102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB4645

 

Introduced 1/21/2022, by Rep. LaToya Greenwood

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Equity and Representation in Health Care Act. Contains the findings of the General Assembly. Creates the Equity and Representation in Health Care Workforce Repayment Program and the Equity and Representation in Health Care Workforce Scholarship Program to be administered by the Department of Public Health. Provides that a health care professional, medical facility, or behavioral health provider may apply to the Department for loan repayment assistance under the Program. Provides that, in order to be eligible for loan repayment under the Act, the health care professional or behavioral health provider shall comply with specified requirements. Requires the Department to submit an annual report with specified requirements to the General Assembly and the Governor. Contains provisions regarding the adoption of rules by the Department. Contains other provisions.


LRB102 24527 CPF 33761 b

 

 

A BILL FOR

 

HB4645LRB102 24527 CPF 33761 b

1    AN ACT concerning health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the Equity
5and Representation in Health Care Act.
 
6    Section 5. Findings; purpose.
7    (a) The General Assembly finds that:
8        (1) Every Illinois resident deserves access to high
9    quality, affordable health care regardless of his or her
10    race, ethnicity, zip code, gender identification, or
11    sexual orientation. Moreover, Illinois residents deserve
12    support from a strong, diverse health care workforce that
13    reflects, represents, and understands the patients they
14    serve.
15        (2) Establishing and building trusted relationships
16    between patients and health care providers can lead to
17    more compassionate care and improved outcomes. This is
18    particularly important for communities of color and
19    populations that experience systemic racism and other
20    barriers to obtaining equitable high quality care that
21    improves health.
22        (3) A 2004 report from Johns Hopkins University and
23    the Commonwealth Fund focused on the disparities in

 

 

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1    patient experience brought on by a lack of racial and
2    ethnic diversity among health care providers. From the
3    article:
4            "In what is called 'race-discordant'
5        relationships, patients from ethnic groups frequently
6        are treated by professionals from a different ethnic
7        background. The research reviewed here documents
8        ongoing racial and ethnic disparities in health care
9        and links patient–physician race and ethnic
10        concordance with higher patient satisfaction and
11        better health care processes. Based on this research,
12        the authors issue the following recommendation: ...
13        health policy should be revised to encourage workforce
14        diversity by funding programs that support the
15        recruitment of minority students and medical
16        faculty...".
17        (4) Another 2021 study by the National Center for
18    Biotechnology Information at the National Institutes of
19    Health analyzed minority representation across 10
20    different health care provider designations and found
21    significant underrepresentation among Black, Hispanic, and
22    Native American people across all 10 designations. This
23    study makes specific mention of the disproportionate
24    impact that the COVID-19 pandemic had on minority
25    communities and how greater diversity in our health care
26    workforce could lead to increased cultural competence and

 

 

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1    improved health outcomes.
2        (5) These are just 2 studies among the countless that
3    make clear the importance of diversity in our health care
4    workforce. Illinois is no exception. More must be done to
5    increase the diversity and community representation of our
6    State's health care workforce in order to better meet the
7    needs of underrepresented communities. This Act is
8    intended to support workforce development programs
9    specifically aimed at this mission.
10    (b) The purpose of this Act is to recognize and address the
11historic and systemic barriers that have prevented
12proportional representation by race, ethnicity, language,
13gender, sexual orientation, gender identity, and disability
14status in the health care provider community and address
15access to care and health disparities by prioritizing
16scholarship and loan repayment programs to individuals from
17underrepresented communities pursuing health care careers.
18    These scholarship and loan repayment programs shall
19encourage health care providers to locate and practice in
20areas of greatest need, as determined by provider shortage
21area data or health disparity data, and to support efforts for
22health care providers to better reflect the communities they
23serve.
 
