Section 1010.10  Purpose (Repealed)

 

(Source:  Repealed at 36 Ill. Reg. 8017, effective May 8, 2012)

 

Section 1010.20  Definitions

 

"Act" means the Health Finance Reform Act.

 

"Admission, Discharge and Transfer (ADT) trigger event" means messages from HL7 standard, triggered by admission (A01), Register (A04), Update (A08) and Discharge (A03).

 

"Affirmation statement" means a document that, when signed by a hospital or ambulatory surgical treatment center administrator or an authorized representative of a hospital or ambulatory surgical treatment center submitting data to the Department, affirms, to the best of the signer's knowledge, that any necessary corrections to data submitted to the Department have been made and that the data submitted are complete and accurate.

 

"Agency for Healthcare Research and Quality" or "AHRQ" means a federal agency that is a part of the U.S. Department of Health and Human Services.

 

"Ambulatory patient classification" or "APC" means a definition by the Centers for Medicare and Medicaid Services (CMMS) for the prospective payment system (PPS) under Medicare for hospital outpatient services. All services paid under the PPS are classified into groups called APCs. Services in each APC are similar clinically and in terms of the resources they require. A payment rate is established for each APC based on the resources involved in treatment.

 

"Ambulatory surgical treatment center" means a facility licensed under the Ambulatory Surgical Treatment Center Act.

 

"Application" means technical software tools that provide access and analysis for the syndromic surveillance data.

 

"Batch" means a file that transfers multiple messages together.

 

"CCYYMMD" means a calendar date in the format of century, year, month and day of the week, where 1 = Sunday, 2 = Monday, etc.

 

"CCYYMMDD" means a calendar date in the format of century, year, month and day, without separators.

 

"Chief complaint" means a patient’s self-reported complaint of reason for visit. It is the most complete description and may include multiple symptoms as free text summary of the patient’s own words as well as a drop-down selection of symptoms.

 

"Claims and encounter" means either a request to obtain payment, and necessary accompanying information, from a health care provider to a health plan, for health care or an inpatient stay or outpatient visit in which a claim is not generated.

 

"Cleaned claims data" means data that have passed validity tests that edit for individual element content and comparison with related elements for appropriate context within the time periods and value ranges appropriate for the data file.

 

"Clinical Classification Software" or "CCS" means a diagnosis and procedure categorization scheme developed by the Healthcare Cost and Utilization Project.

 

"Compliance percentage" means the value obtained when the number of cleaned and unduplicated claims and encounters per calendar month is divided by the reported discharge count for the same calendar month, with the dividend of this calculation multiplied by 100.

 

"Computed tomographic scan" or "CT scan" means a computed tomographic scan of the head and other parts of the human body.

 

"Consumer Guide to Health Care" means a comparative health care information report showing conditions and procedures that demonstrate the widest variation in charges and quality of care in inpatient and outpatient services provided in hospitals and ambulatory surgical treatment centers.

 

"Current Procedural Terminology" or "CPT" means a listing of descriptive terms and identifying codes providing a consistent and standardized language for reporting medical services and procedures performed by physicians. These codes are maintained and distributed by the American Medical Association (330 N. Wabash Ave., Suite 39300, Chicago IL 60611-5885).

 

"Custom dataset" means requests for specific data elements for particular research or reporting tasks. This may include specific aggregations or combinations of data values into categories or groups.

 

"Data submission manual" means the Department's Technical Reference for Data Submission document specifying the details of the record layout, the outpatient surgical procedure code range, specifications of identification of emergency department and observation cases and contact information for questions related to data submission.

 

"Data submission profile" means a set of validation and verification reports containing accumulated statistical summaries of all data submitted to the Department by the facility for each month of the current collection period. These reports contain information identifying claims and encounters that fail Departmental edits, as well as data quality statistics showing data accepted up to and including the latest submission.

 

"Data use agreement" means a written contract between parties that defines the care and handling of sensitive or restricted use data, including, but not limited to, the terms of the agreement, ownership of the data, security measures and access to the data, uses of the data, data confidentiality procedures, duration of the agreement, disposition of the data at the completion of the contract, and any penalties for violation of the terms of the agreement.

 

"De-identified" means data that do not contain directly identifiable individual patient health information as defined in HIPAA privacy regulations (Security and Privacy); or data that, through analysis by an experienced expert statistician or by the use of probability software, can be shown to have a low probability of individual identification.

 

"Department" or "DPH" means the Illinois Department of Public Health.

 

"Diagnosis Related Group" or "DRG" means a patient classification scheme that provides a means of categorizing hospital inpatients according to the resources required in treatment, developed for the Centers for Medicare and Medicaid Services for use in the Medicare Prospective Payment System.

 

"Diagnostic" means the process used to identify or characterize, as accurately as possible, the details of a medical condition or injury.

 

"Electronically submit" means that required data submission will be carried out by the transfer of appropriate files to the Department's secure web server. Physical media of any form or type will not be used in the transfer of these data.

 

"Emergency Department" or "ED" means the location within hospitals where persons receive initial treatment by health care professionals for conditions of an immediate nature caused by injury or illness. The person treated may or may not be admitted to the hospital as an inpatient. Services furnished to an individual who has an emergency medical condition are defined in 42 CFR 424.101.

 

"Emerging technology" means new approaches to the treatment of medical conditions through the use of existing machines and equipment in new and different ways or the development of new machines and equipment for a specific form of medical treatment.

 

"Ethnicity" means the classification of a person's ethnic background. Classification categories collected will follow the Federal Office of Management and Budget (OMB) Statistical Policy Directive Number 15, "Race and Ethnic Standards for Federal Statistics and Reporting".

 

"Facility" means a hospital, as defined in the Hospital Licensing Act and the University of Illinois Hospital Act, or an ambulatory surgical treatment center, as defined in the Ambulatory Surgical Treatment Center Act. For syndromic surveillance, a facility can also be a site that provides urgent care, and does not include ambulatory surgical treatment centers.

 

"Final closing date" means the final day, 65 days after the end of each calendar quarter, on which electronically submitted corrections and missing data are accepted for each quarterly data submission period.

 

"Federal Information Processing Standards" or "FIPS" means a standardized set of numeric or alphabetic codes issued by the National Institute of Standards and Technology (NIST) to ensure uniform identification of geographic entities through all federal government agencies.

 

"Fully populated test data" means that each field or individual element specified in each record of the file contains data values. Complete data allow the exercise of all parts of the computer program used to produce the file. This will provide more robust testing outcomes, reduce the number of test runs necessary, and improve the quality of data submissions.

 

"Healthcare Common Procedure Coding System" or "HCPCS" means a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). The HCPCS was established to provide a standardized coding system for describing the specific items and services provided in the delivery of health care. HIPAA made the HCPCS mandatory for Medicare and Medicaid billings. HCPCS includes three levels of codes:

 

Level I consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric.

 

Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices.

 

Level III consists of temporary codes for emerging technologies, services and procedures.

 

"Healthcare Cost and Utilization Project" or "HCUP" means a group of health care databases and software tools and products created by a government and industry partnership and sponsored by AHRQ.

 

"Health plan" means an individual or group plan that provides, or pays the cost of, medical care. Further explanation can be found in HIPAA privacy regulations.

 

"HH" means clock time in hours using 24-hour time from 00 to 23 rounded to the nearest hour.

 

"Health Insurance Portability and Accountability Act privacy regulations" or "HIPAA privacy regulations" means regulations promulgated at 45 CFR 160 and 45 CFR 164, Subparts A and E, under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.

 

"Health Level 7 (HL7)" means the industry standards organization (www.hl7.org) for healthcare data exchange. HL7 is a registered trademark of Health Level Seven, Inc. Reg. U.S. Pat and TM office.

 

"HL7 version 2.5.1" means a nationally recognized standard for electronic data exchange between systems housing health care data. HL7 version 2.5.1 defines syntax, format and standard vocabulary for HL7 messages.

 

"Hospital" means any institution, place, building, or agency, public or private, whether organized for profit or not for profit, that is subject to licensure by the Illinois Department of Public Health under the Hospital Licensing Act, and the University of Illinois Hospital as defined in the University of Illinois Hospital Act.

 

"Imaging" means the technique and process used to create images of the human body or its parts or functions for clinical purposes seeking to reveal, diagnose or examine disease or injury.

