103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2080

 

Introduced 2/9/2023, by Sen. Robert Peters

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 88/5
210 ILCS 88/10
210 ILCS 88/16 new
210 ILCS 88/30
210 ILCS 89/15

    Amends the Fair Patient Billing Act. Requires hospitals to screen patients for health insurance and financial assistance. Prohibits the sale of a patient's medical debt by a hospital. Prohibits hospitals from offering a payment plan to an uninsured patient without first exhausting any discount available to the uninsured patient under the Hospital Uninsured Patient Discount Act and from entering into a payment plan for a bill that is eligible to be discounted by 100% under the Hospital Uninsured Patient Discount Act. Makes other changes. Amends the Hospital Uninsured Patient Discount Act. Provides that hospital may not make the availability of a discount and maximum collectible amount contingent upon an uninsured patient's eligibility for specified programs if the patient declines to apply for a public health insurance program on the basis of concern for immigration-related consequences to the patient, which shall not be grounds for the hospital to deny financial assistance under the hospital's financial assistance policy.


LRB103 27565 CPF 53941 b

 

 

A BILL FOR

 

SB2080LRB103 27565 CPF 53941 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Fair Patient Billing Act is amended by
5changing Sections 5, 10, and 30 and by adding Section 16 as
6follows:
 
7    (210 ILCS 88/5)
8    Sec. 5. Purpose; findings.
9    (a) The purpose of this Act is to advance the prompt and
10accurate payment of health care services through fair and
11reasonable billing and collection practices of hospitals.
12    (b) The General Assembly finds that:
13        (1) Medical debts are the cause of an increasing
14    number of bankruptcies in Illinois and are typically
15    associated with severe financial hardship incurred by
16    bankrupt persons and their families.
17        (2) Patients, hospitals, and government bodies alike
18    will benefit from clearly articulated standards regarding
19    fair billing and collection practices for all Illinois
20    hospitals.
21        (3) Hospitals should employ responsible standards when
22    collecting debt from their patients.
23        (4) Patients should be provided sufficient billing

 

 

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1    information from hospitals to determine the accuracy of
2    the bills for which they may be financially responsible.
3        (5) Patients should be given a fair and reasonable
4    opportunity to discuss and assess the accuracy of their
5    bill.
6        (6) Patients should be provided information regarding
7    the hospital's policies regarding financial assistance
8    options the hospital may offer to qualified patients.
9        (7) Hospitals should offer patients the opportunity to
10    enter into a reasonable payment plan for their hospital
11    care.
12        (8) Patients have an obligation to pay for the
13    hospital services they receive.
14        (9) Hospitals should provide patients with timely and
15    meaningful access to the hospital's financial assistance
16    options to prevent patients from incurring avoidable
17    medical debt. Hospitals should assist patients who need
18    financial assistance in accessing financial assistance in
19    a culturally competent manner. Patients should not be
20    improperly billed, steered into payment plans, or
21    collected upon if they are eligible for hospital financial
22    assistance or public health insurance coverage.
23        (10) Hospitals have an obligation to provide financial
24    assistance to uninsured patients. To promote the general
25    welfare, hospitals should not attempt to collect a debt
26    from an uninsured patient without first (i) adequately

 

 

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1    screening the patient for eligibility to enroll in public
2    health insurance programs and financial assistance and
3    (ii) assisting the patient in obtaining the financial
4    assistance for which the patient is eligible.
5(Source: P.A. 94-885, eff. 1-1-07.)
 
6    (210 ILCS 88/10)
7    Sec. 10. Definitions. As used in this Act:
8    "Collection action" means any referral of a bill to a
9collection agency or law firm to collect payment for services
10from a patient or a patient's guarantor for hospital services.
11    "Culturally competent" or "cultural competency" means
12providing services, support, or other assistance in a manner
13that has the greatest likelihood of ensuring maximum
14participation and is responsive to the beliefs, interpersonal
15styles, attitudes, languages, and behaviors of individuals who
16receive services.
17    "Health care plan" means a health insurance company,
18health maintenance organization, preferred provider
19arrangement, or third party administrator authorized in this
20State to issue policies or subscriber contracts or administer
21those policies and contracts that reimburse for inpatient and
22outpatient services provided in a hospital. Health care plan,
23however, does not include any government-funded program such
24as Medicare or Medicaid, workers' compensation, and accident
25liability insurers.

