory surgical treatment center
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information initiatives use standard-based
norms |
derived from widely accepted provider-developed
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practice guidelines;
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(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 |
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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
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helpful explanatory comments about the information |
before
the publication;
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(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;
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(viii) Effective safeguards to protect against the
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unauthorized use or disclosure of hospital and |
ambulatory surgical treatment center information are
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developed and implemented;
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(ix) Effective safeguards to protect against the
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dissemination of inconsistent, incomplete, invalid,
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inaccurate, or subjective provider data are developed |
and
implemented;
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(x) The quality and accuracy of hospital and |
ambulatory surgical treatment center information
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reported under this Act and its data collection, |
analysis, and
dissemination methodologies are |
evaluated regularly; and
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(xi) Only the most basic hospital or ambulatory |
surgical treatment center identifying information from |
mandatory reports is used. Information regarding a |
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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.
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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.
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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.
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(9) The Department must develop and implement an |
outreach
campaign to educate the public regarding the |
availability of the "Consumer
Guide to Health Care".
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(10) By January 1, 2006, the Department must study the
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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
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health care decisions and report its recommendations to the
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Governor and to the General Assembly.
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(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.
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(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.
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