H.F. 2224 Section 1. NEW SECTION . 135.167 Health care cost and 1 quality transparency —— development of information portal. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Health care provider” means a person who is licensed, 5 certified, or otherwise authorized or permitted by the laws of 6 this state to administer health care in the ordinary course of 7 business or in the practice of a profession. 8 b. “Hospital” means a hospital as defined in section 135B.1. 9 c. “Performance measure” means a quantitative tool that 10 provides an indication of an organization’s performance in 11 relation to a specified health care process or outcome. 12 d. “Performance outcomes” means information about the 13 results of health care based on performance measures. 14 e. “Quality of care” means the result or outcome of health 15 care efforts. 16 f. “Reporting program” means an objective health care 17 feedback mechanism regarding individual or facility performance 18 that can be used internally to support performance improvement 19 activities and externally to demonstrate accountability to the 20 public and other purchasers, payers, and stakeholders. 21 2. a. The department shall develop a public access health 22 care cost and quality information portal. The information 23 portal shall provide information reported by hospitals and 24 health care providers on quality of care and the costs of 25 receiving care. The information portal shall be phased in 26 over a multiyear period, beginning with information collected 27 from hospitals and subsequently including other health care 28 providers. The department shall work with existing hospital 29 and health care provider data collection entities in developing 30 and implementing the information portal. 31 b. The department shall develop an internet site, in 32 cooperation with the electronic health information advisory 33 council and its executive committee created in section 135.156, 34 to support the public access health care cost and quality 35 -1- LSB 5243YH (5) 83 pf/rj 1/ 4

H.F. 2224 information portal in a manner that allows consumers to perform 1 a comparative analysis of the cost and quality of health care 2 provided in the state. In making the health care information 3 available on the internet site, the department shall: 4 (1) Organize the an internet site in a manner that 5 facilitates ease of use by consumers. 6 (2) Exclude from the internet site any information that 7 compromises patient privacy. 8 (3) Include links to internet sites of hospitals and other 9 health care providers to enable consumers to obtain additional 10 information about hospitals and health care providers, 11 including programs designed to enhance quality and safety, and 12 reduce costs. 13 (4) Allow the linkage of other internet sites, at the 14 discretion of the department, to the internet site for the 15 purposes of maximizing information sharing. 16 (5) To the extent possible, include state and federal 17 benchmarks for performance measures. 18 (6) Clearly identify the sources of data used in the 19 internet site and explain the methodology used to develop the 20 performance measures. 21 3. The department shall determine which medical conditions 22 and procedures, performance measures and performance outcomes, 23 and cost and charge data to include on the internet site. 24 a. In determining which medical conditions and procedures to 25 include, the department shall consider such factors as volume, 26 severity of the illness, urgency of admission, individual and 27 societal costs, whether the condition is acute or chronic, 28 variation in costs, variation in outcomes, and magnitude of 29 variations and other relevant information. 30 b. (1) In determining which performance measures and 31 performance outcomes to include, the department shall consider 32 such factors as volume of cases, average patient charges, 33 average length of stay, complication rates, mortality rates, 34 and infection rates, among others, which shall be risk-adjusted 35 -2- LSB 5243YH (5) 83 pf/rj 2/ 4

H.F. 2224 and severity-adjusted, if applicable. 1 (2) Performance outcome indicators shall be risk-adjusted 2 or severity-adjusted, as applicable, using nationally 3 recognized risk adjustment methodologies, consistent with 4 national standards, as selected by the department. 5 (3) The performance measures shall be based on medical 6 evidence and shall be developed through a process in which 7 hospitals and health care providers participate. 8 (4) The department may also consider such additional 9 measures adopted by the federal centers for Medicare and 10 Medicaid services, the national quality forum, the joint 11 commission on accreditation of healthcare organizations, the 12 federal agency for healthcare research and quality, or a 13 similar national entity that establishes standards to measure 14 the performance of hospitals and health care providers, or such 15 additional measures adopted by other states. 16 c. In determining which cost and charge data to include, 17 the department shall consider such measures as average charge, 18 average net revenue per adjusted patient day, average cost 19 per adjusted patient day, and average cost per admission. 20 The department shall also utilize its authority and the 21 data collected pursuant to sections 135.74 through 135.79 in 22 providing cost and charge data. 23 d. The department shall have the right to review any and 24 all documentation upon which submitted data are based, upon 25 reasonable notice and in accordance with department rules. 26 4. a. The department shall develop a reporting program and 27 uniform reporting form for distribution to hospitals and health 28 care providers to report the medical conditions and procedures, 29 performance measures and performance outcomes, and cost and 30 charge data selected for inclusion on the internet site. 31 b. The department shall require each hospital to make 32 available an electronic copy of the hospital’s charge 33 description master for the department to post on its internet 34 site. For the purposes of this paragraph, “charge description 35 -3- LSB 5243YH (5) 83 pf/rj 3/ 4

H.F. 2224 master” means a uniform schedule of charges represented by the 1 hospital as its gross billed charge for a given service or 2 item, regardless of payer type. 3 EXPLANATION 4 This bill relates to health care transparency. The bill 5 directs the department of public health (DPH) to develop 6 a public access health care cost and quality information 7 portal to provide information reported by hospitals and 8 health care providers on quality of care and the costs of 9 receiving care. The portal is to be phased in over a multiyear 10 period, beginning with information collected from hospitals 11 and subsequently including other health care providers. The 12 department is required to work with existing hospital and 13 health care provider data collection entities in developing and 14 implementing the information portal. 15 The bill directs DPH to develop an internet site, in 16 cooperation with the electronic health information advisory 17 council and executive committee, to support the public access 18 health care cost and quality information portal in a manner 19 that allows consumers to perform a comparative analysis of 20 the cost and quality of health care provided in the state. 21 The internet site is required to include medical conditions 22 and procedures, performance measures and outcomes, and cost 23 and charge data, and the bill specifies the considerations 24 DPH is to review in determining the medical conditions and 25 procedures, performance measures and outcomes, and cost and 26 charge data to include. The bill also directs DPH to develop a 27 reporting program and uniform reporting form for distribution 28 to hospitals and health care providers to report the medical 29 conditions and procedures, performance measures and outcomes, 30 and cost and charge data selected for inclusion on the internet 31 site. Additionally, DPH is to require each hospital to 32 make available an electronic copy of the hospital’s charge 33 description master for the department to post on its internet 34 site. 35 -4- LSB 5243YH (5) 83 pf/rj 4/ 4