 

 

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1    "Insured patient" means a patient who is insured by a
2health care plan.
3    "Medical debt" means a debt arising from the receipt of
4health care services.
5    "Patient" means the individual receiving services from the
6hospital and any individual who is the guarantor of the
7payment for such services.
8    "Reasonable payment plan" means a plan to pay a hospital
9bill that is offered to the patient or the patient's legal
10representative and takes into account the patient's available
11income and assets, the amount owed, and any prior payments.
12"Reasonable payment plan" does not include a payment plan that
13requires a patient to pay moneys that the hospital knows or
14should know are eligible for a discount under the Hospital
15Uninsured Patient Discount Act.
16    "Screen" or "screening" means a process whereby a hospital
17engages with an uninsured patient to review whether the
18patient's circumstances are conducive with eligibility
19criteria for financial assistance that is offered by the
20hospital or known to the hospital, public health insurance, or
21discounted care. "Screen" or "screening" includes, but is not
22limited to, informing the patient of the hospital's
23assessment, documenting the circumstances of the screening in
24the patient's file, and either assisting with the
25application's completion or providing information to the
26patient about how he or she can enroll or otherwise apply for

 

 

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1the assistance.
2    "Uninsured patient" means a patient who is not insured by
3a health care plan and is not a beneficiary under a
4government-funded program, workers' compensation, or accident
5liability insurance.
6(Source: P.A. 94-885, eff. 1-1-07.)
 
7    (210 ILCS 88/16 new)
8    Sec. 16. Screening for health insurance and financial
9assistance; sale of medical debt; enforcement.
10    (a) A hospital shall screen each uninsured patient for
11eligibility in:
12        (1) all available public health insurance programs,
13    including, but not limited to:
14            (A) Medicare;
15            (B) Medicaid;
16            (C) the following programs offered by the
17        Department of Human Services:
18                (i) medical benefits for noncitizen victims of
19            trafficking, torture, or other serious crimes;
20                (ii) health benefits for immigrant adults; and
21                (iii) health benefits for immigrant seniors;
22            (D) the Illinois All Kids program managed by the
23        U.S. Department of Health and Human Services; and
24            (E) any other program if there is a reasonable
25        basis to believe that the uninsured patient may be

 

 

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1        eligible for it;
2        (2) any financial assistance offered by the hospital;
3    and
4        (3) any other public programs that may assist with the
5    patient's health care costs.
6    (b) All screening activities taken under this Act,
7including, but not limited to, initial screenings and follow
8up activities, must be culturally competent. All information
9provided to an uninsured patient for a screening must be in the
10uninsured patient's primary language, worded in a way that is
11easy to understand, and in an accessible format. Information
12from a screening that is provided to an uninsured patient
13verbally may include use of a professional interpretation
14service. Information from a screening that is provided to an
15uninsured patient in writing shall be in the uninsured
16patient's or the uninsured patient's legal representative's
17primary language, if applicable.
18    (c) If an uninsured patient declines the screening
19described in subsection (a), the hospital shall document the
20uninsured patient's informed written consent to decline the
21screening and the date and method by which the uninsured
22patient declined it. An uninsured patient's decision to
23decline a screening is a defense to a claim brought by an
24uninsured patient under this Section if contemporaneous
25hospital documentation shows that the decision to decline the
26screening was an informed decision and presented in the

 

 

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1uninsured patient's primary language.
2    (d) A hospital must screen an uninsured patient at the
3earliest reasonable moment, which in all circumstances means
4before issuing a bill to the uninsured patient. After the
5screening, the hospital shall inform the uninsured patient of
6the hospital's assessment of his or her circumstances.
7    (e) If a screening indicates that the uninsured patient
8may be eligible for financial assistance, the hospital shall
9assist the uninsured patient with applying for financial
10assistance in accordance with Section 27.
11    (f) If a screening indicates that the uninsured patient
12may be eligible for financial assistance, the hospital shall
13provide information to the uninsured patient detailing how the
14uninsured patient can enroll in the financial assistance,
15including, but not limited to, referring the uninsured patient
16to health care navigators who provide free and unbiased
17eligibility and enrollment assistance such as Federally
18Qualified Health Centers (FQHCs), programs offered by the
19Department of Human Services, or any other resource that is
20recognized by the State as being designed to assist uninsured
21individuals in obtaining health care coverage.
22    (g) The date that an uninsured patient's screening takes
23place, or the date on which a decision regarding the uninsured
24patient's eligibility for financial assistance described under
25subsection (a) is pending, whichever is applicable, is the
26starting date of any deadline for the uninsured patient to

 

 

