103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB2886

 

Introduced 2/16/2023, by Rep. Justin Slaughter

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 89/5
210 ILCS 89/10
210 ILCS 89/15
305 ILCS 5/1-7  from Ch. 23, par. 1-7

    Amends the Hospital Uninsured Patient Discount Act. Provides that a hospital subject to the Act shall disregard household income received through participation in a guaranteed income program reported by an uninsured patient who applies for financial assistance. Defines "guaranteed income program" to mean a publicly or privately funded program that provides one-time or recurring unconditional cash transfers or payments, or gifts to individuals or households, for a defined number of months or years for the purposes of reducing poverty, promoting economic mobility, or increasing the financial stability of Illinois residents. Amends the Illinois Public Aid Code. Provides that for purposes of determining eligibility and the amount of assistance under the Code, the Department of Human Services and local governmental units shall exclude from consideration any financial assistance, including cash transfers or gifts, that is provided to a person through a guaranteed income program (rather than the Department of Human Services and local governmental units shall exclude from consideration, for a period of no more than 60 months, any financial assistance, including wages, cash transfers, or gifts, that is provided to a person who is enrolled in a program or research project that is not funded with general revenue funds and that is intended to investigate the impacts of policies or programs designed to reduce poverty, promote social mobility, or increase financial stability for Illinois residents if there is an explicit plan to collect data and evaluate the program or initiative that is developed prior to participants in the study being enrolled in the program and if a research team has been identified to oversee the evaluation). Effective immediately.


LRB103 27578 KTG 53954 b

 

 

A BILL FOR

 

HB2886LRB103 27578 KTG 53954 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Hospital Uninsured Patient Discount Act is
5amended by changing Sections 5, 10, and 15 as follows:
 
6    (210 ILCS 89/5)
7    Sec. 5. Definitions. As used in this Act:
8    "Community health center" means a federally qualified
9health center as defined in Section 1905(l)(2)(B) of the
10federal Social Security Act or a federally qualified health
11center look-alike.
12    "Cost to charge ratio" means the ratio of a hospital's
13costs to its charges taken from its most recently filed
14Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
15Inpatient Ratios).
16    "Critical Access Hospital" means a hospital that is
17designated as such under the federal Medicare Rural Hospital
18Flexibility Program.
19    "Family income" means the sum of a family's annual
20earnings and cash benefits from all sources before taxes, less
21payments made for child support.
22    "Federal poverty income guidelines" means the poverty
23guidelines updated periodically in the Federal Register by the

 

 

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1United States Department of Health and Human Services under
2authority of 42 U.S.C. 9902(2).
3    "Financial assistance" means a discount provided to a
4patient under the terms and conditions a hospital offers to
5qualified patients or as required by law.
6    "Free and charitable clinic" means a 501(c)(3) tax-exempt
7health care organization providing health services to
8low-income uninsured or underinsured individuals that is
9recognized by either the Illinois Association of Free and
10Charitable Clinics or the National Association of Free and
11Charitable Clinics.
12    "Guaranteed income program" means a publicly or privately
13funded program that provides one-time or recurring
14unconditional cash transfers or payments, or gifts to
15individuals or households, for a defined number of months or
16years for the purposes of reducing poverty, promoting economic
17mobility, or increasing the financial stability of Illinois
18residents.
19    "Health care services" means any medically necessary
20inpatient or outpatient hospital service, including
21pharmaceuticals or supplies provided by a hospital to a
22patient.
23    "Hospital" means any facility or institution required to
24be licensed pursuant to the Hospital Licensing Act or operated
25under the University of Illinois Hospital Act.
26    "Illinois resident" means any person who lives in Illinois

 

 

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1and who intends to remain living in Illinois indefinitely.
2Relocation to Illinois for the sole purpose of receiving
3health care benefits does not satisfy the residency
4requirement under this Act.
5    "Medically necessary" means any inpatient or outpatient
6hospital service, including pharmaceuticals or supplies
7provided by a hospital to a patient, covered under Title XVIII
8of the federal Social Security Act for beneficiaries with the
9same clinical presentation as the uninsured patient. A
10"medically necessary" service does not include any of the
11following:
12        (1) Non-medical services such as social and vocational
13    services.
14        (2) Elective cosmetic surgery, but not plastic surgery
15    designed to correct disfigurement caused by injury,
16    illness, or congenital defect or deformity.
17    "Rural hospital" means a hospital that is located outside
18a metropolitan statistical area.
19    "Uninsured discount" means a hospital's charges multiplied
20by the uninsured discount factor.
21    "Uninsured discount factor" means 1.0 less the product of
22a hospital's cost to charge ratio multiplied by 1.35.
23    "Uninsured patient" means an Illinois resident who is a
24patient of a hospital and is not covered under a policy of
25health insurance and is not a beneficiary under a public or
26private health insurance, health benefit, or other health

