99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB2684
 
Introduced , by Rep. Greg Harris
 
SYNOPSIS AS INTRODUCED:



See Index

 Provides that the Act may be referred to as the Medicaid Reform Research Act. Provides that, given that Illinois' Medical Assistance Program is undergoing a transition to managed care for Medicaid populations subject to the Medicaid Reform Act of 2011, the Save Medicaid Access Together (SMART) Act of 2012, and other Acts affecting Medicaid populations and delivery systems, a lawful and well-regulated dissemination of Medicaid data to qualified researchers is the best way to create accurate and creative unbiased analysis and information about Illinois' Medical Assistance Program that will lead to better health outcomes at a lower cost. Amends the Commission on Government Forecasting and Accountability Act. Provides that the Commission on Government Forecasting and Accountability may, subject to appropriations, coordinate and enter into agreements with the Department of Healthcare and Family Services and certain institutions and entities for research on medical assistance managed care or other State medical assistance programs pursuant to the analysis purposes of the State-Funded Health Care Quality Assurance and Research Fund. Contains provisions concerning individual patient medical claims information provided by the Department to those institutions and entities and other matters. Amends the State Finance Act. Creates the State-Funded Health Care Quality Assurance and Research Fund to provide the General Assembly with an independent analysis on certain matters, including the efficacy of State managed care programs to improve continuity of care, ensure adequate provider participation, and maintain appropriate utilization of health services. Provides that the Fund shall consist of certain moneys, including transfers from the Healthcare Provider Relief Fund and other matters. Effective immediately.



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FISCAL NOTE ACT MAY APPLY
 
 
A BILL FOR
 


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1 AN ACT concerning State government.


2 Be it enacted by the People of the State of Illinois,

3represented in the General Assembly:



4 Section 1. Short title. This Act may be referred to as the 
5Medicaid Reform Research Act.

6 Section 5. Findings. Whereas Illinois' Medical Assistance 
7program is undergoing a transition to managed care for Medicaid 
8populations subject to the Medicaid Reform Act of 2011, the 
9Save Medicaid Access Together (SMART) Act of 2012, and other 
10Acts affecting Medicaid populations and delivery systems; and
11 Whereas Illinois possesses an abundance of academic 
12research entities with expertise in the academic fields related 
13to health care practices, health outcomes, special needs 
14populations, and health care delivery design, the General 
15Assembly finds that:
16  (1) A lawful and well-regulated dissemination of 
17 Medicaid data to qualified researchers is the best way to 
18 create accurate and creative unbiased analysis and 
19 information about Illinois' Medical Assistance Program 
20 that will lead to better health outcomes at a lower cost.
21  (2) Accurate research findings should be made 
22 available to the General Assembly from a variety of 
23 independent qualified research entities.
 
 
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1  (3) As Illinois' Medical Assistance Program transforms 
2 from a fee-for-service system to a system based on 
3 capitated contracts, there must be sufficient transparency 
4 in those contracts to allow for evaluation of their 
5 effectiveness by the General Assembly through receipt of 
6 data analysis performed by qualified independent research 
7 institutions.
8  (4) Any data received under this Act must be used 
9 solely for research purposes by the research entity; and 
10 the confidentiality of any data provided to authorized 
11 individuals pursuant to this Act must be maintained in 
12 accordance with the provisions of this Act and other 
13 applicable laws.
14  (5) Any use of the data for commercial purposes in 
15 violation of this Act shall be subject to the fines and 
16 penalties specified in the State Finance Act, including the 
17 loss of access to data.

18 Section 10. The Commission on Government Forecasting and 
19Accountability Act is amended by changing Section 3 as follows:

20 (25 ILCS 155/3) (from Ch. 63, par. 343)
21 Sec. 3.  
22 (a) The Commission shall:


23  (1) Study from time to time and report to the General 
24 Assembly on
economic development and trends in the State.


 
 
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1  (2) Make such special economic and fiscal studies as it 
2 deems
appropriate or desirable or as the General Assembly 
3 may request.