 

"Implementation guide" means a national HL7 standard document that guides the HL7 messages for syndromic surveillance submissions defining the message and content references for electronic health record certifications.

 

"Initial closing date" means the date, 60 days after the end of each calendar quarter, established for all hospitals and ambulatory surgical treatment centers to electronically submit inpatient and outpatient claims and encounter data to the Department.

 

"Invasive" means a medical procedure that penetrates or breaks the skin or a body cavity by means of a perforation, incision, catheterization or other methods into a patient's body.

 

"Limited datasets" means data containing protected health information (PHI) that excludes certain direct identifiers of the individual or of relatives, employers or household members of the individual, as defined in HIPAA privacy regulations.

 

"Magnetic resonance imaging" or "MRI" means a technology used to visualize internal body structures by using strong magnet fields in conjunction with radio frequency fields to analyze deep soft tissue without the use of harmful radiation.

 

"Major Diagnostic Category" or "MDC" means a collection of DRGs for categorizing specifically defined interventions and illnesses related to an organ or a body system, not to the cause of an illness or injury.

 

"Mammography" means the process of utilizing low-dose X-rays to examine the human breast as a diagnostic and screening tool for the detection of cancer.

 

"Meaningful Use" is the original term in the Health Information Technology for Economic and Clinical Health (HITECH) Act for the exchange of health care data across systems to promote meaningful use of health information technology to improve the quality and value of American health care. Meaningful Use is the criteria cited to satisfy the CMMS final rule of the federal HITECH Act of 2009 (78 FR 5565, January 25, 2013). Meaningful Use program was later termed Promoting Interoperability.

 

"Minimally invasive" means a medical procedure carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest disturbance possible to these structures. Special medical equipment may be used, such as fiber optic cables, miniature video cameras and special surgical instruments handled via tubes inserted into the body through small openings in its surface.

 

"National Provider Identifier" or "NPI" means a unique identification number assigned to all health care providers to be used by all health plans. The NPI will be issued and maintained by the National Provider System.

 

"National Uniform Billing Committee" or "NUBC" means the group including all major national provider and payer organizations formed to develop and maintain the national standard health care uniform bill.

 

"Near real-time" means the timeliness of the data submitted for syndromic surveillance. Near real-time is defined in the implementation guide as data that must be submitted at least within 24 hours of the date and time of the patient’s initial encounter. Updates to a patient record must also be submitted within 24 hours of the information being added to the record. Real time data transmission, or very frequent batch data transmission, is at least hourly or <15 minutes from entry in the hospital record.

 

"National Institute of Standards and Technology (NIST)" means the government agency that developed the syndromic surveillance message certification tool.

 

"Non-invasive surgery" means a medical procedure using highly focused beams of radiation when the nature or location of the condition is not amenable to mechanical intervention.

 

"Observation care" or "OC" means services furnished to a person by a hospital on the hospital's premises, including use of a bed and at least periodic monitoring by a hospital's nursing or other staff, which are reasonable and necessary to evaluate an outpatient's condition or to determine the need for a possible admission to the hospital as an inpatient. In general, the duration of observation care services is less than 24 hours, although, in some circumstances, patients may require a second day.

 

"Office of the National Coordinator (ONC)" means the national agency that establishes the standard used for syndromic surveillance in the CMMS final rule of the HITECH Act of 2009.

 

"On-boarding" means the process for a hospital or facility to connect to DPH to test and submit syndromic surveillance messages.

 

"Organizational Identifier (OID)" means the registration of a facility obtained at HL7.org. This is an alternative Facility ID to the NPI for syndromic surveillance.

 

"Outpatient" means any health care service provided in a hospital to a patient who is not admitted to the hospital as an inpatient, or any health care service provided to a patient in a licensed ambulatory surgical treatment center. For syndromic surveillance, Emergency Department services are uniquely identified as separate from other outpatient visits.

 

"Outpatient surgery" means specific procedures performed on an outpatient basis in a hospital or licensed ambulatory surgical treatment center. Specific ranges of required procedure codes can be found in the Department's data submission manual.

 

"Patient class" means patient classification within a facility, including for example Emergency, Inpatient or Observation.

 

"Personal health information" or "PHI" means the information defined in HIPAA privacy regulations.

 

"Public Health Information Network" or "PHIN" means the Center for Disease Control's (CDC) national initiative to increase capacity of public health agencies to electronically exchange data and information across organizations and jurisdictions.  The PHIN Vocabulary Access and Distribution System (VADS) standard code set values are available at https://www.cdc.gov/phin/resources /vocabulary/index.html.

 

"Positron emission tomography scan" or "PET scan" means a nuclear medicine imaging technology that creates a three dimensional view of functional body processes.

 

"Public use data" means any form of data from the Department's comprehensive discharge database or facility-level database that contains de-identified data.

 

"Race" means the classification of a person's racial background. Classification categories collected will follow the Federal Office of Management and Budget (OMB) Statistical Policy Directive Number 15, "Race and Ethnic Standards for Federal Statistics and Reporting".

 

"Raw data" means any file, individual record, or any subset thereof that contains information about an individual health care service provided to a single patient and is released by the Department in data products or custom data files.

 

"Reciprocal data availability" means that, if a data requester controls the discharge data or syndromic surveillance of another state, release of Illinois discharge data or syndromic surveillance to that state entity would be contingent on the availability of discharge data or syndromic surveillance from that state of comparable quantity, quality and content at a similar price point.

 

"Research" means a systematic investigation, including development, testing and evaluation, designed to develop or contribute to generalizable knowledge. Activities that meet this definition constitute research, whether or not they are conducted or supported under a program that is considered research for other purposes. For example, some demonstration and service programs may include research activities.

 

"Secure file transfer protocol (SFTP)" means a network protocol for sending files securely in a protected shell for data submissions.

 

"Small number" means any number that is small enough to be useful in an attempt to determine the identity of a specific individual patient when used in conjunction with other elements in the data file or when the data file is linked with information from other sources. The Department considers a small number to be any cell size fewer than 10.

 

"Sonography" and "Ultrasonography" mean the use of sound waves at frequencies above the audible range of human hearing as a diagnostic tool for visualizing internal body structures, including tendons, muscles, joints, organs and other internal masses.

 

"Standard" means technical specifications for data exchange.

 

"Surgery" means treatment of diseases or injuries by manual and/or instrumental methods. The methods may include invasive, minimally invasive, or non-invasive procedures, depending on the condition treated and the nature of the instruments and technology used.

 

"Syndromic Surveillance" means a data collection process that regularly and systematically uses health-related data in near real-time to make information available on the health of a community. The information provides disease trends and detection of emerging events for surveillance.

 

"Therapeutic" means medical activities designed to treat or cure a disease, condition or injury.

 

"Uniform" means related unique data values that are combined into a smaller number of common categories.

 

"Uniform bill" means the uniform electronic billing form pursuant to the Health Insurance Portability and Accountability Act, which is developed as a standard instrument for use by institutions and payers in the handling of health care claims. (Section 4-2(d)(1) of the Act)

 

"Unique Physician Identification Number" or "UPIN" means a unique identification number assigned to all Medicare providers. The UPIN Registry is maintained by the National Heritage Insurance Company under contract from the Centers for Medicare and Medicaid Services.

 

"Urgent Care Services" means services defined in 42 CFR 405.400 that are furnished within 12 hours in order to avoid onset of an emergency medical condition. Urgent Care Services differs from services provided in response to an emergency medical condition because immediate care is not needed to avoid placing the health of the individual in serious jeopardy or to avoid serious impairment or dysfunction.

 

"Validation" means the process for healthcare systems to test and certify the syndromic messages to be correctly formatted with complete information.

