Sen. Mattie Hunter

Filed: 4/19/2021





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2    AMENDMENT NO. ______. Amend Senate Bill 1840 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Community Benefits Act is amended by
5changing Sections 10, 15, and 20 and by adding Section 22 as
7    (210 ILCS 76/10)
8    Sec. 10. Definitions. As used in this Act:
9    "Bad debt" means the current period charge for actual or
10expected doubtful accounting resulting from the extension of
12    "Charity care" means care provided by a health care
13provider for which the provider does not expect to receive
14payment from the patient or a third party payer. "Charity
15care" includes the actual cost of services provided based upon
16the total cost to charge ratio derived from a nonprofit



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1hospital's most recently filed Medicare cost report Worksheet
2C and not based upon the charges for the services. "Charity
3care" does not include bad debt.
4    "Community benefits" means the unreimbursed cost to a
5hospital or health system of providing charity care, language
6assistant services, government-sponsored indigent health care,
7donations, volunteer services, education,
8government-sponsored program services, research, and
9subsidized health services and collecting bad debts.
10"Community benefits" does not include the cost of paying any
11taxes or other governmental assessments.
12    "Financial assistance" means a discount provided to a
13patient under the terms and conditions the hospital offers to
14qualified patients or as required by law.
15    "Government-sponsored Government sponsored indigent
16health care" means the unreimbursed cost to a hospital or
17health system of Medicare, providing health care services to
18recipients of Medicaid, and other federal, State, or local
19indigent health care programs, eligibility for which is based
20on financial need.
21    "Health system" means an entity that owns or operates at
22least one hospital.
23    "Net patient revenue" means gross service revenue less
24provisions for contractual adjustments with third-party
25payors, courtesy and policy discounts, or other adjustments
26and deductions, excluding charity care.



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1    "Nonprofit hospital" means a hospital that is organized as
2a nonprofit corporation, including religious organizations, or
3a charitable trust under Illinois law or the laws of any other
4state or country.
5    "Subsidized health services" means those services provided
6by a hospital in response to community needs for which the
7reimbursement is less than the hospital's cost of providing
8the services that must be subsidized by other hospital or
9nonprofit supporting entity revenue sources. "Subsidized
10health services" includes, but is not limited to, emergency
11and trauma care, neonatal intensive care, community health
12clinics, and collaborative efforts with local government or
13private agencies to prevent illness and improve wellness, such
14as immunization programs.
15(Source: P.A. 93-480, eff. 8-8-03.)
16    (210 ILCS 76/15)
17    Sec. 15. Organizational mission statement; community
18benefits plan. A nonprofit hospital shall develop:
19        (1) an organizational mission statement that
20    identifies the hospital's commitment to serving the health
21    care needs of the community; and
22        (2) a community benefits plan defined as an
23    operational plan for serving the community's health care
24    needs that:
25            (A) sets out goals and objectives for providing



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1        community benefits that include charity care and
2        government-sponsored government sponsored indigent
3        health care; and
4            (B) identifies the populations and communities
5        served by the hospital; and .
6            (C) describes activities the hospital is
7        undertaking to address health equity, reduce health
8        disparities, and improve community health. This may
9        include, but is not limited to:
10                (i) efforts to recruit and promote a racially
11            and culturally diverse and representative
12            workforce;
13                (ii) efforts to procure goods and services
14            locally and from historically underrepresented
15            communities;
16                (iii) training that addresses cultural
17            competency and implicit bias; and
18                (iv) partnerships and investments to address
19            social needs such as food, housing, and community
20            safety.
21(Source: P.A. 93-480, eff. 8-8-03.)
22    (210 ILCS 76/20)
23    Sec. 20. Annual report for community benefits plan.
24    (a) Each nonprofit hospital shall prepare an annual report
25of the community benefits plan. The report must include, in