4  (3) Based on its studies, recommend such State fiscal 
5 and economic
policies as it deems appropriate or desirable 
6 to improve the functioning
of State government and the 
7 economy of the various regions within the
State.


8  (4) Prepare annually a State economic report.


9  (5) Provide information for all appropriate 
10 legislative
organizations and personnel on economic trends 
11 in relation to long range
planning and budgeting.


12  (6) Study and make such recommendations as it deems 
13 appropriate to
the General Assembly on local and regional 
14 economic and fiscal policy
and on federal fiscal policy as 
15 it may affect Illinois.


16  (7) Review capital expenditures, appropriations and 
17 authorizations
for both the State's general obligation and 
18 revenue bonding authorities.
At the direction of the 
19 Commission, specific reviews may include
economic 
20 feasibility reviews of existing or proposed revenue bond

21 projects to determine the accuracy of the original estimate 
22 of useful
life of the projects, maintenance requirements 
23 and ability to meet debt
service requirements through their 
24 operating expenses.


25  (8) Receive and review all executive agency and revenue 
26 bonding
authority annual and 3 year plans. The Commission 
 
 
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1 shall prepare a
consolidated review of these plans, an 
2 updated assessment of current
State agency capital plans, a 
3 report on the outstanding and unissued
bond 
4 authorizations, an evaluation of the State's ability to 
5 market
further bond issues and shall submit them as the 
6 "Legislative Capital
Plan Analysis" to the House and Senate 
7 Appropriations Committees at
least once a year. The 
8 Commission shall annually submit to the General
Assembly on 
9 the first Wednesday of April a report on the State's 
10 long-term
capital needs, with particular emphasis upon and 
11 detail of the 5-year
period in the immediate future.


12  (9) Study and make recommendations it deems 
13 appropriate to the
General Assembly on State bond 
14 financing, bondability guidelines, and
debt management. At 
15 the direction of the Commission, specific studies
and 
16 reviews may take into consideration short and long-run 
17 implications
of State bonding and debt management policy.


18  (10) Comply with the provisions of the "State Debt

19 Impact Note Act" as now or hereafter amended.


20  (11) Comply with the provisions of the Pension Impact 
21 Note Act, as now
or hereafter amended.


22  (12) By August 1st of each year, the Commission must 
23 prepare and cause to
be published a summary report of State 
24 appropriations for the State fiscal year
beginning the 
25 previous July 1st. The summary report must discuss major

26 categories of appropriations, the issues the General 
 
 
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1 Assembly faced in
allocating appropriations, comparisons 
2 with appropriations for previous
State fiscal years, and 
3 other matters helpful in providing the citizens of
Illinois 
4 with an overall understanding of appropriations for that 
5 fiscal year.
The summary report must be written in plain 
6 language and designed for
readability. Publication must be 
7 in newspapers of general circulation in the
various areas 
8 of the State to ensure distribution statewide. The summary

9 report must also be published on the General Assembly's web 
10 site.


11  (13) Comply with the provisions of the State Facilities 
12 Closure Act.

13  (14) For fiscal year 2012 and thereafter, develop a 
14 3-year budget forecast for the State, including 
15 opportunities and threats concerning anticipated revenues 
16 and expenditures, with an appropriate level of detail. 
17 (b) In addition to any other powers and duties, the 
18Commission may, subject to appropriations, coordinate and 
19enter into agreements with the Department of Healthcare and 
20Family Services and State universities, Tier I and Tier II 
21academic medical centers as defined in the Illinois Public Aid 
22Code, or other entities as designated by the Department of 
23Healthcare and Family Services for research on medical 
24assistance managed care or other State medical assistance 
25programs in accordance with the analysis purposes for which the 
26State-Funded Health Care Quality Assurance and Research Fund is 
 