24    Section 10. Definitions.
25    "Accredited school" means a college or university in which

 

 

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1a degree in allopathic medicine, osteopathic medicine,
2dentistry, or an equivalent credential for a health program is
3earned and for which the Council for Higher Education
4Accreditation or its affiliates has determined that the school
5meets specific standards for its programs, faculty, and
6curriculum.
7    "Advanced practice registered nurse" or "APRN" means an
8advanced practice registered nurse as defined under Section
950-10 of the Nurse Practice Act.
10    "Allopathic medicine" means the use of pharmacological
11agents or physical interventions to treat or suppress symptoms
12or processes of diseases or conditions.
13    "Applicant" means a health care professional or medical
14facility who applies for loan repayment assistance or
15scholarship funds under this Act.
16    "Approved graduate training" means training in medicine,
17dentistry, or any other health profession that leads to
18eligibility for board certification, provides evidence of
19completion, and is approved by the appropriate health care
20professional's body.
21    "Behavioral health provider" means a provider of a
22commonly recognized discipline in the behavioral health
23industry, including, but not limited to, licensed clinical
24social workers, behavioral health therapists, certified
25marriage and family counselors, licensed social workers, and
26addiction counselors.

 

 

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1    "Breach of service obligation" means failure for any
2reason to begin or complete a contractual service commitment.
3    "Commercial loan" means a loan made by a bank, credit
4union, savings and loan association, insurance company,
5school, or other financial institution.
6    "Community health center" means a migrant health center,
7community health center, health care program for the homeless
8or for residents of public housing supported under Section 330
9of the federal Public Health Service Act, or FQHC, including
10an FQHC Look-Alike, as designated by the U.S. Department of
11Health and Human Services, that operates at least one
12federally designated primary health care delivery site in
13Illinois.
14    "Default" means failure to meet a legal obligation or
15condition of a loan.
16    "Department" means the Department of Public Health.
17    "Dental assistant" means a person who serves as a member
18of a dental care team, working directly with a dentist to
19perform duties that include, but are not limited to, assisting
20with dental procedures, preparing patients for procedures,
21preparing examinations, and sterilizing equipment.
22    "Dentist" means a person licensed to practice dentistry
23under the Illinois Dental Practice Act.
24    "Director" means the Director of Public Health.
25    "Equity and Representation in Health Care Workforce
26Repayment Program" or "Repayment Program" means the Equity and

 

 

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1Representation in Health Care Workforce Repayment Program
2created under subsection (a) of Section 15.
3    "Equity and Representation in Health Care Workforce
4Scholarship Program" or "Scholarship Program" means the Equity
5and Representation in Health Care Workforce Scholarship
6Program created under subsection (b) of Section 15.
7    "Federally Qualified Health Center" or "FQHC" means a
8health center funded under Section 330 of the federal Public
9Health Service Act.
10    "Federally Qualified Health Center Look-Alike" or "FQHC
11Look-Alike" means a health center that meets the requirements
12for receiving a grant under Section 330 of the federal Public
13Health Service Act but does not receive funding under that
14authority.
15    "Government loan" means a loan made by a federal, State,
16county, or city agency authorized to make the loan.
17    "Health care professional" means a physician, physician
18assistant, advanced practice registered nurse, behavioral
19health provider, psychiatrist, psychologist, pharmacist,
20dentist, or dental hygienist.
21    "Health professional shortage area" or "HPSA" means a
22designation from the U.S. Department of Health and Human
23Services that indicates the shortage of primary medical care
24or dental or mental health providers. The designation may be
25geographic, such as a county or service area; demographic,
26such as low-income population; or institutional, such as a

 

 

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1comprehensive health center, FQHC, or other public facility.
2    "Lender" means the commercial or government entity that
3makes a qualifying loan.
4    "Loan repayment award" or "award" means the amount of
5funding awarded to a recipient based upon his or her
6reasonable educational expenses, up to a maximum established
7by the program.
8    "Loan repayment agreement" or "agreement" means the
9written instrument defining a legal relationship entered into
10between the Department and a recipient.
11    "Medical assistant" means a person who serves as a member
12of a medical care team working directly with other providers
13to perform duties that include, but are not limited to,
14gathering patient information, taking vital signs, preparing
15patients for examinations, and assisting physicians during
16examinations.
17    "Medical facility" means a facility in which the delivery
18of health services is provided. A medical facility must be a
19nonprofit or public facility located in Illinois and includes
20the following:
21        (1) A Federally Qualified Health Center.
22        (2) An FQHC Look-Alike.
23        (3) A hospital system operated by a county with more
24    than 3,000,000 residents.
25    "Medically underserved area" or "MUA" means an area
26designated by the U.S. Department of Health and Human