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1addition to the community benefits plan itself, all of the
2following background information:
3        (1) The hospital's mission statement.
4        (2) A disclosure of the health care needs of the
5    community that were considered in developing the
6    hospital's community benefits plan.
7        (3) A disclosure of the amount and types of community
8    benefits actually provided, including charity care, and
9    details about financial assistance applications received
10    and processed by the hospital as specified in paragraph
11    (5) of subsection (a) of Section 22. Charity care must be
12    reported separate from other community benefits. In
13    reporting charity care, the hospital must report the
14    actual cost of services provided, based on the total cost
15    to charge ratio derived from the hospital's Medicare cost
16    report (CMS 2552-96 Worksheet C, Part 1, PPS Inpatient
17    Ratios), not the charges for the services. For a health
18    system that includes more than one hospital, charity care
19    spending and financial assistance application data must be
20    reported separately for each individual hospital within
21    the health system.
22        (4) Audited annual financial reports for its most
23    recently completed fiscal year.
24    (b) Each nonprofit hospital shall annually file a report
25of the community benefits plan with the Attorney General. The
26report must be filed not later than the last day of the sixth



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1month after the close of the hospital's fiscal year, beginning
2with the hospital fiscal year that ends in 2004.
3    (c) Each nonprofit hospital shall prepare a statement that
4notifies the public that the annual report of the community
5benefits plan is:
6        (1) public information;
7        (2) filed with the Attorney General; and
8        (3) available to the public on request from the
9    Attorney General.
10    This statement shall be made available to the public.
11    (d) The obligations of a hospital under this Act, except
12for the filing of its audited financial report, shall take
13effect beginning with the hospital's fiscal year that begins
14after the effective date of this Act. Within 60 days of the
15effective date of this Act, a hospital shall file the audited
16annual financial report that has been completed for its most
17recently completed fiscal year. Thereafter, a hospital shall
18include its audited annual financial report for its most
19recently completed fiscal year in its annual report of its
20community benefits plan.
21(Source: P.A. 93-480, eff. 8-8-03.)
22    (210 ILCS 76/22 new)
23    Sec. 22. Public reports.
24    (a) In order to increase transparency and accessibility of
25charity care and financial assistance data, a hospital shall



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1make the annual hospital community benefits plan report
2submitted to the Attorney General under Section 20 available
3to the public by publishing the information on the hospital's
4website in the same location where annual reports are posted
5or on a prominent location on the homepage of the hospital's
6website. A hospital is not required to post its audited
7financial statements. Information made available to the public
8shall include, but shall not be limited to, the following:
9        (1) The reporting period.
10        (2) Charity care costs consistent with the reporting
11    requirements in paragraph (3) of subsection (a) of Section
12    20. Charity care costs associated with services provided
13    in a hospital's emergency department shall be reported as
14    a subset of total charity care costs.
15        (3) Total net patient revenue, reported separately by
16    hospital if the reporting health system includes more than
17    one hospital.
18        (4) Total community benefits spending. If a hospital
19    is owned or operated by a health system, total community
20    benefits spending may be reported as a health system.
21        (5) Data on financial assistance applications
22    consistent with the reporting requirements in paragraph
23    (3) of subsection (a) of Section 20, including:
24            (A) the number of applications submitted to the
25        hospital, both complete and incomplete;
26            (B) the number of applications approved; and



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1            (C) the number of applications denied and the 5
2        most frequent reasons for denial.
3        (6) To the extent that race, ethnicity, sex, or
4    preferred language is collected and available for
5    financial assistance applications, the data outlined in
6    paragraph (5) shall be reported by race, ethnicity, sex,
7    and preferred language. If this data is not provided by
8    the patient, the hospital shall indicate this in its
9    reports. Public reporting of this information shall begin
10    with the community benefit report filed on or after July
11    1, 2022. A hospital that files a report without having a
12    full year of demographic data as required by this Act may
13    indicate this in its report.
14    (b) The Attorney General shall provide notice on the
15Attorney General's website informing the public that, upon
16request, the Attorney General will provide the annual reports
17filed with the Attorney General under Section 20. The notice
18shall include the contact information to submit a request.
19    Section 10. The Hospital Uninsured Patient Discount Act is
20amended by changing Sections 5, 10, 15, and 25 as follows:
21    (210 ILCS 89/5)
22    Sec. 5. Definitions. As used in this Act:
23    "Community health center" means a federally qualified
24health center as defined in Section 1905(l)(2)(B) of the