 
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1created, as specified in Section 6z-101 of the State Finance 
2Act. As used in this subsection, "research" means a systematic 
3investigation, including research development, testing, and 
4evaluation, that is designed to develop or contribute to 
5generalizable knowledge. 
6 Notwithstanding any other provisions of law to the 
7contrary, subject to appropriations or funds made available by 
8agreement through the Commission, the Department of Healthcare 
9and Family Services is authorized and directed to provide the 
10individual patient medical claims information, including 
11individual data for services provided through capitated 
12contracts, concerning recipients of medical assistance to the 
13following institutions and entities for the analysis purposes 
14for which the State-Funded Health Care Quality Assurance and 
15Research Fund is created, as specified in Section 6z-101 of the 
16State Finance Act: 
17  (1) State universities. 
18  (2) Tier I and Tier II academic medical centers as 
19 defined in the Illinois Public Aid Code. 
20  (3) Associations incorporated in Illinois that (i) 
21 possess demonstrated research capacity and an 
22 institutional review board that is in compliance with the 
23 U.S. Health and Human Services' Office for Human Research 
24 Protections and (ii) are determined by the Department of 
25 Healthcare and Family Services to represent a broad number 
26 of providers who serve recipients of medical assistance 
 
 
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1 provided under Article V of the Illinois Public Aid Code. 
2  (4) Other entities designated by the Department of 
3 Healthcare and Family Services for the analysis purposes 
4 for which the State-Funded Health Care Quality Assurance 
5 and Research Fund is created, as specified in Section 
6 6z-101 of the State Finance Act. 
7 The patient medical claims information provided (i) shall 
8include only the Medicaid recipient identification number, 
9which shall not be de-identified, and any other individual 
10medical patient data that has been de-identified in accordance 
11with the federal Health Insurance Portability and 
12Accountability Act of 1996 (HIPAA) so as to qualify as a 
13"limited data set" and (ii) shall be shared only in accordance 
14with HIPAA. 
15 The Commission, the Department of Healthcare and Family 
16Services, and the entities listed in paragraphs (1) through (4) 
17of this subsection must enter into data sharing agreements and 
18business associate agreements to ensure privacy protection and 
19HIPAA compliance and to safeguard the security and 
20confidentiality of the patient medical claims information 
21provided by the Department. The Department of Healthcare and 
22Family Services shall make as much data available as possible 
23in order to promote transparency and unencumbered data 
24analysis. 
25 The data shall be shared electronically with each 
26participating entity on a State fiscal year basis once the data 
 
 
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1year is considered complete, and not longer than 8 months after 
2the close of the State fiscal year. A complete State fiscal 
3year data set shall be based on dates of service during a State 
4fiscal year and shall be considered complete when sufficient 
5time has occurred after the end of the State fiscal year to 
6process all claims and make corrections to improperly filed 
7claims. 
8 Participating institutions and entities may, at their own 
9expense and consistent with rules adopted by the Department of 
10Healthcare and Family Services, produce research reports 
11related to the purposes of this amendatory Act of the 99th 
12General Assembly, provided that all patient medical claims 
13information provided in any such report has been aggregated and 
14de-identified. Participating institutions and entities may not 
15use such patient medical claims information for commercial 
16purposes or otherwise transfer such patient medical claims 
17information to any other entity. Nothing in this amendatory Act 
18of the 99th General Assembly shall be construed as prohibiting 
19a participating institution or entity from partnering with 
20another entity voluntarily or by contract to produce research 
21reports, so long as no individually identifiable data is shared 
22with the participating institution or entity.
23 The Commission shall report to the General Assembly the 
24findings and recommendations resulting from the research and 
25analyses conducted in accordance with Section 6z-101 of the 
26State Finance Act. 
 
 
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1 (c) The requirement for reporting to the General Assembly 
2shall be satisfied
by filing copies of the report with the 
3Speaker, the Minority Leader and
the Clerk of the House of 
4Representatives and the President, the Minority
Leader and the 
5Secretary of the Senate and the Legislative
Research
Unit, as 
6required by Section 3.1 of the General Assembly
Organization 
7Act, and
filing such additional copies with the State 
8Government Report Distribution
Center for the General Assembly 
9as is required under paragraph (t) of
Section 7 of the State 
10Library Act.


11(Source: P.A. 96-958, eff. 7-1-10.)