 

 

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1coverage program, including high deductible health insurance
2plans, workers' compensation, accident liability insurance, or
3other third party liability.
4(Source: P.A. 102-581, eff. 1-1-22.)
 
5    (210 ILCS 89/10)
6    Sec. 10. Uninsured patient discounts.
7    (a) Eligibility.
8        (1) A hospital, other than a rural hospital or
9    Critical Access Hospital, shall provide a discount from
10    its charges to any uninsured patient who applies for a
11    discount and has family income of not more than 600% of the
12    federal poverty income guidelines for all medically
13    necessary health care services exceeding $150 in any one
14    inpatient admission or outpatient encounter.
15        (2) A hospital, other than a rural hospital or
16    Critical Access Hospital, shall provide a charitable
17    discount of 100% of its charges for all medically
18    necessary health care services exceeding $150 in any one
19    inpatient admission or outpatient encounter to any
20    uninsured patient who applies for a discount and has
21    family income of not more than 200% of the federal poverty
22    income guidelines.
23        (3) A rural hospital or Critical Access Hospital shall
24    provide a discount from its charges to any uninsured
25    patient who applies for a discount and has annual family

 

 

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1    income of not more than 300% of the federal poverty income
2    guidelines for all medically necessary health care
3    services exceeding $300 in any one inpatient admission or
4    outpatient encounter.
5        (4) A rural hospital or Critical Access Hospital shall
6    provide a charitable discount of 100% of its charges for
7    all medically necessary health care services exceeding
8    $300 in any one inpatient admission or outpatient
9    encounter to any uninsured patient who applies for a
10    discount and has family income of not more than 125% of the
11    federal poverty income guidelines.
12        (5) A hospital subject to this Act shall disregard
13    household income received through participation in a
14    guaranteed income program reported by an uninsured patient
15    who applies for financial assistance.
16    (b) Discount. For all health care services exceeding $300
17in any one inpatient admission or outpatient encounter, a
18hospital shall not collect from an uninsured patient, deemed
19eligible under subsection (a), more than its charges less the
20amount of the uninsured discount.
21    (c) Maximum Collectible Amount.
22        (1) The maximum amount that may be collected in a
23    12-month period for health care services provided by the
24    hospital from a patient determined by that hospital to be
25    eligible under subsection (a) is 20% of the patient's
26    family income, and is subject to the patient's continued

 

 

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1    eligibility under this Act.
2        (2) The 12-month period to which the maximum amount
3    applies shall begin on the first date, after the effective
4    date of this Act, an uninsured patient receives health
5    care services that are determined to be eligible for the
6    uninsured discount at that hospital.
7        (3) To be eligible to have this maximum amount applied
8    to subsequent charges, the uninsured patient shall inform
9    the hospital in subsequent inpatient admissions or
10    outpatient encounters that the patient has previously
11    received health care services from that hospital and was
12    determined to be entitled to the uninsured discount. The
13    availability of the maximum collectible amount shall be
14    included in the hospital's financial assistance
15    information provided to uninsured patients.
16        (4) Hospitals may adopt policies to exclude an
17    uninsured patient from the application of subdivision
18    (c)(1) when the patient owns assets having a value in
19    excess of 600% of the federal poverty level for hospitals
20    in a metropolitan statistical area or owns assets having a
21    value in excess of 300% of the federal poverty level for
22    Critical Access Hospitals or hospitals outside a
23    metropolitan statistical area, not counting the following
24    assets: the uninsured patient's primary residence;
25    personal property exempt from judgment under Section
26    12-1001 of the Code of Civil Procedure; or any amounts

 

 

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1    held in a pension or retirement plan, provided, however,
2    that distributions and payments from pension or retirement
3    plans may be included as income for the purposes of this
4    Act.
5    (d) Each hospital bill, invoice, or other summary of
6charges to an uninsured patient shall include with it, or on
7it, a prominent statement that an uninsured patient who meets
8certain income requirements may qualify for an uninsured
9discount and information regarding how an uninsured patient
10may apply for consideration under the hospital's financial
11assistance policy. The hospital's financial assistance
12application shall include language that directs the uninsured
13patient to contact the hospital's financial counseling
14department with questions or concerns, along with contact
15information for the financial counseling department, and shall
16state: "Complaints or concerns with the uninsured patient
17discount application process or hospital financial assistance
18process may be reported to the Health Care Bureau of the
19Illinois Attorney General.". A website, phone number, or both
20provided by the Attorney General shall be included with this
21statement.
22(Source: P.A. 102-581, eff. 1-1-22.)
 
