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

HB2719ham001 103RD GENERAL ASSEMBLY

Rep. Dagmara Avelar

Filed: 3/21/2023

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 2719

2    AMENDMENT NO. ______. Amend House Bill 2719 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1shall include, but shall not be limited to, the following:
2        (1) The reporting period.
3        (2) Charity care costs consistent with the reporting
4    requirements in paragraph (3) of subsection (a) of Section
5    20. Charity care costs associated with services provided
6    in a hospital's emergency department shall be reported as
7    a subset of total charity care costs.
8        (3) Total net patient revenue, reported separately by
9    hospital if the reporting health system includes more than
10    one hospital.
11        (4) Total community benefits spending. If a hospital
12    is owned or operated by a health system, total community
13    benefits spending may be reported as a health system.
14        (5) Data on financial assistance applications
15    consistent with the reporting requirements in paragraph
16    (3) of subsection (a) of Section 20, including:
17            (A) the number of applications submitted to the
18        hospital, both complete and incomplete;
19            (B) the number of applications approved; and
20            (C) the number of applications denied and the 5
21        most frequent reasons for denial; and .
22            (D) the number of uninsured patients who have
23        declined or failed to respond to the screening
24        described in subsection (a) of Section 16 of the Fair
25        Patient Billing Act and the 5 most frequent reasons
26        for declining.

 

 

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1        (6) To the extent that race, ethnicity, sex, or
2    preferred language is collected and available for
3    financial assistance applications, the data outlined in
4    paragraph (5) shall be reported by race, ethnicity, sex,
5    and preferred language. If this data is not provided by
6    the patient, the hospital shall indicate this in its
7    reports. Public reporting of this information shall begin
8    with the community benefit report filed on or after July
9    1, 2022. A hospital that files a report without having a
10    full year of demographic data as required by this Act may
11    indicate this in its report.
12    (b) The Attorney General shall provide notice on the
13Attorney General's website informing the public that, upon
14request, the Attorney General will provide the annual reports
15filed with the Attorney General under Section 20. The notice
16shall include the contact information to submit a request.
17(Source: P.A. 102-581, eff. 1-1-22.)
 
18    Section 10. The Fair Patient Billing Act is amended by
19changing Sections 5, 10, 30, 45, and 70 and by adding Section
2016 as follows:
 
21    (210 ILCS 88/5)
22    Sec. 5. Purpose; findings.
23    (a) The purpose of this Act is to advance the prompt and
24accurate payment of health care services through fair and

 

 

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1reasonable billing and collection practices of hospitals.
2    (b) The General Assembly finds that:
3        (1) Medical debts are the cause of an increasing
4    number of bankruptcies in Illinois and are typically
5    associated with severe financial hardship incurred by
6    bankrupt persons and their families.
7        (2) Patients, hospitals, and government bodies alike
8    will benefit from clearly articulated standards regarding
9    fair billing and collection practices for all Illinois
10    hospitals.
11        (3) Hospitals should employ responsible standards when
12    collecting debt from their patients.
13        (4) Patients should be provided sufficient billing
14    information from hospitals to determine the accuracy of
15    the bills for which they may be financially responsible.
16        (5) Patients should be given a fair and reasonable
17    opportunity to discuss and assess the accuracy of their
18    bill.
19        (6) Hospitals should provide patients with timely and
20    meaningful access to any financial assistance available
21    through the hospital and any public health insurance
22    programs for which patients may be eligible to prevent
23    patients from ending up with avoidable medical debt.
24    Hospitals should assist patients who need financial
25    assistance to access it. Patients who are deemed eligible
26    for hospital financial assistance or public health

 

 

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1    insurance programs should not be improperly billed,
2    steered into payment plans, or sent to collections
3    Patients should be provided information regarding the
4    hospital's policies regarding financial assistance options
5    the hospital may offer to qualified patients.
6        (7) Hospitals should offer patients the opportunity to
7    enter into a reasonable payment plan for their hospital
8    care.
9        (8) Patients have an obligation to pay for the
10    hospital services they receive subject to any discounts or
11    free care for which they are eligible under Illinois law.
12        (9) Hospitals have an obligation to screen uninsured
13    patients before pursuing collection action. To promote the
14    general welfare and to mitigate the negative impact that
15    medical debt has on accessing and using needed health
16    care, hospitals should not attempt to collect a debt from
17    an uninsured patient without first adequately screening
18    the patient for public health insurance programs and
19    financial assistance available to the patient and
20    assisting the patient in obtaining the hospital financial
21    assistance for which they are eligible.
22(Source: P.A. 94-885, eff. 1-1-07.)
 