 

 

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1Services' Health Resources and Services Administration as
2having too few primary care providers, high infant mortality,
3high poverty, or a high elderly population.
4    "Osteopathic medicine" means medical practice based upon
5the theory that diseases are due to loss of structural
6integrity, which can be restored by manipulation of the parts
7and supplemented by therapeutic measures.
8    "Physician" means a person licensed to practice medicine
9in all of its branches under the Medical Practice Act of 1987.
10    "Physician assistant" means an individual licensed under
11the Physician Assistant Practice Act of 1987.
12    "Primary care" means health care that encompasses
13prevention services, basic diagnostic and treatment services,
14and support services, including laboratory, radiology,
15transportation, and pharmacy services.
16    "Psychiatrist" means a physician licensed to practice
17medicine in Illinois under the Medical Practice Act of 1987
18who has successfully completed an accredited residency program
19in psychiatry.
20    "Qualifying loan" means a government loan or commercial
21loan used for tuition and reasonable educational and living
22expenses related to undergraduate or graduate education that
23was obtained by the recipient prior to his or her application
24for loan repayment and that is contemporaneous with the
25education received.
26    "Reasonable educational expenses" means costs for

 

 

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1education, exclusive of tuition. These costs include, but are
2not limited to, fees, books, supplies, clinical travel,
3educational equipment, materials, board certification, or
4licensing examinations. "Reasonable educational expenses" do
5not exceed the estimated standard budget for expenses for the
6degree program and for the years of enrollment.
7    "Reasonable living expenses" means room and board,
8transportation, and commuting costs associated with the
9applicant's attendance and participation in educational and
10workforce training program. "Reasonable living expenses" do
11not exceed the estimated standard budget for the recipient's
12degree program and for the years of enrollment.
13    "Recognized training entity" means an entity approved by
14the Department to provide training and education for medical
15assistants and dental assistants.
16    "Recipient" means a health care professional or medical
17facility that may use loan repayment funds.
18    "Rural" has the same meaning that is used by the federal
19Health Resources and Services Administration to determine
20eligibility for Rural Health Grants.
21    "State" means the State of Illinois.
 
22    Section 15. Repayment Program; Scholarship Program;
23eligibility requirements.
24    (a) The Department shall create and administer an Equity
25and Representation in Health Care Workforce Repayment Program.

 

 

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1A health care professional may apply to the Department for
2loan repayment assistance under the Repayment Program. In
3order to be eligible for loan repayment under this Act, the
4health care professional or behavioral health provider shall
5comply with the following:
6        (1) Either:
7            (A) be working at a medical facility; or
8            (B) have accepted an offer of employment at a
9        medical facility and will begin employment at that
10        medical facility within 90 calendar days after the
11        submission of the application.
12        (2) Either:
13            (A) have a degree in allopathic or osteopathic
14        medicine, nursing, dentistry, or other eligible health
15        profession from an accredited school; have completed
16        an approved graduate training program; and have a
17        current, valid, and unencumbered license to practice
18        the health profession in Illinois; or
19            (B) have a degree in a relevant field of study,
20        such as behavioral health or social work.
21        (3) As necessary to his or her field of work, agree to
22    see and treat all patients at the medical facility
23    regardless of the patient's ability to pay for services.
24        (4) Submit an application to participate in the
25    Program.
26        (5) Not be in breach of a health professional service

 

 

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1    obligation to the federal, State, or a local government.
2        (6) Not have any judgment liens arising from federal
3    debt.
4        (7) Not be excluded, suspended, or disqualified by a
5    federal agency.
6        (8) Sign a written agreement attesting to accepting
7    repayment of health professional educational loans and to
8    serve for the applicable period of obligated service in an
9    HPSA or MUA located in Illinois.
10    (b) The Department shall create and administer an Equity
11and Representation in Health Care Workforce Scholarship
12Program. A medical facility or an individual may apply to the
13Department to receive funds under the Scholarship Program. A
14medical facility may apply for a scholarship that covers
15expenses described under subsection (e) of Section 20. If an
16individual is the applicant, the individual shall either:
17        (1) be working at a medical facility; or
18        (2) have accepted an offer of employment at a medical
19    facility and will begin employment at that medical
20    facility within 90 calendar days after the submission of
21    the application.
22    (c) A person who earns a degree from an unaccredited
23school may not participate in the Repayment Program.
 