23    (210 ILCS 89/15)
24    Sec. 15. Patient responsibility.
25    (a) Hospitals may make the availability of a discount and

 

 

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1the maximum collectible amount under this Act contingent upon
2the uninsured patient first applying for coverage under public
3health insurance programs, such as Medicare, Medicaid,
4AllKids, the State Children's Health Insurance Program, or any
5other program, if there is a reasonable basis to believe that
6the uninsured patient may be eligible for such program.
7    (b) Hospitals shall permit an uninsured patient to apply
8for a discount within 90 days of the date of discharge or date
9of service.
10    Hospitals shall offer uninsured patients who receive
11community-based primary care provided by a community health
12center or a free and charitable clinic, are referred by such an
13entity to the hospital, and seek access to nonemergency
14hospital-based health care services with an opportunity to be
15screened for and assistance with applying for public health
16insurance programs if there is a reasonable basis to believe
17that the uninsured patient may be eligible for a public health
18insurance program. An uninsured patient who receives
19community-based primary care provided by a community health
20center or free and charitable clinic and is referred by such an
21entity to the hospital for whom there is not a reasonable basis
22to believe that the uninsured patient may be eligible for a
23public health insurance program shall be given the opportunity
24to apply for hospital financial assistance when hospital
25services are scheduled.
26        (1) Income verification. Hospitals may require an

 

 

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1    uninsured patient who is requesting an uninsured discount
2    to provide documentation of family income. Household
3    income received through participation in a guaranteed
4    income program shall not be considered income for the
5    purposes of reviewing eligibility for financial
6    assistance. Acceptable family income documentation shall
7    include any one of the following:
8            (A) a copy of the most recent tax return;
9            (B) a copy of the most recent W-2 form and 1099
10        forms;
11            (C) copies of the 2 most recent pay stubs;
12            (D) written income verification from an employer
13        if paid in cash; or
14            (E) one other reasonable form of third party
15        income verification deemed acceptable to the hospital.
16        (2) Asset verification. Hospitals may require an
17    uninsured patient who is requesting an uninsured discount
18    to certify the existence or absence of assets owned by the
19    patient and to provide documentation of the value of such
20    assets, except for those assets referenced in paragraph
21    (4) of subsection (c) of Section 10. Acceptable
22    documentation may include statements from financial
23    institutions or some other third party verification of an
24    asset's value. If no third party verification exists, then
25    the patient shall certify as to the estimated value of the
26    asset.

 

 

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1        (3) Illinois resident verification. Hospitals may
2    require an uninsured patient who is requesting an
3    uninsured discount to verify Illinois residency.
4    Acceptable verification of Illinois residency shall
5    include any one of the following:
6            (A) any of the documents listed in paragraph (1);
7            (B) a valid state-issued identification card;
8            (C) a recent residential utility bill;
9            (D) a lease agreement;
10            (E) a vehicle registration card;
11            (F) a voter registration card;
12            (G) mail addressed to the uninsured patient at an
13        Illinois address from a government or other credible
14        source;
15            (H) a statement from a family member of the
16        uninsured patient who resides at the same address and
17        presents verification of residency;
18            (I) a letter from a homeless shelter, transitional
19        house or other similar facility verifying that the
20        uninsured patient resides at the facility; or
21            (J) a temporary visitor's drivers license.
22    (c) Hospital obligations toward an individual uninsured
23patient under this Act shall cease if that patient
24unreasonably fails or refuses to provide the hospital with
25information or documentation requested under subsection (b) or
26to apply for coverage under public programs when requested

 

 

