HB2343 94TH GENERAL ASSEMBLY

LRB094 05025 BDD 39283 b

94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB2343

Introduced 2/16/2005, by Rep. Julie Hamos

SYNOPSIS AS INTRODUCED:

20 ILCS 2215/4-2	from Ch. 111 1/2, par. 6504-2
20 ILCS 2215/4-4	from Ch. 111 1/2, par. 6504-4

Amends the Illinois Health Finance Reform Act. Provides that the Department of Public Health must require ambulatory surgical treatment centers licensed to operate in the State of Illinois to adopt a uniform system, based on certain federal laws, for submitting patient charges for payment from public and private payors. Provides that no later than 60 days after the end of each calendar quarter, each hospital and ambulatory surgical treatment center must submit billing data to the Department and sets forth information that must be included in the submission (now, hospitals must submit billing data for conditions and procedures required for public disclosure in the "Consumer Guide to Health Care" and for all inpatient surgical cases). Requires the Department to collect and compile the billing data on a quarterly basis. Sets forth additional information that must be included in the "Consumer Guide to Health Care". Requires that ambulatory surgical treatment centers, organizations representing ambulatory surgical treatment centers, purchasers, consumer groups, and health plans be meaningfully involved in the development of all aspects of the Department's methodology for collecting, analyzing, and disclosing the information collected under this Act. Requires the Department to evaluate additional methods for comparing the performance of hospitals and ambulatory surgical treatment centers and report its findings and recommendations on its Internet website and to the Governor and General Assembly no later than January 1, 2006. Requires the Department to study methods to collect and report data on mortality and nosocomial infection rates from hospitals and ambulatory surgical treatment centers for outpatient services and report its findings and recommendations on its Internet website and to the Governor and General Assembly no later than January 1, 2006. Requires the Department to authorize electronic access to patient billing data collected pursuant to these provisions for use by certain entities. Requires ambulatory surgical treatment centers to make available to prospective patients information on the normal charge incurred for any procedure or operation the prospective patient is considering. Requires the Department to adopt rules for inpatient and outpatient data collection and reporting no later than January 1, 2006. Makes other changes. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

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 Sections 4-2 and 4-4 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 charges for payment from public and private payors. This system shall be based upon adoption of the uniform electronic hospital billing form pursuant to requirements adopted by the Secretary of Health and Human Services under the the Health Insurance Portability and Accountability Act 42 U.S.C. 1320d-2.

(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 Each hospital licensed in the State shall electronically submit to the Department inpatient and outpatient patient billing data 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 billing data collected under paragraph (5) for each patient. conditions and procedures required for public disclosure pursuant to paragraph (6). For hospitals, the billing data to be reported shall include all inpatient surgical cases.

Billing data submitted under this Act shall not include a patient's name, address, or Social Security number.

(5) The By no later than January 1, 2005, the Department must collect and compile billing data , on a quarterly basis, required under paragraph (6) according to uniform electronic submission formats as required under the Health Insurance Portability and Accountability Act and adopted by the Secretary of Health and Human Services under 42 U.S.C. 1320d-2. The collection and compilation of billing data under this paragraph must begin no later than:

(i) January 1, 2006, for hospitals; and

(ii) January 1, 2006, for ambulatory surgical treatment centers.

(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, for each hospital licensed in the State, 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. 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 for each hospital. Information disclosed pursuant to this paragraph on mortality and infection rates shall be based upon information hospitals have previously submitted to the Department pursuant to their obligations to report health care information under other public health reporting laws and regulations outside of this Act.

The Department shall include in the "Consumer Guide to Health Care" information for each hospital and ambulatory surgical treatment center on at least 30 outpatient conditions and procedures by July 1, 2006. As to each outpatient procedure, the "Consumer Guide to Health Care" shall include up-to-date comparison information relating to average charges and volume of cases for each hospital and ambulatory surgical treatment center.

(7) Publicly disclosed information must be provided in language that is easy to understand and accessible to consumers using an interactive query system.

(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 and ambulatory surgical treatment centers, and organizations representing hospitals and ambulatory surgical treatment centers, purchasers, consumer groups, and health plans are meaningfully involved 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 collection 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 among 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 identifying information from mandatory reports is used, and 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) The Within 12 months after the effective date of this amendatory Act of the 93rd General Assembly, the Department must study the most effective methods for public disclosure of patient charge 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 no later than January 1, 2006.

(11) The Department must undertake all steps necessary under State and Federal law, including the Gramm-Leach-Bliley Act (12 U.S.C. §1811 et. seq.) and the Health Insurance Portability and Accountability Act privacy regulations (45 C.F.R. Part 164), to protect patient confidentiality in order to prevent the identification of individual patient records.

(12) The department 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, or a similar national entity that establishes 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 January 1, 2006.

(13) The Department shall study methods to collect and report data on mortality and nosocomial infection rates from hospitals and ambulatory surgical treatment centers for outpatient services and report its findings and recommendations on its Internet website and to the Governor and General Assembly no later than January 1, 2006.

(14) The Department must authorize electronic access to patient billing data collected pursuant to this Section for use by a requesting entity, including, but not limited to, an agency, academic research organization, or private sector organization for purposes of clinical performance measurement, including making information available to compare individual hospitals and ambulatory surgical treatment centers based on performance outcomes data, promoting evidence-based medicine and best practices, patient safety and quality improvement, public health research and other purposes as determined by the Department, by no later than September 1, 2005.

(15) The Department must adopt rules for inpatient and outpatient data collection and reporting no later than January 1, 2006.

(e) (Blank).

(Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)

(20 ILCS 2215/4-4) (from Ch. 111 1/2, par. 6504-4)

Sec. 4-4. (a) Hospitals and ambulatory surgical treatment centers shall make available to prospective patients information on the normal charge incurred for any procedure or operation the prospective patient is considering.

(b) The Department of Public Health shall require hospitals and ambulatory surgical treatment centers to post in letters no more than one inch in height the established charges for services, where applicable, including but not limited to the hospital's private room charge, semi-private room charge, charge for a room with 3 or more beds, intensive care room charges, emergency room charge, operating room charge, electrocardiogram charge, anesthesia charge, chest x-ray charge, blood sugar charge, blood chemistry charge, tissue exam charge, blood typing charge and Rh factor charge. The definitions of each charge to be posted shall be determined by the Department.

(Source: P.A. 92-597, eff. 7-1-02.)

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