 

(Source:  Amended at 47 Ill. Reg. 4017, effective March 10, 2023)

 

Section  1010.30  Incorporated and Referenced Materials

 

The following materials are incorporated or referenced in this Part:

 

a)         Federal Regulations

 

1)         Prospective Payment Systems for Inpatient Hospital Services (42 CFR 412), October 1, 2005

 

2)         Medical Facility Construction and Modernization (42 CFR 124), October 1, 2005

 

3)         Security and Privacy (45 CFR 164), October 1, 2005

 

4)         Medicare and Medicaid Programs; Electronic Health Record Incentive Program, Final Rule (75 FR 44313, July 28, 2010) available at:  https://www.federalregister.gov/documents/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-program

 

5)         Medicare and Medicaid Programs; Electronic Health Record Incentive Program - Stage 2, (See Meaningful Use), Final Rule (77 FR 53967, September 4, 2012) available at:  https://www.federalregister.gov/documents/ 2012/09/04/2012-21050/medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage-2

 

6)         Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, and Health Care Providers (See CMMS Interoperability rule; Admission, Discharge, and Transfer (ADT) at 25586-25603), Final Rule (85 FR 25510, May 1, 2020) available at:  https://www.federalregister.gov/documents/2020/05/01/ 2020-05050/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-and

 

7)         Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, Final Rule (75 FR 44589, July 28, 2010) available at:  https://www.federalregister.gov/documents/2010/07/28/2010-17210/health-information-technology-initial-set-of-standards-implementation-specifications-and

 

8)         2014 Edition Release 2 Electronic Health Record (EHR) Certification Criteria and the ONC HIT Certification Program; Regulatory Flexibilities, Improvements, and Enhanced Health Information Exchange, Final Rule (79 FR 54429, September 11, 2014) available at:  https://www.federalregister.gov/documents/2014/09/11/2014-21633/2014-edition-release-2-electronic-health-record-ehr-certification-criteria-and-the-onc-hit

 

b)         Federal Guidelines

 

1)         "Race and Ethnic Standards for Federal Statistics and Reporting", Statistical Policy Directive Number 15, Federal Office of Management and Budget (OMB), October 30, 1997

 

2)         HL7 version 2.5.1. Implementation Guide: Syndromic Surveillance Release 1-US Realm, Standard for Trial Use, July 2019. (http://www.hl7.org/)

 

3)         Data Modernization Initiative available at:  https://www.cdc.gov/ surveillance /data-modernization/index.html?CDC_AA_refVal=https %3A%2F%2Fwww.cdc.gov%2Fsurveillance%2Fsurveillance-data-strategies%2Fdata-IT-transformation.html

 

4)         NIST 2015 Edition ONC HealthIT Certification Test Tools available at:  https://www.nist.gov/itl/ssd/systems-interoperability-group/nist-2015-edition-onc-healthit-certification-test-tools

 

c)         Federal Statutes

 

1)         Gramm-Leach-Bliley Act (12 U.S.C. 1811)

 

2)         Social Security Act (42 U.S.C. 1320)

 

3)         Health Insurance Portability and Accountability Act of 1996 (110 U.S.C. 1936)

 

4)         Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA), 42 U.S.C. Section 300jj et seq.; Section 17901 et seq.

 

5)         Public Health Security and Bioterrorism Preparedness and Response Act of 2002, 42 U.S.C. 262a

 

d)         State Statutes

 

1)         Illinois Health Finance Reform Act [20 ILCS 2215]

 

2)         Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois [20 ILCS 2310]

 

3)         University of Illinois Hospital Act [110 ILCS 330]

 

4)         Ambulatory Surgical Treatment Center Act [210 ILCS 5]

 

5)         Hospital Licensing Act [210 ILCS 85]

 

6)         Communicable Disease Reporting Act [745 ILCS 45]

 

7)         Illinois Health Statistics Act [410 ILCS 520]

 

8)         Department of Public Health Act [20 ILCS 2305]

 

e)         State of Illinois Rules

 

Control of Communicable Diseases Code (77 Ill. Admin. Code 690)

 

f)         Federal regulations and guidelines incorporated by reference in this Part are incorporated on the date specified and do not include any later amendments or editions.

 

(Source:  Amended at 47 Ill. Reg. 4017, effective March 10, 2023)

 

Section 1010.40  Data Submission Requirements

 

a)         Inpatient and Outpatient Claims and Encounter Data

 

1)         Hospitals and ambulatory surgical treatment centers shall electronically submit patient claims and encounter data, as outlined in this subsection (a), to the Department no later than the initial closing date, 60 calendar days after the last day of each calendar quarter.  Calendar quarters shall begin on January 1, April 1, July 1, and October 1 and shall end on March 31, June 30, September 30, and December 31.  Beginning no later than 45 days after the last day of each calendar quarter, hospitals and ambulatory surgical treatment centers shall begin an internal review of all quarterly data accepted by the Department.  The quarterly review shall involve detailed evaluation of data quality feedback reports by facility staff with sufficient general knowledge of patient mix and services provided to allow identification of unreasonable or incomplete submission statistics.

 

A)        Hospitals shall submit to the Department:

 

i)          Claims and encounter data pertaining to each inpatient discharged.  Production and test data shall be submitted as specified in Appendix A;

 

ii)         Claims and encounter data pertaining to case data for each emergency department (ED) visit (wherever care is administered) and each observation case (OC) in the outpatient format specified in Appendix C; and

 

iii)        Claims and encounter data related to diagnostic or therapeutic imaging conducted during or related to an inpatient stay that may include, but are not limited to, techniques described in Appendix K.  These data may include, but are not limited to, events occurring during a visit for surgery or scheduled imaging for purposes of evaluating the need for treatment, determining the nature or extent of necessary treatment, or evaluating the outcomes of treatment.  Data elements for these cases, specified in Appendix C, shall begin with the cases for patients discharged on October 1, 2012.

 

B)        Hospitals and ambulatory surgical treatment centers shall report to the Department:

 

i)          Information relating to any patient treated with an ambulatory surgical procedure within any of the general types of surgeries as specified in Appendix B;

 

ii)         Claims and encounter data for each surgical or invasive procedure outlined in subsection (a)(1)(B)(i), as specified in Appendix C;

 

iii)        Claims and encounter data related to diagnostic or therapeutic imaging that may include, but are not limited to, techniques described in Appendix K. These data may include, but are not limited to, events occurring during a visit for surgery or scheduled imaging for purposes of evaluating the need for treatment, determining the nature or extent of necessary treatment, or evaluating the outcomes of treatment. Data elements for these cases, specified in Appendix C, shall begin with the cases for patients discharged on October 1, 2012.

 

C)        Only data consisting of the elements listed in Appendices A and C in the expanded format, as detailed in the Department's data submission manual, will be accepted.

 

2)         Each hospital and ambulatory surgical treatment center shall electronically submit to the Department all patient claims and encounter data pursuant to this subsection (a).  These submissions shall be in accordance with the uniform electronic transaction standards and code set standards adopted by the Secretary of Health and Human Services under the Social Security Act and the physical specifications, format and record layout specified in the Department's data submission manual.

 

3)         To be considered compliant with this Section, a hospital's or ambulatory surgical treatment center's data submission shall:

 

A)        Be submitted to the Department electronically, as specified in the data submission manual;

 

B)        Consist of an individual facility data file; and

 

C)        Meet the Department's minimum level of data submission compliance on or before the data submission due date.  Hospitals and ambulatory surgical treatment centers shall maintain a compliance percentage of no less than 98% for each calendar month.

 

4)         Failure to comply with this Section may subject the facility to penalties as provided in the Ambulatory Surgical Treatment Center Act and the Hospital Licensing Act.

 

b)         Inpatient and Outpatient Report of Monthly Discharge and Outpatient Surgery Counts

 

1)         Each hospital shall, within 30 calendar days following the last day of each calendar month, submit:

 

A)        The actual total number of hospital inpatient discharges for that calendar month.  In the case of multiple births, each child is counted as a discharge.  This number shall include those inpatient cases receiving diagnostic or therapeutic imaging as defined in subsection (a)(1)(A)(iii); and

 

B)        The actual number of hospital outpatient cases with a surgical procedure as defined in this Part for that calendar month.

 

2)         Each hospital shall, within 30 calendar days following the last day of each calendar month, submit for each category the actual number of hospital outpatient cases with an emergency department visit, observation stay, or surgery, as defined in this Part for that calendar month. Beginning with patients discharged on October 1, 2012, each hospital shall submit the actual number of cases with an outpatient visit for diagnostic or therapeutic imaging as defined in subsection (a)(1)(B)(iii).  Each patient shall be counted only once, except that imaging-only visits shall be counted separately.  Outpatient surgical cases, regardless of other services, shall be counted as surgical cases.  Non-surgical cases, excluding imaging-only visits, shall be counted separately as ED or OC, based on the last service received.