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1federal Social Security Act or a federally qualified health
2center look-alike.
3    "Cost to charge ratio" means the ratio of a hospital's
4costs to its charges taken from its most recently filed
5Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
6Inpatient Ratios).
7    "Critical Access Hospital" means a hospital that is
8designated as such under the federal Medicare Rural Hospital
9Flexibility Program.
10    "Family income" means the sum of a family's annual
11earnings and cash benefits from all sources before taxes, less
12payments made for child support.
13    "Federal poverty income guidelines" means the poverty
14guidelines updated periodically in the Federal Register by the
15United States Department of Health and Human Services under
16authority of 42 U.S.C. 9902(2).
17    "Financial assistance" means a discount provided to a
18patient under the terms and conditions a hospital offers to
19qualified patients or as required by law.
20    "Free and charitable clinic" means a 501(c)(3) tax-exempt
21health care organization providing health services to
22low-income uninsured or underinsured individuals that is
23recognized by either the Illinois Association of Free and
24Charitable Clinics or the National Association of Free and
25Charitable Clinics.
26    "Health care services" means any medically necessary



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1inpatient or outpatient hospital service, including
2pharmaceuticals or supplies provided by a hospital to a
4    "Hospital" means any facility or institution required to
5be licensed pursuant to the Hospital Licensing Act or operated
6under the University of Illinois Hospital Act.
7    "Illinois resident" means any a person who lives in
8Illinois and who intends to remain living in Illinois
9indefinitely. Relocation to Illinois for the sole purpose of
10receiving health care benefits does not satisfy the residency
11requirement under this Act.
12    "Medically necessary" means any inpatient or outpatient
13hospital service, including pharmaceuticals or supplies
14provided by a hospital to a patient, covered under Title XVIII
15of the federal Social Security Act for beneficiaries with the
16same clinical presentation as the uninsured patient. A
17"medically necessary" service does not include any of the
19        (1) Non-medical services such as social and vocational
20    services.
21        (2) Elective cosmetic surgery, but not plastic surgery
22    designed to correct disfigurement caused by injury,
23    illness, or congenital defect or deformity.
24    "Rural hospital" means a hospital that is located outside
25a metropolitan statistical area.
26    "Uninsured discount" means a hospital's charges multiplied



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1by the uninsured discount factor.
2    "Uninsured discount factor" means 1.0 less the product of
3a hospital's cost to charge ratio multiplied by 1.35.
4    "Uninsured patient" means an Illinois resident who is a
5patient of a hospital and is not covered under a policy of
6health insurance and is not a beneficiary under a public or
7private health insurance, health benefit, or other health
8coverage program, including high deductible health insurance
9plans, workers' compensation, accident liability insurance, or
10other third party liability.
11(Source: P.A. 95-965, eff. 12-22-08.)
12    (210 ILCS 89/10)
13    Sec. 10. Uninsured patient discounts.
14    (a) Eligibility.
15        (1) A hospital, other than a rural hospital or
16    Critical Access Hospital, shall provide a discount from
17    its charges to any uninsured patient who applies for a
18    discount and has family income of not more than 600% of the
19    federal poverty income guidelines for all medically
20    necessary health care services exceeding $150 $300 in any
21    one inpatient admission or outpatient encounter.
22        (2) A hospital, other than a rural hospital or
23    Critical Access Hospital, shall provide a charitable
24    discount of 100% of its charges for all medically
25    necessary health care services exceeding $150 $300 in any