24    Section 20. Use of Repayment Program and Scholarship
25Program funds.

 

 

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1    (a) Loan repayment funds under the Repayment Program shall
2be used according to the following:
3        (1) To repay qualifying educational loans of health
4    care professionals who agree to serve in a medical
5    facility for a specified period of time to be determined
6    by the Department.
7        (2) For educational loans that were obtained prior to
8    the date the recipient submits an application for loan
9    repayment assistance.
10        (3) To retire qualifying educational loans if the
11    loans are the result of consolidated or refinanced debt.
12    To qualify, the consolidated or refinanced loans shall:
13            (A) be a government loan or a loan from a
14        commercial lender; and
15            (B) include only qualifying educational loans of
16        the health care professional.
17    (b) Loan repayment funds under the Repayment Program shall
18not be used for any of the following:
19        (1) To repay a practice obligation resulting from
20    educational loans or scholarships, whether from
21    Illinois-based institutions or governments or those in
22    other states.
23        (2) To fulfill practice obligations to the federal
24    government, the State, or any other entity under an
25    agreement with the federal government, State, or other
26    entity.

 

 

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1        (3) To retire qualifying educational loans if the
2    consolidated or refinanced debt is:
3            (A) commingled with nonqualifying debt; or
4            (B) consolidated with a loan owed by another
5        person, such as a spouse or child.
6    (c) Loan repayment funds under the Repayment Program may
7not be used by the recipient to reimburse himself or herself
8for a loan that has been repaid.
9    (d) Under the provisions of the federal Treasury Offset
10Program and the State Comptroller Act, recipients shall have
11their loan repayment assistance funds offset to fulfill a
12delinquent federal or State debt. The offset of loan repayment
13assistance funds shall not reduce, waive, or suspend a
14recipient's service obligation under this Act.
15    (e) Scholarship Program funds shall be used to cover the
16costs of training as a medical assistant or dental assistant,
17or another health care profession training or education
18program, as deemed appropriate by the Department. Costs shall
19include the following:
20        (1) The cost of enrollment in a training program
21    offered by an institute of higher learning, accredited
22    online program, Illinois-based community college, or
23    recognized training entity.
24        (2) Lab fees.
25        (3) Materials and test vouchers.
26        (4) Background checks.

 

 

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1        (5) Drug screenings.
2        (6) Professional equipment and attire, such as scrubs.
3    (f) Applications for loan repayments and scholarships
4shall be available twice a year, with at least 5 months between
5the closing date of the last process and application deadline
6for the next process.
7    (g) An individual who meets the eligibility requirements
8set forth in this Act may apply for loan repayment or
9scholarship funds authorized by this Act. In order to promote
10greater diversity and community representation in health care,
11the Department shall set forward criteria that prioritizes
12applicants, including, but not limited to, the following:
13        (1) Those who identify as a person from a race,
14    ethnicity, gender, sexual orientation, gender identity, or
15    disability status that is underrepresented in the health
16    care sector.
17        (2) First generation postsecondary students.
18        (3) Reservists in the U.S. Armed Forces or military
19    veterans.
20        (4) Persons working in rural medical facilities.
 
21    Section 25. Department powers. The Department may exercise
22the following powers:
23        (1) To make loan repayment and scholarship awards
24    under the Repayment Program or Scholarship Program with
25    the following priorities:

 

 

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1            (A) To increase the number of health care
2        providers in MUAs.
3            (B) To increase the number of behavioral health
4        providers in MUAs.
5            (C) To increase the number of accredited, eligible
6        health care provider residencies within the State.
7            (D) To increase the percentage of eligible health
8        care providers establishing practice within the State
9        upon completion of residency.
10            (E) To promote greater diversity and community
11        representation in Illinois' health care workforce.
12        (2) To adopt rules necessary for the establishment and
13    maintenance of the Repayment Program and Scholarship
14    Program required under this Act.
 