 

3)         Each ambulatory surgical treatment center shall, within 30 calendar days following the last day of each calendar month, submit the actual total number of licensed ambulatory surgical treatment center outpatient cases with surgery for that calendar month as defined in this Part.  Beginning with patients discharged on October 1, 2012, this count shall include the actual number of cases with a visit for diagnostic or therapeutic imaging as defined in subsection (a)(1)(B)(iii).

 

4)         All filings required in this Section shall be reported using the Department's electronic submission systems.

 

5)         Effective 60 days after the end of each calendar quarter, monthly reported discharge count acceptance for that calendar quarter will end. If any facility finds it necessary to change monthly reported counts after the initial closing date and before the final closing date, the facility administrator shall submit the revised monthly count with a written justification.

 

c)         Syndromic Surveillance

 

Hospitals are facilities that are mandated to report and urgent care centers and other facilities providing urgent care services are recommended to report the following:

 

1)         Facilities shall electronically submit all patient clinical encounter data, as outlined in this subsection (c), to the Department in near real-time, no later than 24 hours from the initial patient date and time of visit, and preferably within 1 hour of the encounter.  Updates to the patient record shall also be submitted within these timeframes. Facilities shall submit to the Department:

 

A)        Clinical encounter data pertaining to each Emergency Department (ED) visit. Message types for Registration, Admissions, Discharge and Update to be submitted. Production data elements are specified in Appendix L;

 

B)        Clinical encounter data pertaining to all inpatient visits. Message types for Admission, Updates and Discharge to be submitted. Production data elements are specified in Appendix L;

 

C)        Clinical encounter data pertaining to observation visits which may occur as a result of an ED visits or precede an inpatient admission. Production data elements are specified in Appendix L; and

 

D)        Clinical encounter data pertaining to urgent care visits as defined in Section 1010.20.

 

2)         Each facility shall electronically submit to the Department all patient clinical encounter data pursuant to this subsection (c).  These submissions shall be in accordance with the uniform electronic transaction standards and code set standards adopted by the Office of the National Coordinator and the CMMS in accordance with the HITECH Act of 2009 and the HL7 specifications, format and record layout specified in the HL7 syndromic surveillance implementation guide version 2.0 or later as adopted by the HL7 organization.

 

3)         To be considered compliant with this Section, a facility's data submission shall:

 

A)        Be submitted to the Department electronically, in near real-time no later than within 24 hours of the date and time of visit.

 

B)        Consist of batched HL7 version 2.5.1 messages.

 

C)        Meet the Department's minimum level of data submission compliance for data quality standards for completion of elements outlined in Appendix L.

 

D)        Be submitted for every calendar day. Any outages of data submission will need to be backfilled once issues are resolved.

 

E)        Facilities shall provide notice one week in advance of the reporting system being offline for 24 hours or more for any reason such as system upgrade or vendor transition, if the event was planned. In the event of an unplanned system outage, hospitals shall make all possible attempts to bring the system online in a timely manner.

 

F)         Any facility that falls out of compliance for more than seven days shall submit a resolution plan to the Department with a correction timeline of 30 days.

 

G)        Facilities may submit data directly to the Department or through a third party acting as their agent. Providers selecting this option are responsible for ensuring that all data specifications conform to the requirements of this Part.

 

4)         Failure to comply with this Section may subject the facility to penalties as provided in the Ambulatory Surgical Treatment Center Act and the Hospital Licensing Act.

 

(Source:  Amended at 47 Ill. Reg. 4017, effective March 10, 2023)

 

Section 1010.50  Common Data Verification, Review, and Comment Procedures

 

a)         Each facility shall review its patient discharge data for accuracy and completeness before submitting the data specified in this Part to the Department.

 

b)         The Department will edit each data submission for proper file formatting; content and context edits will be applied to each data element as appropriate; the file will be checked for duplicate records; and the database transactions will result in a data submission profile that will be available in electronic format on the Department's data submission web site.

 

c)         The submitting facility shall obtain and review the data submission profile as specified in subsection (b) of this Section from each data submission to verify that data received and accepted by the Department are in fact a complete and accurate representation of the services provided by the facility during the stated time frames.  If a facility or the Department determines that any data are in fact incomplete or inaccurate, it is the facility's responsibility to submit corrected data prior to the final closing date of the affected data collection period.

 

d)         If the Department determines that data submitted by a facility are questionable, inaccurate or incomplete during or after the close of a quarterly submission period, the Department shall conduct an on-site review of the facility's data submission practices.  Upon notification of the need for such a review by the Department, any hospital or ambulatory surgical treatment center affected shall, within 2 calendar weeks or 10 working days, whichever is the longer, gather information related to the review process.  The facility shall provide suitable workspace and access to all required information from the medical records and patient claims and encounter data underlying and documenting the inpatient or outpatient data under review.  Facilities shall provide access to other related documentation deemed necessary to conduct a successful desk audit of inpatient and outpatient data submitted.  The on-site review shall be carried out by Department staff over a minimum of one working day and extend for no more than three working days.  The facility under review shall ensure the availability of persons knowledgeable of the internal organizational processes and information processing systems with the ability to identify inaccurate and unreasonable data characteristics based on the patient mix and services provided by the facility. Facility staff shall produce a summary document within 30 days identifying the findings of the on-site review and detailing the corrective action necessary to correct the deficiencies discovered.  The facility shall closely monitor future data submissions to ensure that submissions accurately reflect actual patient mix and health care services provided.  It is the responsibility of each facility to review the results of each data submission for erroneous, inaccurate, incomplete or unreasonable information in data accepted by the Department and to resubmit accurate data prior to the end of the submission period.

 

e)         Final edited data shall be received prior to the final closing date, 20 calendar days after the start date for internal data review as specified in Section 1010.40(a)(1) of this Part.  Five calendar days are specified between the initial and final closing dates to correct errors in claims and encounter data that were rejected on the last day of submission.  There shall be no correction period for erroneous data received during this five-day period.  To meet these requirements, the facility shall do all of the following:

 

1)         Correct and re-submit all data rejected throughout the quarterly submission period because of errors revealed by the Department edit checks performed under subsection (b) of this Section, and submit any missing claims and encounter data;

 

2)         Review the resultant data profile for accuracy and completeness; and

 

3)         Supply the Department with an affirmation statement, signed by the chief executive officer or designee, indicating that the facility's data are accurate and complete.

 

f)         Failure to comply with subsections (d) and (e) of this Section shall result in the facility's being noncompliant with this Section, and the facility may be subject to penalties as provided in the Ambulatory Surgical Treatment Center Act and the Hospital Licensing Act.

           

g)         After the facility has made any revisions under subsection (e) of this Section in the data for a particular time period, a data submission profile will be available for the submitting facility's review.

 

h)         If the Department discovers data errors after releasing the data, or if a facility representative notifies the Department of data errors after the Department releases the data, the Department will note the data errors as caveats to the completed datasets.  No revisions or additions to discharge data, case data, or monthly counts will be accepted after the final closing date of each quarterly data collection period.  If the Department makes an error in the preparation, presentation or reporting of collected data, the error will be corrected.

 

i)          The Department will reply to the submitting facility acknowledging receipt of the signed affirmation statement required in subsection (e)(3).

 

Section 1010.55  Syndromic Data Verification, Review, and Comment Procedures

 

a)         The facility will participate in on-boarding and validation by submitting test messages to the Department in HL7 version 2.5.1 format.

 

b)         Validation will include Department review of test messages demonstrating the ability to send all data elements listed in Appendix L. Upon Department approval, facilities will begin sending continuous live data as a production feed, post-testing. The Department will review the first 30-days of messages in production for completion and accuracy with code sets as a second step in validation. The Department will confirm whether the submission is valid.

 

c)         The Department will process data from the HL7 message, extracting the data and storing it in Department technology infrastructure.

 

d)         The Department will send modified messages to the Centers for Disease Control and Prevention for additional processing into analytical applications for use by public health authorities as identified in the Control of Communicable Diseases Code.

 

e)         The facility will send messages from an ONC NIST-certified interface.

 

f)         The facility technical contact information will be provided to the Department and kept up-to-date for the Department to utilize in the event data submission issues arise.  This will include a facility point of contact and can also include an Electronic Medical Record vendor at the discretion of the facility.