23    (210 ILCS 88/10)
24    Sec. 10. Definitions. As used in this Act:
25    "Collection action" means any referral of a bill to a

 

 

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1collection agency or law firm to collect payment for services
2from a patient or a patient's guarantor for hospital services.
3    "Health care plan" means a health insurance company,
4health maintenance organization, preferred provider
5arrangement, or third party administrator authorized in this
6State to issue policies or subscriber contracts or administer
7those policies and contracts that reimburse for inpatient and
8outpatient services provided in a hospital. Health care plan,
9however, does not include any government-funded program such
10as Medicare or Medicaid, workers' compensation, and accident
11liability insurers.
12    "Insured patient" means a patient who is insured by a
13health care plan.
14    "Medical debt" means a debt arising from the receipt of
15health care services, products, or devices.
16    "Patient" means the individual receiving services from the
17hospital and any individual who is the guarantor of the
18payment for such services.
19    "Public health insurance program" means Medicare;
20Medicaid; medical assistance under the Non-Citizen Victims of
21Trafficking, Torture and Other Serious Crimes program; Health
22Benefit for Immigrant Adults; Health Benefit for Immigrant
23Seniors; All Kids; or other medical assistance programs
24offered by the Department of Healthcare and Family Services.
25    "Reasonable payment plan" means a plan to pay a hospital
26bill that is offered to the patient or the patient's legal

 

 

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1representative and takes into account the patient's available
2income and assets, the amount owed, and any prior payments.
3    "Screen" or "screening" means a process whereby a hospital
4engages with a patient to review and assess the patient's
5potential eligibility for any financial assistance offered by
6the hospital, public health insurance program, or other
7discounted care known to the hospital; informs the patient of
8the hospital's assessment; documents in the patient's record
9the circumstances of the screening; and assists with the
10application for hospital financial assistance.
11    "Uninsured patient" means a patient who is not insured by
12a health care plan and is not a beneficiary under a
13government-funded program, workers' compensation, or accident
14liability insurance.
15(Source: P.A. 94-885, eff. 1-1-07.)
 
16    (210 ILCS 88/16 new)
17    Sec. 16. Screening patients for health insurance and
18financial assistance.
19    (a) All hospitals shall screen each uninsured patient,
20upon the uninsured patient's agreement, at the earliest
21reasonable moment for potential eligibility for both:
22        (1) public health insurance programs; and
23        (2) any financial assistance offered by the hospital.
24    (b) All screening activities, including initial screenings
25and all follow-up assistance, must be provided in compliance

 

 

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1with the Language Assistance Services Act and other applicable
2federal and State laws and regulations. Nothing in this
3Section is intended to extend the enforcement authority of the
4Office of the Attorney General beyond any authority not
5otherwise granted.
6    (c) If a patient declines or fails to respond to the
7screening described in subsection (a), the hospital shall
8document in the patient's record the patient's decision to
9decline or failure to respond to the screening, confirming the
10date and method by which the patient declined or failed to
11respond.
12    (d) If a patient does not decline the screening described
13in subsection (a), a hospital should screen an uninsured
14patient during registration unless it would cause a delay of
15care to the patient, otherwise a hospital must screen an
16uninsured patient at the earliest reasonable moment.
17    (e) If a patient does not submit screening, financial
18assistance application, or reasonable payment plan
19documentation within 30 days after a request as required under
20Section 45, the hospital shall document the lack of received
21documentation, confirming the date that the screening took
22place and that the 30-day timeline for responding to the
23hospital's request has lapsed, but may be reopened within 90
24days after the date of discharge, date of service, or
25completion of the screening.
26    (f) If the screening indicates that the patient may be

 

 

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1eligible for a public health insurance program, the hospital
2shall provide information to the patient about how the patient
3can apply for the public health insurance program, including,
4but not limited to, referral to health care navigators who
5provide free and unbiased eligibility and enrollment
6assistance, including health care navigators at federally
7qualified health centers; local, State, or federal government
8agencies; or any other resources that Illinois recognizes as
9designed to assist uninsured individuals in obtaining health
10coverage.
11    (g) If the uninsured patient's application for a public
12health insurance program is approved, the hospital shall bill
13the insuring entity and shall not pursue the patient for any
14aspect of the bill, except for any required copayment,
15coinsurance, or other similar payment for which the patient is
16responsible under the insurance. If the uninsured patient's
17application for public health insurance is denied, the
18hospital shall again offer to screen the uninsured patient for
19hospital financial assistance and the timeline for applying
20for financial assistance under the Hospital Uninsured Patient
21Discount Act shall begin again.
22    (h) A hospital shall offer to screen an insured patient
23for hospital financial assistance under this Section if the
24patient requests financial assistance screening, if the
25hospital is contacted in response to a bill, if the hospital
26learns information that suggests an inability to pay, or if

 

 

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1the circumstances otherwise suggest the patient's inability to
2pay.
3    (i) Any hospital that submits an annual hospital community
4benefits plan report to the Attorney General shall include in
5that report the number of uninsured patients who have declined
6or failed to respond to screening under subsection (a) of
7Section 16 and the 5 most frequent reasons for declining.
 
