Illinois General Assembly - Full Text of HB2719
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Full Text of HB2719  103rd General Assembly

HB2719enr 103RD GENERAL ASSEMBLY

  
  
  

 


 
HB2719 EnrolledLRB103 27682 AWJ 54059 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 Community Benefits Act is amended by
5changing Section 22 as follows:
 
6    (210 ILCS 76/22)
7    Sec. 22. Public reports.
8    (a) In order to increase transparency and accessibility of
9charity care and financial assistance data, a hospital shall
10make the annual hospital community benefits plan report
11submitted to the Attorney General under Section 20 available
12to the public by publishing the information on the hospital's
13website in the same location where annual reports are posted
14or on a prominent location on the homepage of the hospital's
15website. A hospital is not required to post its audited
16financial statements. Information made available to the public
17shall include, but shall not be limited to, the following:
18        (1) The reporting period.
19        (2) Charity care costs consistent with the reporting
20    requirements in paragraph (3) of subsection (a) of Section
21    20. Charity care costs associated with services provided
22    in a hospital's emergency department shall be reported as
23    a subset of total charity care costs.

 

 

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1        (3) Total net patient revenue, reported separately by
2    hospital if the reporting health system includes more than
3    one hospital.
4        (4) Total community benefits spending. If a hospital
5    is owned or operated by a health system, total community
6    benefits spending may be reported as a health system.
7        (5) Data on financial assistance applications
8    consistent with the reporting requirements in paragraph
9    (3) of subsection (a) of Section 20, including:
10            (A) the number of applications submitted to the
11        hospital, both complete and incomplete;
12            (B) the number of applications approved; and
13            (C) the number of applications denied and the 5
14        most frequent reasons for denial; and .
15            (D) the number of uninsured patients who have
16        declined or failed to respond to the screening
17        described in subsection (a) of Section 16 of the Fair
18        Patient Billing Act and the 5 most frequent reasons
19        for declining.
20        (6) To the extent that race, ethnicity, sex, or
21    preferred language is collected and available for
22    financial assistance applications, the data outlined in
23    paragraph (5) shall be reported by race, ethnicity, sex,
24    and preferred language. If this data is not provided by
25    the patient, the hospital shall indicate this in its
26    reports. Public reporting of this information shall begin

 

 

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1    with the community benefit report filed on or after July
2    1, 2022. A hospital that files a report without having a
3    full year of demographic data as required by this Act may
4    indicate this in its report.
5    (b) The Attorney General shall provide notice on the
6Attorney General's website informing the public that, upon
7request, the Attorney General will provide the annual reports
8filed with the Attorney General under Section 20. The notice
9shall include the contact information to submit a request.
10(Source: P.A. 102-581, eff. 1-1-22.)
 
11    Section 10. The Fair Patient Billing Act is amended by
12changing Sections 5, 10, 30, 45, and 70 and by adding Section
1316 as follows:
 
14    (210 ILCS 88/5)
15    Sec. 5. Purpose; findings.
16    (a) The purpose of this Act is to advance the prompt and
17accurate payment of health care services through fair and
18reasonable billing and collection practices of hospitals.
19    (b) The General Assembly finds that:
20        (1) Medical debts are the cause of an increasing
21    number of bankruptcies in Illinois and are typically
22    associated with severe financial hardship incurred by
23    bankrupt persons and their families.
24        (2) Patients, hospitals, and government bodies alike

 

 

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1    will benefit from clearly articulated standards regarding
2    fair billing and collection practices for all Illinois
3    hospitals.
4        (3) Hospitals should employ responsible standards when
5    collecting debt from their patients.
6        (4) Patients should be provided sufficient billing
7    information from hospitals to determine the accuracy of
8    the bills for which they may be financially responsible.
9        (5) Patients should be given a fair and reasonable
10    opportunity to discuss and assess the accuracy of their
11    bill.
12        (6) Hospitals should provide patients with timely and
13    meaningful access to any financial assistance available
14    through the hospital and any public health insurance
15    programs for which patients may be eligible to prevent
16    patients from ending up with avoidable medical debt.
17    Hospitals should assist patients who need financial
18    assistance to access it. Patients who are deemed eligible
19    for hospital financial assistance or public health
20    insurance programs should not be improperly billed,
21    steered into payment plans, or sent to collections
22    Patients should be provided information regarding the
23    hospital's policies regarding financial assistance options
24    the hospital may offer to qualified patients.
25        (7) Hospitals should offer patients the opportunity to
26    enter into a reasonable payment plan for their hospital

 

 

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1    care.
2        (8) Patients have an obligation to pay for the
3    hospital services they receive subject to any discounts or
4    free care for which they are eligible under Illinois law.
5        (9) Hospitals have an obligation to screen uninsured
6    patients before pursuing collection action. To promote the
7    general welfare and to mitigate the negative impact that
8    medical debt has on accessing and using needed health
9    care, hospitals should not attempt to collect a debt from
10    an uninsured patient without first adequately screening
11    the patient for public health insurance programs and
12    financial assistance available to the patient and
13    assisting the patient in obtaining the hospital financial
14    assistance for which they are eligible.
15(Source: P.A. 94-885, eff. 1-1-07.)
 