 

g)         The facility will complete a re-validation process, when there is a major upgrade, long outage or vendor change to the facility’s Electronic Medical Record. Notification shall be made to the Department at least 30 days prior to a change that requires a need for re-validation.

 

h)         The facility will respond within 15 days to any Department identified errors or needs for improvements and corrections of data quality. This may include review of chief complaint content for free text content improvements, incomplete information or non-standardized coded data.

 

i)          The facility may be asked for independent confirmation of counts of total visits, visit types or specific causes (such as overdose counts) to confirm accuracy and validity of the syndromic surveillance data.

 

j)          The Department will supply annual documentation that the facility is compliant with Promoting Interoperability standards for Federal CMS reimbursement.

 

(Source:  Added at 47 Ill. Reg. 4017, effective March 10, 2023)

 

Section 1010.60  Data Dissemination

 

a)         The Department will provide facilities the opportunity to review the Consumer Guide to Health Care (Guide) prior to public release. The entire report will be made available to each facility on the Department's secure web server for review before publication. This review period will end 15 working days after the availability date of the review material. During the review period, each facility may submit written comments concerning its report content to the Department. Comments shall be submitted on facility letterhead and shall be signed by the administrator or designee. All comments received by the Department will be kept on file. No comments will be accepted after the end of the review period and no changes to the content of the Guide will be accepted. If any facility or the Department finds erroneous or incomplete data in the Guide, these data will be identified and footnoted prior to publication. If the Department makes an error in the preparation or presentation of the Guide, the error will be corrected.

 

b)         Limited Data Product and Report requests approved by the Department shall result in the creation of the minimum necessary data set from the population of data elements available to the requester and accompanying data use agreement covering access, usage, distribution and confidentiality of the data.

 

1)         The Department, in accordance with Section 2310-33 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois, will charge fees to the requesting entity for providing access to data files or producing studies, data products or analyses of data. A schedule of fees for standard and custom datasets and products according to category of purchaser is presented in Section 1010.70 of this Part. In determining fees, the Department will consider all of the following:

 

A)        Type of data and specified usage;

 

B)        Record count and computer time required;

 

C)        Access fees for computer time;

 

D)        Staff time expended to process the request; and

 

E)        Handling and shipping charges.

 

2)         All requests for data files, data products, aggregations or reports containing limited data elements shall be made in writing to the Department using Department forms available at https://dph.illinois.gov/content/dam/soi/en/web/idph/files/forms/formsoppsdischarge-data-request-form.pdf. All data obtained from the Department shall be used solely for the purpose identified by the requesting entity and for use by the requesting entity. The scope and term of this usage will be detailed in a data use agreement specific to each request. Use of the data for any other purpose shall require a separate and specific written request, approval, and data use agreement.

 

3)         When the Department prepares facility-specific data, reports or comparative analyses for public release, affected facilities will be given the opportunity to review and comment on the data, studies or reports and their content prior to release to the public. Facilities will be provided access to the entire report on the Department's secure web server for review prior to publication. The review period will end 15 working days after the availability date of the review material. While no changes to previously submitted data will be accepted, the Department will accept written comments and explanations from facilities during the review period. The Department will keep these comments and explanations on file and, as appropriate and reasonable, will incorporate them into the text description of the published report, study or analysis. If a Department error is found in the publication, the error will be corrected.

 

c)         De-identified Data Files and Reports

 

1)         Public use data files, reports and studies based on information submitted by hospitals and ambulatory surgical treatment centers shall contain de-identified data and shall comply with State and federal law, including, but not limited to, the Gramm-Leach-Bliley Act and the HIPAA privacy regulations.

 

2)         All requests for public use files or special compilations, reports, studies or analyses derived from public use files shall be made in writing to the Department, with forms available at https://dph.illinois.gov/content/dam/soi/en/web/idph/files/forms/formsoppsdischarge-data-request-form.pdf. The release of data related to an approved public use data request shall not require a detailed data request form or comprehensive data use agreement. However, each request will be evaluated and, if necessary, will require a signed data use agreement appropriate to the content of the data requested. The data use agreement will include, but not be limited to, restrictions on patient identification and sale or release of the data to third parties.

 

3)         Facility syndromic surveillance data submitted to the Department may be used for epidemiological investigation or other disease intervention activities of the Department or local health department. Investigation shall include obtaining laboratory and clinical data necessary for case ascertainment. Findings of the investigation shall be used to institute control measures to minimize or reduce the risk of disease spread or to reduce exposures in a public health emergency event recognized or declared by local, State, or federal authorities.

 

4)         Syndromic surveillance data will be released for local health departments and the Centers for Disease Control and Prevention, consistent with the Department of Public Health Act and the Control of Communicable Diseases Code and used for monitoring public health. Release will be through secure transfer of data and accessed by approved software tools for data analysis.

 

5)         Release of aggregate, de-identified syndromic surveillance data is permitted only by the Department or local health department of the jurisdiction that the data describes.

 

6)         Release of syndromic surveillance data to individuals or entities other than the public health agencies identified requires a data use agreement. A data request form to initiate the process will be made available publicly at https://redcap.dph.illinois.gov/surveys/?s=MAPECL9E73. Any release of syndromic surveillance data must be consistent with the Department of Public Health Act and Health Statistics Act. Only the Department can review and approve the release of visit-level syndromic surveillance data to a third party.

 

7)         Facility user access is permitted only for data specific to the user's facility or health care system. Any sharing of data across facilities will require an agreement between the facilities and provided to the Department or due to provisions in applicable administrative rules (such as for extensively drug-resistant organism (XDRO) data or data for the Prescription Monitoring Program (PMP)). Aggregate data at the State level may be shared with facility users, but aggregate level of visits to facilities at the county level may not be shared with facility users.

 

8)         The Department will not release any syndromic data or information obtained pursuant to this Part to any individuals or entities for purposes other than the protection of the public health. Release will be through secure transfer of data and accessed by approved software tools for data analysis.

 

A)        All access to data by the Department, reports made to the Department, the identity of or facts that would tend to lead to the identity of the individual who is the subject of the report, and the identity of or facts that would tend to lead to the identity of the author of the report, the author being an individual or the reporting facility, in the case of syndromic surveillance, shall be strictly confidential, are not subject to inspection or dissemination, and shall be used only for public health purposes by the Department, local public health authorities, or the Centers for Disease Control and Prevention.

 

B)        Entities or individuals submitting reports or providing access to the Department shall not be held liable for the release of information or confidential data to the Department in accordance with this subsection. (Section 2(h)(i)(C) of the Department of Public Health Act) [20 ILCS 2305/2(h)(i)(C)]

 

d)        Patient Confidentiality and Data Security

 

1)         Patient name, address, any part of the Social Security number, unique patient identifier based on the last four digits of the patient's Social Security number, or any other data that the Department believes could be used to determine the identity of an individual patient shall be stored and processed in the most secure manner possible. (Section 4-2(d)(4) of the Act) Only authorized staff will have access to these data, with all computers and databases secured by password. Only computers located in controlled Department work sites will allow access to these data.

 

2)         Patient name, address, and any part of the Social Security number will not be released publicly. These data may be used to link discharge data or syndromic surveillance with other data sets internal or external to the Department, with linkage results released under guidelines of appropriate Department controls. The patient name, address, and any part of the Social Security number will not be released as part of these linkage results. The Department will evaluate any request for access to any or all of these three specific identifiers by authorized staff of other Illinois State agencies, local health departments, or approved research project participants individually. Evaluation criteria include need and security of patient confidentiality. The unique patient identifier may be released to State agencies, local health departments and approved data requesters using appropriate guidelines.

 

(Source:  Amended at 47 Ill. Reg. 4017, effective March 10, 2023)

 

Section 1010.70  Data Customer Categories and Data Product Fee Schedule

 

This Section establishes customer categories, data product descriptions, and data product fees.  The release of any patient level or small number data by the Department shall be contingent on the approval of the request and execution of an appropriate data use agreement.

 

a)         Customer categories are established as follows:

 

1)         Category I:  Resellers

 

A)        Any corporation, association, coalition, person, entity or individual that redistributes in any form any of the data or products (or any subset of the data or products) obtained from the Department for any revenue is engaged in reselling of the data or products and shall pay for the data or products at the reseller rate.