15    Section 30. Administrative procedure. The Illinois
16Administrative Procedure Act is hereby expressly adopted and
17incorporated herein as if all of the provisions of the Act were
18included in this Act.
 
19    Section 35. Annual report.
20    (a) The Department shall annually report the results and
21progress of the Repayment Program and Scholarship Program on
22or before March 15 of each year to the General Assembly and the
23Governor.
24    (b) The annual report to the General Assembly and the

 

 

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1Governor shall include the impact of the Repayment Program and
2Scholarship Program on the ability of MUAs to attract and
3retain eligible health care providers, as well as increase
4diversity and community representation in Illinois' health
5care workforce. The report shall include recommendations to
6improve that ability.
7    (c) The requirement for reporting to the General Assembly
8shall be satisfied by filing copies of the report as required
9by Section 3.1 of the General Assembly Organization Act, and
10filing such additional copies with the State Government Report
11Distribution Center for the General Assembly as required under
12paragraph (t) of Section 7 of the State Library Act.
 
13    Section 40. Failure to fulfill obligations.
14    (a) Loan repayment recipients under the Repayment Program
15who fail to maintain employment at a medical facility as
16defined in this Act for the amount of time determined by the
17Department shall pay to the Department a sum equal to the
18amount of the annual scholarship grant for each year the
19recipient fails to fulfill such obligation. A scholarship
20recipient who fails to fulfill the employment obligation set
21forth in this Section shall have 30 days from the date on which
22that failure begins in which to enter into a contract with the
23Department that sets forth the manner in which that sum is
24required to be paid. If the contract is not entered into within
25that 30-day period or if the contract is entered into but the

 

 

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1required payments are not made in the amounts and at the times
2provided in the contract, the scholarship recipient also shall
3be required to pay to the Department interest at the rate of 9%
4per annum on the amount of that sum remaining due and unpaid.
5The amounts paid to the Department under this Section shall be
6deposited into the Community Health Center Care Fund and shall
7be used by the Department to improve access to primary health
8care services as authorized by subsection (a) of Section
92310-200 of the Department of Public Health Powers and Duties
10Law of the Civil Administrative Code of Illinois.
11    (b) Scholarship recipients under the Scholarship Program
12who fail to maintain employment at a medical facility for the
13amount of time determined by the Department shall pay to the
14Department a sum equal to the amount of the annual scholarship
15grant for each year the recipient fails to fulfill the
16employment obligation. A scholarship recipient who fails to
17fulfill the employment obligation shall have 30 days from the
18date on which that failure begins in which to enter into a
19contract with the Department that sets forth the manner in
20which that sum is required to be paid. If the contract is not
21entered into within that 30-day period, or if the contract is
22entered into but the required payments are not made in the
23amounts and at the times provided in the contract, the
24scholarship recipient shall also be required to pay to the
25Department interest at the rate of 9% per annum on the amount
26of that sum remaining due and unpaid. The amounts paid to the

 

 

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1Department under this Section shall be deposited into the
2Community Health Center Care Fund and shall be used by the
3Department to improve access to primary health care services
4as authorized by subsection (a) of Section 2310-200 of the
5Department of Public Health Powers and Duties Law of the Civil
6Administrative Code of Illinois.
 
7    Section 45. Transfer of moneys; use of funds.
8    (a) The Department may transfer to the Illinois Finance
9Authority, into an account outside the State treasury, moneys
10in the Community Health Center Care Fund as needed, but not to
11exceed an amount established, by rule, by the Department to
12establish a reserve or credit enhancement escrow account to
13support a financing program or a loan or equipment leasing
14program to provide moneys to support the purposes of
15subsection (a) of Section 2310-200 of the Department of Public
16Health Powers and Duties Law of the Civil Administrative Code
17of Illinois. The disposition of moneys at the conclusion of
18any financing program under this Section shall be determined
19by an interagency agreement.
20    (b) The Department may use a reasonable portion of funds
21appropriated for this Act to increase Department resources as
22is necessary in order to effectively administer the Repayment
23Program and Scholarship Program.