12 Section 15. The State Finance Act is amended by adding 
13Section 6z-101 as follows:

14 (30 ILCS 105/6z-101 new)
15 Sec. 6z-101. State-Funded Health Care Quality Assurance 
16and Research Fund.
17 (a) The State-Funded Health Care Quality Assurance and 
18Research Fund is created. The Fund shall consist of:
19  (1) receipts from State fund transfers, including 
20 transfers from the Healthcare Provider Relief Fund;
21  (2) contributions from participating institutions and 
22 entities as provided in subsection (c); and
23  (3) any receipts from the federal government related to 
24 expenditures from the Fund.
 
 
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1 All interest earned on moneys in the Fund shall be 
2deposited into the Fund. 
3 (b) The Fund shall be appropriated to the Commission on 
4Government Forecasting and Accountability. The purpose of the 
5Fund is to fund an independent analysis of each of the 
6following: 
7  (1) The efficacy of State managed care programs to 
8 improve the patient's experience with healthcare, to 
9 improve the health of Medicaid populations, and to reduce 
10 healthcare costs. 
11  (2) The efficacy of the Department of Healthcare and 
12 Family Services in monitoring healthcare outcomes in 
13 managed care and other healthcare settings. 
14  (3) Any possible gaps in healthcare for Medicaid 
15 populations served by the State and recommendations on how 
16 to close them. 
17  (4) Successful outcomes and best practices in 
18 improving the health of Medicaid populations and the 
19 quality of care while reducing the cost. 
20  (5) The efficacy of State managed care programs to 
21 improve continuity of care, ensure adequate provider 
22 participation, and maintain appropriate utilization of 
23 health services. 
24  (6) In combination with other data sources, the impact 
25 of managed care on the social determinants of health as 
26 well as on non-clinical outcomes such as employment and 
 
 
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1 educational attainment. 
2  (7) The degree to which appropriate mechanisms are in 
3 place to assess the internal quality assurance processes of 
4 the Department of Healthcare and Family Services. 
5 (c) The following institutions and entities may choose to 
6participate in the Fund and the associated research by 
7contributing not more than $250,000 into the Healthcare 
8Provider Relief Fund annually: 
9  (1) State universities. 
10  (2) Tier I or Tier II academic medical centers as 
11 defined in the Illinois Public Aid Code. 
12  (3) Associations incorporated in Illinois that possess 
13 demonstrated research capacity and an institutional 
14 research board and that, as determined by the Department of 
15 Healthcare and Family Services, represent a broad number of 
16 providers who serve recipients of medical assistance 
17 provided under Article V of the Illinois Public Aid Code. 
18  (4) Other entities as designated by the Department of 
19 Healthcare and Family Services. 
20 Based upon the number of participants, the costs to the 
21Department of Healthcare and Family Services, and the 
22appropriations made to the Department of Healthcare and Family 
23Services and the Commission on Forecasting and Governmental 
24Accountability, the Department shall determine the 
25contribution amount for participants. All participants shall 
26pay the same amount. Each participant shall be refunded the 
 
 
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1amount it paid into the Fund if (i) the research data described 
2in subsection (b) of Section 3 of the Commission on Government 
3Forecasting and Accountability Act is not provided to the 
4participating entities free of charge or (ii) the research data 
5or similar data is shared with an entity not identified in 
6subsection (b) of Section 3 of the Commission on Government 
7Forecasting and Accountability Act. 
8 The State shall transfer into the Fund, from the Healthcare 
9Provider Relief Fund, an amount equal to the contributions made 
10by participating entities. 
11 Any use of the data for commercial purposes or for another 
12purpose not authorized under subsection (b) of Section 3 of the 
13Commission on Government Forecasting and Accountability Act 
14shall result in: (i) no access to the data for a period of one 
15year after the data year the last data set had been received; 
16(ii) no refund of the fees authorized under this Section; and 
17(iii) a civil penalty of $2,500 for each violation, which shall 
18be deposited into the State-Funded Quality Care and Research 
19Fund. 


20 Section 99. Effective date. This Act takes effect upon 
21becoming law. 


 
 
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1
INDEX

2
Statutes amended in order of appearance