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1under subsection (a) within 30 days of the hospital's request.
2    (d) In order for a hospital to determine the 12 month
3maximum amount that can be collected from a patient deemed
4eligible under Section 10, an uninsured patient shall inform
5the hospital in subsequent inpatient admissions or outpatient
6encounters that the patient has previously received health
7care services from that hospital and was determined to be
8entitled to the uninsured discount.
9    (e) Hospitals may require patients to certify that all of
10the information provided in the application is true. The
11application may state that if any of the information is
12untrue, any discount granted to the patient is forfeited and
13the patient is responsible for payment of the hospital's full
14charges.
15    (f) Hospitals shall ask for an applicant's race,
16ethnicity, sex, and preferred language on the financial
17assistance application. However, the questions shall be
18clearly marked as optional responses for the patient and shall
19note that responses or nonresponses by the patient will not
20have any impact on the outcome of the application.
21(Source: P.A. 102-581, eff. 1-1-22.)
 
22    Section 10. The Illinois Public Aid Code is amended by
23changing Section 1-7 as follows:
 
24    (305 ILCS 5/1-7)  (from Ch. 23, par. 1-7)

 

 

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1    Sec. 1-7. (a) For purposes of determining eligibility for
2assistance under this Code, the Illinois Department, County
3Departments, and local governmental units shall exclude from
4consideration restitution payments, including all income and
5resources derived therefrom, made to persons of Japanese or
6Aleutian ancestry pursuant to the federal Civil Liberties Act
7of 1988 and the Aleutian and Pribilof Island Restitution Act,
8P.L. 100-383.
9    (b) For purposes of any program or form of assistance
10where a person's income or assets are considered in
11determining eligibility or level of assistance, whether under
12this Code or another authority, neither the State of Illinois
13nor any entity or person administering a program wholly or
14partially financed by the State of Illinois or any of its
15political subdivisions shall include restitution payments,
16including all income and resources derived therefrom, made
17pursuant to the federal Civil Liberties Act of 1988 and the
18Aleutian and Pribilof Island Restitution Act, P.L. 100-383, in
19the calculation of income or assets for determining
20eligibility or level of assistance.
21    (c) For purposes of determining eligibility for or the
22amount of assistance under this Code, except for the
23determination of eligibility for payments or programs under
24the TANF employment, education, and training programs and the
25Food Stamp Employment and Training Program, the Illinois
26Department, County Departments, and local governmental units

 

 

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1shall exclude from consideration any financial assistance
2received under any student aid program administered by an
3agency of this State or the federal government, by a person who
4is enrolled as a full-time or part-time student of any public
5or private university, college, or community college in this
6State.
7    (d) For purposes of determining eligibility for or the
8amount of assistance under this Code, except for the
9determination of eligibility for payments or programs under
10the TANF employment, education, and training programs and the
11SNAP Employment and Training Program, the Illinois Department,
12County Departments, and local governmental units shall exclude
13from consideration, for a period of 36 months, any financial
14assistance, including wages, that is provided to a person who
15is enrolled in a demonstration project that is not funded with
16general revenue funds and that is intended as a bridge to
17self-sufficiency by offering (i) intensive workforce support
18and training and (ii) support services for new and expectant
19parents that are intended to foster multi-generational healthy
20families as described in Section 12-4.51.
21    (e)(1) Notwithstanding any other provision of this Code,
22and to the maximum extent permitted by federal law, for
23purposes of determining eligibility and the amount of
24assistance under this Code, the Illinois Department and local
25governmental units shall exclude from consideration, for a
26period of no more than 60 months, any financial assistance,

 

 

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1including wages, cash transfers, or gifts, that is provided to
2a person through a guaranteed income program. As used in this
3subsection, "guaranteed income program" means a publicly or
4privately funded program that provides one-time or recurring
5unconditional cash transfers or payments, or gifts to
6individuals or households, for a defined number of months or
7years for the purposes of reducing poverty, promoting economic
8mobility, or increasing the financial stability of Illinois
9residents. who is enrolled in a program or research project
10that is not funded with general revenue funds and that is
11intended to investigate the impacts of policies or programs
12designed to reduce poverty, promote social mobility, or
13increase financial stability for Illinois residents if there
14is an explicit plan to collect data and evaluate the program or
15initiative that is developed prior to participants in the
16study being enrolled in the program and if a research team has
17been identified to oversee the evaluation.
18    (2) The Department shall choose State options and seek all
19necessary federal approvals or waivers to implement this
20subsection.
21(Source: P.A. 100-806, eff. 1-1-19; 101-415, eff. 8-16-19.)
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.