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1    one inpatient admission or outpatient encounter to any
2    uninsured patient who applies for a discount and has
3    family income of not more than 200% of the federal poverty
4    income guidelines.
5        (3) A rural hospital or Critical Access Hospital shall
6    provide a discount from its charges to any uninsured
7    patient who applies for a discount and has annual family
8    income of not more than 300% of the federal poverty income
9    guidelines for all medically necessary health care
10    services exceeding $300 in any one inpatient admission or
11    outpatient encounter.
12        (4) A rural hospital or Critical Access Hospital shall
13    provide a charitable discount of 100% of its charges for
14    all medically necessary health care services exceeding
15    $300 in any one inpatient admission or outpatient
16    encounter to any uninsured patient who applies for a
17    discount and has family income of not more than 125% of the
18    federal poverty income guidelines.
19    (b) Discount. For all health care services exceeding $300
20in any one inpatient admission or outpatient encounter, a
21hospital shall not collect from an uninsured patient, deemed
22eligible under subsection (a), more than its charges less the
23amount of the uninsured discount.
24    (c) Maximum Collectible Amount.
25        (1) The maximum amount that may be collected in a
26    12-month 12 month period for health care services provided



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



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1    assets: the uninsured patient's primary residence;
2    personal property exempt from judgment under Section
3    12-1001 of the Code of Civil Procedure; or any amounts
4    held in a pension or retirement plan, provided, however,
5    that distributions and payments from pension or retirement
6    plans may be included as income for the purposes of this
7    Act.
8    (d) Each hospital bill, invoice, or other summary of
9charges to an uninsured patient shall include with it, or on
10it, a prominent statement that an uninsured patient who meets
11certain income requirements may qualify for an uninsured
12discount and information regarding how an uninsured patient
13may apply for consideration under the hospital's financial
14assistance policy. The hospital's financial assistance
15application shall include language that directs the uninsured
16patient to contact the hospital's financial counseling
17department with questions or concerns, along with contact
18information for the financial counseling department, and shall
19state: "Complaints or concerns with the uninsured patient
20discount application process or hospital financial assistance
21process may be reported to the Health Care Bureau of the
22Illinois Attorney General.". A website, phone number, or both
23provided by the Attorney General shall be included with this
25(Source: P.A. 97-690, eff. 6-14-12.)



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1    (210 ILCS 89/15)
2    Sec. 15. Patient responsibility.
3    (a) Hospitals may make the availability of a discount and
4the maximum collectible amount under this Act contingent upon
5the uninsured patient first applying for coverage under public
6programs, such as Medicare, Medicaid, AllKids, the State
7Children's Health Insurance Program, or any other program, if
8there is a reasonable basis to believe that the uninsured
9patient may be eligible for such program.
10    (b) Hospitals shall permit an uninsured patient to apply
11for a discount within 90 60 days of the date of discharge or
12date of service.
13    Hospitals shall offer uninsured patients who receive
14community-based primary care provided by a community health
15center or a free and charitable clinic, are referred by such an
16entity to the hospital, and seek access to nonemergency
17hospital-based health care services with an opportunity to be
18screened for and assistance with applying for public health
19insurance programs if there is a reasonable basis to believe
20that the uninsured patient may be eligible for a public health
21insurance program. An uninsured patient who receives
22community-based primary care provided by a community health
23center or free and charitable clinic and is referred by such an
24entity to the hospital for whom there is not a reasonable basis
25to believe that the uninsured patient may be eligible for a
26public health insurance program shall be given the opportunity



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1to apply for hospital financial assistance when hospital
2services are scheduled.
3        (1) Income verification. Hospitals may require an
4    uninsured patient who is requesting an uninsured discount
5    to provide documentation of family income. Acceptable
6    family income documentation shall include any one of the
7    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; or
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
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. 95-965, eff. 12-22-08.)
22    (210 ILCS 89/25)
23    Sec. 25. Enforcement.
24    (a) The Attorney General is responsible for administering
25and ensuring compliance with this Act, including the



