[ Back ] [ Bottom ]
92_HB1824eng
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
HB1824 Engrossed -2- LRB9204832JMmb
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
HB1824 Engrossed -3- LRB9204832JMmb
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
HB1824 Engrossed -4- LRB9204832JMmb
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:
HB1824 Engrossed -5- LRB9204832JMmb
1 OPERATING REVENUES
2 (1) Net patient service revenue
3 (2) Other revenue
4 (3) Total operating revenue
5 OPERATING EXPENSES
6 (4) Bad debt expense
7 (5) Total operating expenses
8 NON-OPERATING GAINS/LOSSES
9 (6) Total non-operating gains
10 (7) Total non-operating losses
11 PATIENT CARE REVENUES
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
20 DEDUCTIONS FROM 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
HB1824 Engrossed -6- LRB9204832JMmb
1 (27) Total Assets
2 LIABILITIES AND FUND BALANCES
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,
HB1824 Engrossed -7- LRB9204832JMmb
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,
HB1824 Engrossed -8- LRB9204832JMmb
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.
HB1824 Engrossed -9- LRB9204832JMmb
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
HB1824 Engrossed -10- LRB9204832JMmb
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;
HB1824 Engrossed -11- LRB9204832JMmb
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
HB1824 Engrossed -12- LRB9204832JMmb
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.
[ Top ]