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1file an application with the hospital for financial
2assistance. If the uninsured patient's application is
3approved, the hospital shall bill the entity providing the
4financial assistance and shall not pursue a collection action
5against the uninsured patient. If the uninsured patient's
6application is denied, the hospital shall screen the uninsured
7patient again, and the deadline to file an application for
8financial assistance shall begin anew.
9    (h) If a hospital is contacted by an insured patient in
10response to a bill issued by the hospital to the insured
11patient, the hospital shall screen the insured patient for
12discounted care at the earliest reasonable moment if (i) the
13insured patient requests the screening, (ii) the insured
14patient provides information suggesting his or her inability
15to pay the bill, (iii) the hospital obtains information
16suggesting the insured patient's inability to pay, or (iv)
17circumstances suggest the insured patient's inability to pay
18the bill.
19    (i) A hospital shall develop an operational plan for
20implementing the screening requirements under this Section.
21The operational plan shall describe hospital activities to
22adopt and actively implement policies and training to ensure
23compliance with this Section, including, but not limited to,
24training on:
25        (1) screening requirements;
26        (2) interacting with uninsured patients in a

 

 

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1    culturally competent way; and
2        (3) addressing implicit bias when interacting with
3    uninsured patients.
4    The operational plan shall establish the parameters for
5training required under this subsection, including, but not
6limited to, staff required to receive the training and
7ensuring compliance with this Section. Each hospital employee
8shall receive the training, as applicable, required for that
9employee's position at least once each year.
10    (j) An uninsured patient may apply for financial
11assistance at any time before, during, or after a hospital has
12initiated any legal process to collect the uninsured patient's
13medical debt.
14    (k) A hospital shall not sell an obligation due to the
15hospital as an uninsured patient's medical debt.
16    (l) A hospital may demonstrate compliance with this
17Section by submitting the hospital's chief financial
18officer's, or the chief financial officer's designee's, sworn
19affidavit affirming that the uninsured patient does not meet
20the required criteria for financial assistance and listing the
21specific criteria that were not met.
22    (m) Notwithstanding any other provision of law:
23        (1) a hospital that violates this Section shall
24    execute and file a release, a satisfaction of judgment, or
25    both, as applicable, for any medical debt at issue arising
26    from the violation within 30 days after the violation

 

 

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1    occurs;
2        (2) a hospital's failure to screen an uninsured
3    patient in compliance with this Section is a complete
4    defense for an uninsured patient against any legal action
5    by the hospital to collect the uninsured patient's medical
6    debt incurred because of that failure and constitutes a
7    meritorious claim or defense in the uninsured patient's
8    petition for relief from judgment under Section 2-1401 of
9    the Code of Civil Procedure;
10        (3) a hospital that fails to comply with the
11    requirements of this Section is strictly liable, without
12    regard to fault, to an uninsured patient or any other
13    person aggrieved by the violation:
14            (A) in an amount equal to $4,000 or the uninsured
15        patient's or person's actual damages, whichever is
16        greater; and
17            (B) attorney's fees, costs, and expenses, and such
18        other relief, including an injunction, as the court
19        may deem appropriate;
20        (4) the following defenses are not available to a
21    hospital in any legal action brought under this Section:
22            (A) ignorance or mistake of law;
23            (B) misplaced documentation;
24            (C) contributory or comparative negligence; or
25            (D) a claim that the hospital or the hospital's
26        agent was unaware that the hospital (i) did not meet

 

 

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1        the requirements under this Section or (ii) was
2        otherwise engaged in the hospital's conduct described
3        in the legal action;
4        (5) any person aggrieved by a violation of this
5    Section shall have a right of action in any court of
6    competent jurisdiction and shall recover damages equal to
7    the sum of $4,000 or actual damages; and
8        (6) any waiver of an uninsured patient's or aggrieved
9    person's right to sue, defend, or countersue under this
10    Section is against public policy, is void, and shall not
11    be enforceable in any court.
 
12    (210 ILCS 88/30)
13    Sec. 30. Pursuing collection action.
14    (a) Hospitals and their agents may pursue collection
15action against an uninsured patient only if the following
16conditions are met:
17        (1) The hospital has given the uninsured patient the
18    opportunity to:
19            (A) assess the accuracy of the bill;
20            (B) apply for financial assistance under the
21        hospital's financial assistance policy; and
22            (C) avail themselves of a reasonable payment plan.
23        (2) If the uninsured patient has indicated an
24    inability to pay the full amount of the debt in one payment
25    during the screening required under Section 16, the

 

 

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1    hospital has offered the patient a reasonable payment
2    plan. A payment plan is not reasonable if it requires
3    payment of moneys required to be written off or discounted
4    under the Hospital Uninsured Patient Discount Act. The
5    hospital and its agents, including, but not limited to,
6    third-party entities acting as hospital agents, shall not
7    offer a payment plan to an uninsured patient without first
8    exhausting any discount available to the uninsured patient
9    under the Hospital Uninsured Patient Discount Act and
10    shall not at any point enter into a payment plan for a bill
11    that is eligible to be discounted by 100% under the
12    Hospital Uninsured Patient Discount Act. The hospital may
13    require the uninsured patient to provide reasonable
14    verification of his or her inability to pay the full
15    amount of the debt in one payment.
16        (3) To the extent the hospital provides financial
17    assistance and the circumstances of the uninsured patient
18    suggest the potential for eligibility for charity care,
19    the uninsured patient has been given at least 90 60 days
20    following the date of discharge or receipt of outpatient
21    care to submit an application for financial assistance and
22    has been assisted in completing the application in
23    accordance with Sections 16 and 27.
24        (4) If the uninsured patient has agreed to a
25    reasonable payment plan with the hospital, and the patient
26    has failed to make payments in accordance with that