 

B)        All redistribution shall be restricted to de-identified data as defined by HIPAA privacy regulations.

 

2)         Category II:  Commercial, Private, For-Profit Organizations and Non-Illinois State and Local Government Entities

 

A)        Any corporation, association, coalition, person, entity or individual that functions in whole or in part for the benefit of the owners, members, or sponsors of the corporation or organization seeking to obtain data or products (or any subset thereof) from the Department is presumed to be acquiring the data or products for a commercial use;

 

B)        Any non-profit organization that purchases data materials on behalf of, either in whole or in part, or receives payment from, for-profit organizations for work done is presumed to be acquiring the data or products for a commercial use;

 

C)        Non-Illinois state and local government data release will be contingent on reciprocal data availability; and

 

D)        The Department will waive established data fees to non-Illinois government entities when entering into data sharing agreements for exchange of data of similar content.  Discharge data received from non-Illinois data sources will be accepted in lieu of the fees shown in Appendix I.  This waiver of fees will be contingent upon the non-Illinois entity waiving any fees charged, with acceptance of Illinois data in lieu of payment.

 

3)         Category III:  Federal government, educational institutions, all non-profit organizations, and college students enrolled in non-Illinois educational institutions, including:

 

A)        The federal government;

 

B)        Other non-state or local political subdivisions outside of the State of Illinois that are not covered under Category II; and

 

C)        All educational institutions (Illinois and non-Illinois), all non-profit organizations, and all college students enrolled in non-Illinois educational institutions.

 

4)         Category IV:  Illinois General Assembly, Executive Office of the Governor, State of Illinois Constitutional Officers, Agencies of Illinois State Government, Illinois county and local government, and college students enrolled in Illinois educational institutions.

 

b)         The following data products are available at rates established by the Department:

 

1)         Standard datasets are defined sets of data elements consisting of the minimum necessary group of elements for a specific request identified from the list of elements available to each category of requester.

 

A)        Research Oriented Dataset (RODS) containing data elements listed in Appendix D of this Part.

 

B)        Universal Dataset (UDS) containing data elements listed in Appendix E of this Part.

 

C)        State Inpatient Dataset (SIDS) containing elements derived for the purposes of the HCUP, Appendix F of this Part.

 

D)        State Ambulatory Surgery Dataset (SASDS) containing elements derived for the purposes of the HCUP, Appendix G of this Part.

 

E)        Revenue Code Dataset (RCDS), a supplement to datasets A through D containing data elements listed in Appendix H of this Part.

 

2)         The Department will evaluate requests for custom datasets and make the determination of complex or simple based on details of the request.

 

A)        Complex dataset:  a subset of RODS, UDS, SIDS or SASDS (with or without RCDS) that contains the majority of significant data elements, or an intricate aggregation or report that includes many significant data elements and compound relationships.

 

B)        Simple dataset: a subset of RODS, UDS, SIDS or SASDS (without RCDS) that contains a small number of significant data elements, or a straightforward aggregation or report that includes few significant data elements and no, or a single, relationship.

 

c)         Standard data product fees by category are set forth in Appendix I of this Part.  In addition to standard data product fees, the Department will assess data request processing and data product preparation fees as follows:

 

1)         The Department will assess a non-refundable data request application fee of $100.  The application fee shall be applied to the final cost of approved and completed data products.

 

2)         The Department will assess fees for the costs of preparing requested data products, including, but not limited to, programming, research, administrative, media and shipping as described in Appendix J of this Part.  The minimum charge will be one unit per resource factor, with additional units as necessary for more complicated requests.

 

(Source:  Amended at 36 Ill. Reg. 8017, effective May 8, 2012)

Section 1010.APPENDIX A   Uniform Inpatient Discharge Data

 

Data elements affected  by implementation of the ICD-10 coding scheme on October 1, 2013 (or as stipulated by CMMS) are noted when necessary and appropriate.

 

Detail Data

 

1.         Hospital identifier (federal tax identification number/Department assigned/NPI)

 

2.         Patient account number

 

3.         Discharge time (HH)

 

4.         Patient zip code and Plus 4

 

5.         Patient birth date (MMDDCCYY)

 

6.         Patient sex

 

7.         Admission date (MMDDYY) and time (HH)

 

8.         Type of admission

 

9.         Source of admission

 

10.        Patient discharge status

 

11.        Type of bill

 

12.        Total patient charges and components of charges (by revenue code, units of service and charges)

 

13.        Primary payer ID and health plan name

 

14.        Secondary and tertiary payer ID and health plan name (required when present)

 

15.        Principal and secondary diagnosis codes, when present  (up to 25 per data record and up to 50 with record pagination when necessary)

 

ICD-9 codes required: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of ICD-9 codes)

 

ICD-10 codes required: discharges on and after October 1, 2013 (or first date of CMMS acceptance of ICD-10 codes)

 

16.        Principal and secondary procedure codes and dates (MMDDYY), when present (up to 25 per data record and up to 50 with record pagination when necessary)

 

ICD-9 codes required: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of ICD-9 codes)

 

ICD-10 codes required: discharges on and after October 1, 2013 (or first date of CMMS acceptance of ICD-10 codes)

 

17.        Attending clinician ID number/NPI

 

18.        Other clinician ID number/NPI (up to two required when present)

 

19.        Patient race (according to OMB guidelines)

 

20.        Patient ethnicity (according to OMB guidelines)

 

21.        Patient county code (five digits: state and county codes for Illinois and border state residents (FIPS code))

 

22.        Diagnosis present at admission for each diagnosis

 

23.        External cause of injury codes (required when present)

 

ICD-9 Ecodes: three required if available: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of  ICD-9 codes)

 

ICD-10 Ecodes: eight required if available: discharges on and after October 1, 2013 (or first date of CMMS acceptance of ICD-10 codes)

 

24.        Newborn birth weight value code and birth weight in grams

 

25.        Admitting diagnosis code

 

ICD-9 code required: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of  ICD-9  codes)

 

ICD-10 code required: discharges on and after October 1, 2013 (or first date of CMMS acceptance of ICD-10 codes)

 

26.        Do not resuscitate indicator (entered in first 24 hours of stay)

 

27.        Prior stay occurrence code and prior stay from and through dates (required when present)

 

28.        Operating clinician ID number/NPI (required when surgical procedures present as a component of treatment)

 

29.        Accident state abbreviation (required when present)

 

30.        Condition employment related (required when present)

 

31.        Accident employment related occurrence code and date of accident (required when present)

 

32.        Crime victim occurrence code and date of crime (required when present)

 

33.        Statement covers period (from and through [discharge date] dates)

 

34.        Insurance group numbers (up to three required when present)

 

35.        Page number and total number of pages

 

36.        Diagnoses code version qualifier

 

ICD-9 indicator required = 9: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of ICD-9 codes)

 

ICD-10 indicator required = 0: discharges on and after October 1, 2013 (or first date of CMMS acceptance of ICD-10 codes)

 

37.        Condition code indicating patient admitted directly from this facility's emergency room/department

 

38.        Patient name (first, middle, last, suffix)

 

39.        Patient address (PO Box or street address, apartment number, city and state)

 

40.        Unique patient identifier based on the last four digits of patient Social Security number

 

41.        Primary insured's unique identifier (beneficiary/policy #)

 

42.        Any element or service adopted for use by the the National Uniform Billing Committee  pursuant to Section 4-2(d)(14) of the Act. Elements or services would be added as a submission requirement accompanied by sufficient notification to all submitting facilities and health care systems.  Notice would be provided no less than 90 days in advance of the submission requirement.        