16    (210 ILCS 88/10)
17    Sec. 10. Definitions. As used in this Act:
18    "Collection action" means any referral of a bill to a
19collection agency or law firm to collect payment for services
20from a patient or a patient's guarantor for hospital services.
21    "Health care plan" means a health insurance company,
22health maintenance organization, preferred provider
23arrangement, or third party administrator authorized in this
24State to issue policies or subscriber contracts or administer
25those policies and contracts that reimburse for inpatient and

 

 

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1outpatient services provided in a hospital. Health care plan,
2however, does not include any government-funded program such
3as Medicare or Medicaid, workers' compensation, and accident
4liability insurers.
5    "Insured patient" means a patient who is insured by a
6health care plan.
7    "Medical debt" means a debt arising from the receipt of
8health care services, products, or devices.
9    "Patient" means the individual receiving services from the
10hospital and any individual who is the guarantor of the
11payment for such services.
12    "Public health insurance program" means Medicare;
13Medicaid; medical assistance under the Non-Citizen Victims of
14Trafficking, Torture and Other Serious Crimes program; Health
15Benefit for Immigrant Adults; Health Benefit for Immigrant
16Seniors; All Kids; or other medical assistance programs
17offered by the Department of Healthcare and Family Services.
18    "Reasonable payment plan" means a plan to pay a hospital
19bill that is offered to the patient or the patient's legal
20representative and takes into account the patient's available
21income and assets, the amount owed, and any prior payments.
22    "Screen" or "screening" means a process whereby a hospital
23engages with a patient to review and assess the patient's
24potential eligibility for any financial assistance offered by
25the hospital, public health insurance program, or other
26discounted care known to the hospital; informs the patient of

 

 

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1the hospital's assessment; documents in the patient's record
2the circumstances of the screening; and assists with the
3application for hospital financial assistance.
4    "Uninsured patient" means a patient who is not insured by
5a health care plan and is not a beneficiary under a
6government-funded program, workers' compensation, or accident
7liability insurance.
8(Source: P.A. 94-885, eff. 1-1-07.)
 
9    (210 ILCS 88/16 new)
10    Sec. 16. Screening patients for health insurance and
11financial assistance.
12    (a) All hospitals shall screen each uninsured patient,
13upon the uninsured patient's agreement, at the earliest
14reasonable moment for potential eligibility for both:
15        (1) public health insurance programs; and
16        (2) any financial assistance offered by the hospital.
17    (b) All screening activities, including initial screenings
18and all follow-up assistance, must be provided in compliance
19with the Language Assistance Services Act.
20    (c) If a patient declines or fails to respond to the
21screening described in subsection (a), the hospital shall
22document in the patient's record the patient's decision to
23decline or failure to respond to the screening, confirming the
24date and method by which the patient declined or failed to
25respond.

 

 

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1    (d) If a patient does not decline the screening described
2in subsection (a), a hospital should screen an uninsured
3patient during registration unless it would cause a delay of
4care to the patient, otherwise a hospital must screen an
5uninsured patient at the earliest reasonable moment.
6    (e) If a patient does not submit screening, financial
7assistance application, or reasonable payment plan
8documentation within 30 days after a request as required under
9Section 45, the hospital shall document the lack of received
10documentation, confirming the date that the screening took
11place and that the 30-day timeline for responding to the
12hospital's request has lapsed, but may be reopened within 90
13days after the date of discharge, date of service, or
14completion of the screening.
15    (f) If the screening indicates that the patient may be
16eligible for a public health insurance program, the hospital
17shall provide information to the patient about how the patient
18can apply for the public health insurance program, including,
19but not limited to, referral to health care navigators who
20provide free and unbiased eligibility and enrollment
21assistance, including health care navigators at federally
22qualified health centers; local, State, or federal government
23agencies; or any other resources that Illinois recognizes as
24designed to assist uninsured individuals in obtaining health
25coverage.
26    (g) If the uninsured patient's application for a public

 

 

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1health insurance program is approved, the hospital shall bill
2the insuring entity and shall not pursue the patient for any
3aspect of the bill, except for any required copayment,
4coinsurance, or other similar payment for which the patient is
5responsible under the insurance. If the uninsured patient's
6application for public health insurance is denied, the
7hospital shall again offer to screen the uninsured patient for
8hospital financial assistance and the timeline for applying
9for financial assistance under the Hospital Uninsured Patient
10Discount Act shall begin again.
11    (h) A hospital shall offer to screen an insured patient
12for hospital financial assistance under this Section if the
13patient requests financial assistance screening, if the
14hospital is contacted in response to a bill, if the hospital
15learns information that suggests an inability to pay, or if
16the circumstances otherwise suggest the patient's inability to
17pay.
18    (i) Any hospital that submits an annual hospital community
19benefits plan report to the Attorney General shall include in
20that report the number of uninsured patients who have declined
21or failed to respond to screening under subsection (a) of
22Section 16 and the 5 most frequent reasons for declining.
 