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1development of any rules necessary for the implementation and
2enforcement of this Act.
3    (b) The Attorney General shall develop and implement a
4process for receiving and handling complaints from individuals
5or hospitals regarding possible violations of this Act.
6    (c) The Attorney General may conduct any investigation
7deemed necessary regarding possible violations of this Act by
8any hospital including, without limitation, the issuance of
9subpoenas to:
10        (1) require the hospital to file a statement or report
11    or answer interrogatories in writing as to all information
12    relevant to the alleged violations;
13        (2) examine under oath any person who possesses
14    knowledge or information directly related to the alleged
15    violations; and
16        (3) examine any record, book, document, account, or
17    paper necessary to investigate the alleged violation.
18    (d) If the Attorney General determines that there is a
19reason to believe that any hospital has violated this Act, the
20Attorney General may bring an action in the name of the People
21of the State against the hospital to obtain temporary,
22preliminary, or permanent injunctive relief for any act,
23policy, or practice by the hospital that violates this Act.
24Before bringing such an action, the Attorney General may
25permit the hospital to submit a Correction Plan for the
26Attorney General's approval.



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1    (e) This Section applies if:
2        (1) A court orders a party to make payments to the
3    Attorney General and the payments are to be used for the
4    operations of the Office of the Attorney General; or
5        (2) A party agrees in a Correction Plan under this Act
6    to make payments to the Attorney General for the
7    operations of the Office of the Attorney General.
8    (f) Moneys paid under any of the conditions described in
9subsection (e) shall be deposited into the Attorney General
10Court Ordered and Voluntary Compliance Payment Projects Fund.
11Moneys in the Fund shall be used, subject to appropriation,
12for the performance of any function, pertaining to the
13exercise of the duties, to the Attorney General including, but
14not limited to, enforcement of any law of this State and
15conducting public education programs; however, any moneys in
16the Fund that are required by the court to be used for a
17particular purpose shall be used for that purpose.
18    (g) The Attorney General may seek the assessment of a
19civil monetary penalty not to exceed $500 per violation in any
20action filed under this Act where a hospital, by pattern or
21practice, knowingly violates Section 10 of this Act.
22    (h) In the event a court grants a final order of relief
23against any hospital for a violation of this Act, the Attorney
24General may, after all appeal rights have been exhausted,
25refer the hospital to the Illinois Department of Public Health
26for possible adverse licensure action under the Hospital



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1Licensing Act.
2    (i) Each hospital shall file Worksheet C Part I from its
3most recently filed Medicare Cost Report with the Attorney
4General within 60 days after the effective date of this Act and
5thereafter shall file each subsequent Worksheet C Part I with
6the Attorney General within 30 days of filing its Medicare
7Cost Report with the hospital's fiscal intermediary.
8    (j) No later than September 1, 2022, the Attorney General
9shall provide data on the Attorney General's website regarding
10enforcement efforts performed under this Act from July 1, 2021
11through June 30, 2022. Thereafter, no later than September 1
12of each year through September 1, 2027, the Attorney General
13shall annually provide data on the Attorney General's website
14regarding enforcement efforts performed under this Act from
15July 1 through June 30 of each year. The data shall include the
17        (1) The total number of complaints received.
18        (2) The total number of open investigations.
19        (3) The number of complaints for which assistance in
20    resolving complaints was provided to constituents
21    throughout the State by the Attorney General without
22    resorting to investigations or actions filed.
23        (4) The total number of resolved complaints.
24        (5) The total number of actions filed.
25        (6) A list of the names of facilities found by a
26    pattern or practice to knowingly violate Section 10, along



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1    with any civil penalties assessed against a listed
2    facility.
3(Source: P.A. 95-965, eff. 12-22-08.)
4    Section 99. Effective date. This Act takes effect January
51, 2022.".