 

(Source:  Amended at 36 Ill. Reg. 8017, effective May 8, 2012)

Section 1010.APPENDIX B   Ambulatory Categories

 

1.         Surgeries on the integumentary system

 

2.         Surgeries on the musculoskeletal system

 

3.         Surgeries on the respiratory system

 

4.         Surgeries on the cardiovascular system

 

5.         Surgeries on the hemic and lymphatic systems

 

6.         Surgeries on the mediastinum and diaphragm

 

7.         Surgeries on the digestive system

 

8.         Surgeries on the urinary system

 

9.         Surgeries on the male genital system

 

10.        Intersex surgery

 

11.        Surgeries on the female genital system

 

12.        Surgeries on the female reproductive system

 

13.        Surgeries on the endocrine system

 

14.        Surgeries on the nervous system

 

15.        Surgeries on the eye and ocular adnexa

 

16.        Surgeries on the auditory system

 

17.        Emergency department visits

 

18.        Diagnostic imaging

 

(Source:  Amended at 36 Ill. Reg. 8017, effective May 8, 2012)

Section 1010.APPENDIX C   Ambulatory Surgical Data Elements

 

Data elements affected by implementation of ICD-10 coding scheme October 1, 2013 (or as stipulated by CMMS) are noted when necessary and appropriate.

                                                                                                             

Detail Data

 

1.         Facility identifier (Federal tax identification number/Department assigned/NPI)

 

2.         Surgical site identifier (Department assigned)

 

3.         Patient account number

 

4.         Patient zip code and Plus 4

 

5.         Patient birth date (MMDDCCYY)

 

6.         Patient sex

 

7.         Date (MMDDYY) and time (HH) of visit

 

8.         Time (HH) of discharge

 

9.         Type of admission/visit

 

10.        Source of admission/visit

 

11.        Patient discharge status

 

12.        Type of bill

 

13.        Total patient charges and components of those charges (revenue codes, HCPCS codes with modifiers, date of service, units of service and charges)

 

14.        Primary payer ID and health plan name

 

15.        Secondary and tertiary payer ID and health plan name (required when present)

 

16.        Principal and secondary diagnosis codes, when present (up to 25 per data record and up to 50 with record pagination when necessary)

 

ICD-9 codes required: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of ICD-9  codes)

 

ICD-10 codes required: discharges on and after October 1, 2013 (or first date of revised CMMS acceptance of ICD-10 codes)

 

17.        Principal and secondary procedure codes and dates (MMDDYY), when present (up to 25 per data record and up to 50 with record pagination when necessary); only the values of the CPT coding scheme will be accepted as procedure codes for outpatient data submissions

 

18.        Attending clinician ID number/NPI

 

19.        Operating clinician ID number/NPI

 

20.        Other clinician ID number/NPI (up to 2 required when present)

 

21.        Patient race (according to OMB guidelines)

 

22.        Patient ethnicity (according to OMB guidelines)

 

23.        External cause of injury codes (required when present)

 

ICD-9 Ecodes: three required if available: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of ICD-9 codes)

 

ICD-10 Ecodes: eight required if available: discharges on and after October 1, 2013 (or first date of CMMS acceptance of ICD-10 codes)

 

24.        Patient county code (5 digits: state and county codes for Illinois and border state residents (FIPS code))

 

25.        Patient reason for visit (diagnosis codes up to three required when present)

 

26.        Accident state abbreviation (required when present)

 

27.        Condition employment related (required when present)

 

28.        Accident employment related occurrence code and date of accident (required when present)

 

29.        Crime victim occurrence code and date of crime (required when present)

 

30.        Page number and total number of pages of this claim

 

31.        Insurance group number (up to three required when present)

 

32.        Diagnoses code version qualifier

 

ICD-9 indicator required = 9: current discharges through discharges of September 30, 2013 (or last date of CMMS acceptance of ICD-9 codes)

 

ICD-10 indicator required = 0: discharges on and after October 1, 2013 (or first date of CMMS acceptance of ICD-10 codes)

 

33.        Statement covers period (from and through [discharge date] dates)

 

34.        Patient name (first, middle, last, suffix)

 

35.        Patient address (PO Box or street address, apartment number, city and state)

 

36.        Unique patient identifier based on the last four digits of patient Social Security number

 

37.        Primary insured's unique identifier (beneficiary/policy #)

 

38.        Any element or service adopted for use by the National Uniform Billing Committee pursuant to Section 4-2(d)(14) of the Act. Elements or services would be added as a submission requirement accompanied by sufficient notification to all submitting facilities and health care systems.  Notice would be provided no less than 90 days in advance of the submission requirement.

 

(Source:  Amended at 36 Ill. Reg. 8017, effective May 8, 2012)

Section 1010.APPENDIX D   Research Oriented Dataset (RODS) Data Elements

 

1.         Facility identifier (federal tax identification number/Department assigned/NPI)

 

2.         Patient sex

 

3.         Admission/visit type

 

4.         Admission/visit source

 

5.         Length of stay (in whole days; inpatient only)

 

6.         Patient discharge status

 

7.         Principal diagnosis code and up to 24 secondary codes

 

8.         Principal procedure code and up to 24 secondary codes

 

9.         DRG (or successor category grouping) code inpatient/APC outpatient

 

10.         MDC (or successor) code inpatient/body system outpatient

 

11.         Total charges

 

12.         Room/board charges (inpatient only)

 

13.         Ancillary charges

 

14.         Anesthesiology charges

 

15.         Pharmacy charges

 

16.         Radiology charges

 

17.         Clinical lab charges

 

18.         Labor/delivery charges (inpatient only)

 

19.         Operating room charges

 

20.         Oncology charges

 

21.         Other charges

 

22.         Combined bill indicator (inpatient only)

 

23.         Patient county

 

24.         Patient planning area

 

25.         Patient Health Service Area

 

26.         Hospital Health Service Area

 

27.         Patient date of birth (CCYYMMDD)

 

28.         Admission date (CCYYMMDD) and time (HH)

 

29.         Discharge Date (CCYYMMDD) and time (HH)

 

30.         Primary, secondary and tertiary payer IDs and health plan names (when available)

 

31.         Patient zip code in every record

 

32.         Primary surgical procedure date (if present)

 

33.         Patient race

 

34.         Patient ethnicity

 

35.         Newborn birth weight in grams

 

36.         Do Not Resuscitate (DNR) (inpatient only)

 

37.         Condition employment related

 

38.         Accident employment related

 

39.         Crime victim

 

40.         Admitting diagnosis code/reason for visit code

 

41.         Diagnosis present at admission for each diagnosis code (inpatient only)

 

42.         Ecodes (when present)

 

43.         Row ID (when necessary: provides linkage to Revenue Code Dataset)

Section 1010.APPENDIX E   Universal Dataset (UDS) Data Elements 

 

1.         Facility identifier (federal tax identification number/Department assigned/NPI)

 

2.         Patient sex

 

3.         Admission/visit type

 

4.         Admission/visit source

 

5.         Length of stay (in whole days) (inpatient only)

 

6.         Patient discharge status

 

7.         Principal diagnosis code and up to 14 secondary codes

 

8.         Principal procedure code and up to 9 secondary codes

 

9.         DRG (or successor category grouping) code inpatient/APC outpatient

 

10.         MDC (or successor) code inpatient/body system outpatient

 

11.         Total charges

 

12.         Room/board charges (inpatient only)

 

13.         Ancillary charges

 

14.         Anesthesiology charges

 

15.         Pharmacy charges

 

16.         Radiology charges

 

17.         Clinical lab charges

 

18.         Labor/delivery charges (inpatient only)

 

19.         Operating room charges

 

20.         Oncology charges

 

21.         Other charges

 

22.         Combined bill indicator (inpatient only)

 

23.         Primary health plan type

 

24.         Secondary health plan type

 

25.         Tertiary health plan type

 

26.         Patient county

 

27.         Patient planning area

 

28.         Patient Health Service Area

 

29.         Hospital Health Service Area

 

30.         Patient age (in whole years or days if less than one year)

 

31.         Admission date (CCYYMMD)

 

32.         Patient zip code (zip may be masked when hospital/zip cell size less than 10)

 

33.         Newborn birth weight in grams

 

34.         Do Not Resuscitate (DNR) (inpatient only)

 

35.         Hospitalization employment related

 

36.         Admitting diagnosis code

 

37.         Diagnosis present at admission for each diagnosis code (inpatient only)

 

38.         Ecodes (when present)

 

39.         Number of days between admission and primary procedure (inpatient only)

(if present)

 

40.         Row ID (when necessary: provides linkage to Revenue Code Dataset)

 

(Source:  Amended at 36 Ill. Reg. 8017, effective May 8, 2012)

Section 1010.APPENDIX F   State Inpatient Dataset (SIDS) Data Elements 

 

1.         Age in years at admission

 

2.         Age in days (when age < 1 year)

 