23    (210 ILCS 88/30)
24    Sec. 30. Pursuing collection action.
25    (a) Hospitals and their agents may pursue collection

 

 

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1action against an uninsured patient only if the following
2conditions are met:
3        (1) The hospital has complied with the screening
4    requirements set forth in Section 16 and applied and
5    exhausted any discount available to a patient under
6    Section 10 of the Hospital Uninsured Patient Discount Act.
7        (2) (1) The hospital has given the uninsured patient
8    the opportunity to:
9            (A) assess the accuracy of the bill;
10            (B) apply for financial assistance under the
11        hospital's financial assistance policy; and
12            (C) avail themselves of a reasonable payment plan.
13        (3) (2) If the uninsured patient has indicated an
14    inability to pay the full amount of the debt in one
15    payment, the hospital has offered the patient a reasonable
16    payment plan. The hospital may require the uninsured
17    patient to provide reasonable verification of his or her
18    inability to pay the full amount of the debt in one
19    payment.
20        (4) (3) To the extent the hospital provides financial
21    assistance and the circumstances of the uninsured patient
22    suggest the potential for eligibility for charity care,
23    the uninsured patient has been given at least 90 60 days
24    following the date of discharge or receipt of outpatient
25    care to submit an application for financial assistance and
26    shall be provided assistance with the application in

 

 

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1    compliance with subsection (a) of Section 16 and Section
2    27.
3        (5) (4) If the uninsured patient has agreed to a
4    reasonable payment plan with the hospital, and the patient
5    has failed to make payments in accordance with that
6    reasonable payment plan.
7        (6) (5) If the uninsured patient informs the hospital
8    that he or she has applied for health care coverage under a
9    public health insurance program Medicaid, Kidcare, or
10    other government-sponsored health care program (and there
11    is a reasonable basis to believe that the patient will
12    qualify for such program) but the patient's application is
13    denied.
14    (a-5) A hospital shall proactively offer information on
15charity care options available to uninsured patients,
16regardless of their immigration status or residency.
17    (b) A hospital may not refer a bill, or portion thereof, to
18a collection agency or attorney for collection action against
19the insured patient, without first ensuring compliance with
20Section 16 and offering the patient the opportunity to request
21a reasonable payment plan for the amount personally owed by
22the patient. Such an opportunity shall be made available for
23the 90 30 days following the date of the initial bill. If the
24insured patient requests a reasonable payment plan, but fails
25to agree to a plan within 90 30 days of the request, the
26hospital may proceed with collection action against the

 

 

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1patient.
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    (210 ILCS 88/45)
16    Sec. 45. Patient responsibilities.
17    (a) To receive the protection and benefits of this Act, a
18patient responsible for paying a hospital bill must act
19reasonably and cooperate in good faith with the hospital in
20the screening process by providing the hospital with all of
21the reasonably requested financial and other relevant
22information and documentation needed to determine the
23patient's potential eligibility for coverage under a public
24health insurance program, under the hospital's financial
25assistance policy, or for a and reasonable payment plan

 

 

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1options to qualified patients within 30 days of a request for
2such information.
3    (b) To receive the protection and benefits of this Act, a
4patient responsible for paying a hospital bill shall
5communicate to the hospital any material change in the
6patient's financial situation that may affect the patient's
7ability to abide by the provisions of an agreed upon
8reasonable payment plan or qualification for financial
9assistance within 30 days of the change.
10(Source: P.A. 94-885, eff. 1-1-07.)
 
11    (210 ILCS 88/70)
12    Sec. 70. Application.
13    (a) This Act applies to all hospitals licensed under the
14Hospital Licensing Act or the University of Illinois Hospital
15Act. This Act does not apply to a hospital that does not charge
16for its services.
17    (b) The obligations of hospitals under this Act shall take
18effect for services provided on or after the first day of the
19month that begins 180 days after the effective date of this
20Act.
21    (c) The obligations of hospitals under this amendatory Act
22of the 103rd General Assembly shall apply to services provided
23on or after the first day of the month that begins 180 days
24after the effective date of this amendatory Act of the 103rd
25General Assembly.

 

 

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1(Source: P.A. 94-885, eff. 1-1-07.)
 