 

 

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1    reasonable payment plan.
2        (5) If the uninsured patient informs the hospital that
3    he or she has applied for health care coverage under
4    Medicaid, Kidcare, or other government-sponsored health
5    care program (and there is a reasonable basis to believe
6    that the patient will qualify for such program) but the
7    patient's application is denied.
8        (6) The hospital has offered to provide the uninsured
9    patient with all financial assistance available to the
10    uninsured patient under the Hospital Uninsured Patient
11    Discount Act.
12        (7) The hospital has screened the uninsured patient
13    under Section 16 and is in full compliance with that
14    Section.
15    (a-5) A hospital shall proactively offer information on
16charity care options available to uninsured patients,
17regardless of their immigration status or residency.
18    (b) A hospital may not refer a bill, or portion thereof, to
19a collection agency or attorney for collection action against
20the insured patient, without first offering the patient the
21opportunity to request a reasonable payment plan for the
22amount personally owed by the patient. Such an opportunity
23shall be made available for the 30 days following the date of
24the initial bill. If the insured patient requests a reasonable
25payment plan, but fails to agree to a plan within 30 days of
26the request, the hospital may proceed with collection action

 

 

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1against the patient.
2    (c) No collection agency, law firm, or individual may
3initiate legal action for non-payment of a hospital bill
4against a patient without the written approval of an
5authorized hospital employee who reasonably believes that the
6conditions for pursuing collection action under this Section
7have been met.
8    (d) Nothing in this Section prohibits a hospital from
9engaging an outside third party agency, firm, or individual to
10manage the process of implementing the hospital's financial
11assistance and reasonable payment plan programs and policies
12so long as such agency, firm, or individual is contractually
13bound to comply with the terms of this Act.
14(Source: P.A. 102-504, eff. 12-1-21.)
 
15    Section 10. The Hospital Uninsured Patient Discount Act is
16amended by changing Section 15 as follows:
 
17    (210 ILCS 89/15)
18    Sec. 15. Patient responsibility.
19    (a) Hospitals may make the availability of a discount and
20the maximum collectible amount under this Act contingent upon
21the uninsured patient first applying for coverage under public
22health insurance programs, such as Medicare, Medicaid,
23AllKids, the State Children's Health Insurance Program, or any
24other program, if there is a reasonable basis to believe that

 

 

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

 

 

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1    Acceptable verification of Illinois residency shall
2    include any one of the following:
3            (A) any of the documents listed in paragraph (1);
4            (B) a valid state-issued identification card;
5            (C) a recent residential utility bill;
6            (D) a lease agreement;
7            (E) a vehicle registration card;
8            (F) a voter registration card;
9            (G) mail addressed to the uninsured patient at an
10        Illinois address from a government or other credible
11        source;
12            (H) a statement from a family member of the
13        uninsured patient who resides at the same address and
14        presents verification of residency;
15            (I) a letter from a homeless shelter, transitional
16        house or other similar facility verifying that the
17        uninsured patient resides at the facility; or
18            (J) a temporary visitor's drivers license.
19    (c) Hospital obligations toward an individual uninsured
20patient under this Act shall cease if that patient
21unreasonably fails or refuses to provide the hospital with
22information or documentation requested under subsection (b) or
23to apply for coverage under public programs when requested
24under subsection (a) within 30 days of the hospital's request.
25    (d) In order for a hospital to determine the 12 month
26maximum amount that can be collected from a patient deemed

 

 

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1eligible under Section 10, an uninsured patient shall inform
2the hospital in subsequent inpatient admissions or outpatient
3encounters that the patient has previously received health
4care services from that hospital and was determined to be
5entitled to the uninsured discount.
6    (e) Hospitals may require patients to certify that all of
7the information provided in the application is true. The
8application may state that if any of the information is
9untrue, any discount granted to the patient is forfeited and
10the patient is responsible for payment of the hospital's full
11charges.
12    (f) Hospitals shall ask for an applicant's race,
13ethnicity, sex, and preferred language on the financial
14assistance application. However, the questions shall be
15clearly marked as optional responses for the patient and shall
16note that responses or nonresponses by the patient will not
17have any impact on the outcome of the application.
18(Source: P.A. 102-581, eff. 1-1-22.)