3.         Age in months (when age < 11 years)

 

4.         Admission month

 

5.         Admission source (uniform)

 

6.         Admission type

 

7.         Admission day is a weekend

 

8.         Room and board charges

 

9.         Ancillary charges

 

10.         Anesthesiology charges

 

11.         Pharmacy charges

 

12.         Radiology charges

 

13.         Clinical lab charges

 

14.         Labor-delivery charges

 

15.         Operating room charges

 

16.         Oncology charges

 

17.         Other charges

 

18.         Died during hospitalization

 

19.         Disposition of patient (uniform)

 

20.         Discharge quarter

 

21.         DRG (or successor category grouping) code in effect on discharge date

 

22.         Data source hospital identifier

 

23.         Principal diagnosis

 

24.         Up to 14 secondary diagnoses

 

25.         CCS: principal diagnosis

 

26.         CCS: up to 14 secondary diagnoses

 

27.         Indicator of sex

 

28.         Length of stay (as received from source)

 

29.         MDC (or successor) code in effect on discharge date

 

30.         Number of diagnoses on this record

 

31.         Number of procedures on this record

 

32.         Primary expected health plan identifier (uniform)

 

33.         Secondary expected health plan identifier (uniform)

 

34.         Principal procedure code (if present)

 

35.         Up to 9 secondary procedure codes (if present)

 

36.         CCS: principal procedure (if present)

 

37.         CCS: up to 9 secondary procedures (if present)

 

38.         Total charges (as received from source)

 

39.         Calendar year of discharge

 

40.         Patient zip code (uniform)

 

41.         Patient county code (uniform)

 

42.         Newborn birth weight in grams

 

43.         Do Not Resuscitate (DNR)

 

44.         Hospitalization employment related

 

45.         Admitting diagnosis code

 

46.         Diagnosis present at admission for each diagnosis code

 

47.         Ecodes (when present)

 

48.         Number of days between admission and primary procedure (if present)

 

49.         Row ID (when necessary: provides linkage to Revenue Code Dataset)

Section 1010.APPENDIX G   State Ambulatory Surgery Dataset (SASDS) Data Elements 

 

1.         Age in years at admission/visit

 

2.         Age in days (when age < 1 year)

 

3.         Age in months (when age < 11 years)

 

4.         Admission/visit month

 

5.         Admission/visit source (uniform)

 

6.         Admission/visit type

 

7.         Admission/visit day is a weekend

 

8.         Anesthesiology charges

 

9.         Pharmacy charges

 

10.         Radiology charges

 

11.         Clinical lab charges

 

12.         Operating room/surgical suite charges

 

13.         Oncology charges

 

14.         Other charges

 

15.         Disposition of patient (uniform)

 

16.         Discharge quarter

 

17.         Data source hospital identifier

 

18.         Principal diagnosis

 

19.         Up to 14 secondary diagnoses

 

20.         CCS: principal diagnosis

 

21.         CCS: up to 14 secondary diagnoses

 

22.         Indicator of sex

 

23.         APC code

 

24.         Body system affected by condition/injury

 

25.         Number of diagnoses on this record

 

26.         Number of procedures on this record

 

27.         Primary expected health plan identifier (uniform)

 

28.         Secondary expected health plan identifier (uniform)

 

29.         Principal procedure code (if present)

 

30.         Up to 9 secondary procedure codes (if present)

 

31.         CCS: principal procedure (if present)

 

32.         CCS: up to 9 secondary procedures (if present)

 

33.         Total charges (as received from source)

 

34.         Calendar year of discharge

 

35.         Patient zip code (uniform)

 

36.         Patient county code (uniform)

 

37.         Race

 

38.         Ethnicity

 

39.         Hospitalization employment related

 

40.         State of accident

 

41.         Reason for visit

 

42.         Ecodes (when present)

 

43.         Row ID (when necessary: provides linkage to Revenue Code Dataset)

Section 1010.APPENDIX H   Revenue Code Dataset (RCDS) Data Elements

1.                  Row ID (provides linkage to primary file)

2.                  Revenue Code

3.                  HCPCS Code (when available: outpatient only)

4.                  Date of Service (when available: outpatient only)

5.                  Units of Service

6.                  Charge

7.                  Revenue Type

8.                  Revenue Category

9.                  Submission Type (Inpatient or Outpatient)

Section 1010.APPENDIX I   Data Product Price List

 

Data Product Price List

 

 

¹Outpatient data may be released earlier if the Department determines that quantity and quality of data from all facilities has reached a satisfactory level of comparability.

Section 1010.APPENDIX J   Data Product Preparation Cost Table

 

Resource		Hours/Units		Cost Per Unit
Programming		1+		$100
Research		1+		$65
Administration		2		$25
Media (cd-rom/dvd-rom)		1+		$5
Shipping		1		Shipper listed cost

 

Section 1010.APPENDIX K    Diagnostic and Therapeutic Imaging Categories

 

1.         X-Ray

 

2.         CT Scan

 

3.         Mammography (diagnostic or screening)

 

4.         Sonography

 

5.         Ultrasonography

 

6.         PET Scans

 

7.         MRI (with and without contrast)

 

8.         Nuclear Medicine

 

(Source:  Added at 36 Ill. Reg. 8017, effective May 8, 2012)

 

Section 1010.APPENDIX L   Syndromic Surveillance Data

 

Data elements are to be submitted by messages in HL7 standard format. Data elements are R (Required), RE (Required but may be empty in messages where the information has not been recorded in the Electronic Medical Record (EMR)) or O (Optional data elements that should be sent if they are available in the EMR).

 

Detail Data

 

1.         Facility identifier (NPI or ODI) Must be unique for each Facility address)

 

2.         Visit Identifier

 

3.         Admission date and time (MMDDCCYYHHMMSS) Only one value (earliest) can be provided per visit.

 

4.         Patient Class

 

5.         Patient birth date (MMDDCCYY) and Age

 

6.         Patient sex

 

7.         Patient Race

 

8.         Patient Ethnicity

 

9.         Patient ZIP

 

10.       Discharge Disposition

 

11.       Discharge date and time (MMDDCCYYHHMMSS)

 

12.       Facility Name

 

13.       Facility Address

 

14.       Unique Patient Identifier (Medical Record Number)

 

15.       Chief Complaint. This must be in an OBX HL7 segment and sent with every message as soon as it is available in the EMR. It should be the free text of the patient’s self-reported reason for visit. If the complaint is captured as from a pick list, all complaints shall be sent. If both free-text and pick list chief complaints are captured in the EMR, both shall be sent to the Department.

 

16.       Diagnosis codes -Admitting, Working or Final. (ICD-10 codes only; as many as available)

 

17.       Triage Note

 

18.       Clinical Impression

 

19.       Discharge date and time (MMDDCCYYHHMMSS)

 

20.       Pregnancy Status

 

21.       Death Data and Time

 

22.       Smoking Status

 

23.       Procedure Codes

 

24.       Patient Country

 

25.       Date of Onset

 

26.       Insurance Type

 

27.       Initial Temperature

 

28.       Initial Pulse Oximetry

 

29.       Initial Blood Pressure

 

30.       International Travel History (Country and dates)

 

31.       Problem List

 

32.       Body Mass Index (or Weight and Height)

 

33.       Patient Assigned Location

 

34.       Hospital Unit

 

35.       Event Date and Time (MMDDCCYYHHMMSS)

 

36.       Message Date and Time (MMDDCCYYHHMMSS)

 

37.       Initial Acuity

 

38.       Patient name (first, middle, last, suffix)

 

39.       Patient address (PO Box or street address, apartment number, city, state, and zip code)

 

40.       Medications Prescribed

 

41.       Attending Physician (National Provider Index)

 

42.       Facility Visit Type

 

43.       Event data and time (MMDDCCYYHHMMSS) and

 

44.       Any element adopted for use by CDC’s PHIN or HL7 standards organization in Version 2.5.1 of the Syndromic Surveillance Messaging Guide on HL7.org (July 26, 2019). Elements supported by the Department will be added as a submission requirement accompanied by sufficient notification to all submitting facilities and health care systems.  Notice will be provided no less than 90 days in advance of the submission requirement.

 

(Source:  Added at 47 Ill. Reg. 4017, effective March 10, 2023)