2    Section 15. The Hospital Uninsured Patient Discount Act is
3amended by changing Section 15 as follows:
 
4    (210 ILCS 89/15)
5    Sec. 15. Patient responsibility.
6    (a) Hospitals may make the availability of a discount and
7the maximum collectible amount under this Act contingent upon
8the uninsured patient first applying for coverage under public
9health insurance programs, such as Medicare, Medicaid,
10AllKids, the State Children's Health Insurance Program, or any
11other program, if there is a reasonable basis to believe that
12the uninsured patient may be eligible for such program. If the
13patient declines to apply for a public health insurance
14program on the basis of concern for immigration-related
15consequences, the hospital may refer the patient to a free,
16unbiased resource such as an Immigrant Family Resource Program
17to address the patient's immigration-related concerns and
18assist in enrolling the patient in a public health insurance
19program. The hospital may still screen the patient for
20eligibility under its financial assistance policy.
21    (b) Hospitals shall permit an uninsured patient to apply
22for a discount within 90 days of the date of discharge, or date
23of service, completion of the screening under the Fair Patient
24Billing Act, or denial of an application for a public health

 

 

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1insurance program.
2    Hospitals shall offer uninsured patients who receive
3community-based primary care provided by a community health
4center or a free and charitable clinic, are referred by such an
5entity to the hospital, and seek access to nonemergency
6hospital-based health care services with an opportunity to be
7screened for and assistance with applying for public health
8insurance programs if there is a reasonable basis to believe
9that the uninsured patient may be eligible for a public health
10insurance program. An uninsured patient who receives
11community-based primary care provided by a community health
12center or free and charitable clinic and is referred by such an
13entity to the hospital for whom there is not a reasonable basis
14to believe that the uninsured patient may be eligible for a
15public health insurance program shall be given the opportunity
16to apply for hospital financial assistance when hospital
17services are scheduled.
18        (1) Income verification. Hospitals may require an
19    uninsured patient who is requesting an uninsured discount
20    to provide documentation of family income. Acceptable
21    family income documentation shall include any one of the
22    following:
23            (A) a copy of the most recent tax return;
24            (B) a copy of the most recent W-2 form and 1099
25        forms;
26            (C) copies of the 2 most recent pay stubs;

 

 

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1            (D) written income verification from an employer
2        if paid in cash; or
3            (E) one other reasonable form of third party
4        income verification deemed acceptable to the hospital.
5        (2) Asset verification. Hospitals may require an
6    uninsured patient who is requesting an uninsured discount
7    to certify the existence or absence of assets owned by the
8    patient and to provide documentation of the value of such
9    assets, except for those assets referenced in paragraph
10    (4) of subsection (c) of Section 10. Acceptable
11    documentation may include statements from financial
12    institutions or some other third party verification of an
13    asset's value. If no third party verification exists, then
14    the patient shall certify as to the estimated value of the
15    asset.
16        (3) Illinois resident verification. Hospitals may
17    require an uninsured patient who is requesting an
18    uninsured discount to verify Illinois residency.
19    Acceptable verification of Illinois residency shall
20    include any one of the following:
21            (A) any of the documents listed in paragraph (1);
22            (B) a valid state-issued identification card;
23            (C) a recent residential utility bill;
24            (D) a lease agreement;
25            (E) a vehicle registration card;
26            (F) a voter registration card;

 

 

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1            (G) mail addressed to the uninsured patient at an
2        Illinois address from a government or other credible
3        source;
4            (H) a statement from a family member of the
5        uninsured patient who resides at the same address and
6        presents verification of residency;
7            (I) a letter from a homeless shelter, transitional
8        house or other similar facility verifying that the
9        uninsured patient resides at the facility; or
10            (J) a temporary visitor's drivers license.
11    (c) Hospital obligations toward an individual uninsured
12patient under this Act shall cease if that patient
13unreasonably fails or refuses to provide the hospital with
14information or documentation requested under subsection (b) or
15to apply for coverage under public programs when requested
16under subsection (a) within 30 days of the hospital's request.
17    (d) In order for a hospital to determine the 12 month
18maximum amount that can be collected from a patient deemed
19eligible under Section 10, an uninsured patient shall inform
20the hospital in subsequent inpatient admissions or outpatient
21encounters that the patient has previously received health
22care services from that hospital and was determined to be
23entitled to the uninsured discount.
24    (e) Hospitals may require patients to certify that all of
25the information provided in the application is true. The
26application may state that if any of the information is

 

 

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1untrue, any discount granted to the patient is forfeited and
2the patient is responsible for payment of the hospital's full
3charges.
4    (f) Hospitals shall ask for an applicant's race,
5ethnicity, sex, and preferred language on the financial
6assistance application. However, the questions shall be
7clearly marked as optional responses for the patient and shall
8note that responses or nonresponses by the patient will not
9have any impact on the outcome of the application.
10(Source: P.A. 102-581, eff. 1-1-22.)