8    (210 ILCS 88/30)
9    Sec. 30. Pursuing collection action.
10    (a) Hospitals and their agents may pursue collection
11action against an uninsured patient only if the following
12conditions are met:
13        (1) The hospital has complied with the screening
14    requirements set forth in Section 16 and applied and
15    exhausted any discount available to a patient under
16    Section 10 of the Hospital Uninsured Patient Discount Act.
17        (2) (1) The hospital has given the uninsured patient
18    the 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        (3) (2) If the uninsured patient has indicated an
24    inability to pay the full amount of the debt in one
25    payment, the hospital has offered the patient a reasonable

 

 

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1    payment plan. The hospital may require the uninsured
2    patient to provide reasonable verification of his or her
3    inability to pay the full amount of the debt in one
4    payment.
5        (4) (3) To the extent the hospital provides financial
6    assistance and the circumstances of the uninsured patient
7    suggest the potential for eligibility for charity care,
8    the uninsured patient has been given at least 90 60 days
9    following the date of discharge or receipt of outpatient
10    care to submit an application for financial assistance and
11    shall be provided assistance with the application in
12    compliance with subsection (a) of Section 16 and Section
13    27.
14        (5) (4) If the uninsured patient has agreed to a
15    reasonable payment plan with the hospital, and the patient
16    has failed to make payments in accordance with that
17    reasonable payment plan.
18        (6) (5) If the uninsured patient informs the hospital
19    that he or she has applied for health care coverage under a
20    public health insurance program Medicaid, Kidcare, or
21    other government-sponsored health care program (and there
22    is a reasonable basis to believe that the patient will
23    qualify for such program) but the patient's application is
24    denied.
25    (a-5) A hospital shall proactively offer information on
26charity care options available to uninsured patients,

 

 

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1regardless of their immigration status or residency.
2    (b) A hospital may not refer a bill, or portion thereof, to
3a collection agency or attorney for collection action against
4the insured patient, without first ensuring compliance with
5Section 16 and offering the patient the opportunity to request
6a reasonable payment plan for the amount personally owed by
7the patient. Such an opportunity shall be made available for
8the 90 30 days following the date of the initial bill. If the
9insured patient requests a reasonable payment plan, but fails
10to agree to a plan within 90 30 days of the request, the
11hospital may proceed with collection action against the
12patient.
13    (c) No collection agency, law firm, or individual may
14initiate legal action for non-payment of a hospital bill
15against a patient without the written approval of an
16authorized hospital employee who reasonably believes that the
17conditions for pursuing collection action under this Section
18have been met.
19    (d) Nothing in this Section prohibits a hospital from
20engaging an outside third party agency, firm, or individual to
21manage the process of implementing the hospital's financial
22assistance and reasonable payment plan programs and policies
23so long as such agency, firm, or individual is contractually
24bound to comply with the terms of this Act.
25(Source: P.A. 102-504, eff. 12-1-21.)
 

 

 

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1    (210 ILCS 88/45)
2    Sec. 45. Patient responsibilities.
3    (a) To receive the protection and benefits of this Act, a
4patient responsible for paying a hospital bill must act
5reasonably and cooperate in good faith with the hospital in
6the screening process by providing the hospital with all of
7the reasonably requested financial and other relevant
8information and documentation needed to determine the
9patient's potential eligibility for coverage under a public
10health insurance program, under the hospital's financial
11assistance policy, or for a and reasonable payment plan
12options to qualified patients within 30 days of a request for
13such information.
14    (b) To receive the protection and benefits of this Act, a
15patient responsible for paying a hospital bill shall
16communicate to the hospital any material change in the
17patient's financial situation that may affect the patient's
18ability to abide by the provisions of an agreed upon
19reasonable payment plan or qualification for financial
20assistance within 30 days of the change.
21(Source: P.A. 94-885, eff. 1-1-07.)
 
22    (210 ILCS 88/70)
23    Sec. 70. Application.
24    (a) This Act applies to all hospitals licensed under the
25Hospital Licensing Act or the University of Illinois Hospital

 

 

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1Act. This Act does not apply to a hospital that does not charge
2for its services.
3    (b) The obligations of hospitals under this Act shall take
4effect for services provided on or after the first day of the
5month that begins 180 days after the effective date of this
6Act.
7    (c) The obligations of hospitals under this amendatory Act
8of the 103rd General Assembly shall apply to services provided
9on or after the first day of the month that begins 180 days
10after the effective date of this amendatory Act of the 103rd
11General Assembly.
12(Source: P.A. 94-885, eff. 1-1-07.)
 
13    Section 15. The Hospital Uninsured Patient Discount Act is
14amended by changing Section 15 as follows:
 
15    (210 ILCS 89/15)
16    Sec. 15. Patient responsibility.
17    (a) Hospitals may make the availability of a discount and
18the maximum collectible amount under this Act contingent upon
19the uninsured patient first applying for coverage under public
20health insurance programs, such as Medicare, Medicaid,
21AllKids, the State Children's Health Insurance Program, or any
22other program, if there is a reasonable basis to believe that
23the uninsured patient may be eligible for such program. If the
24patient declines to apply for a public health insurance

 

 

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1program on the basis of concern for immigration-related
2consequences, the hospital may refer the patient to a free,
3unbiased resource such as an Immigrant Family Resource Program
4to address the patient's immigration-related concerns and
5assist in enrolling the patient in a public health insurance
6program. The hospital may still screen the patient for
7eligibility under its financial assistance policy.
8    (b) Hospitals shall permit an uninsured patient to apply
9for a discount within 90 days of the date of discharge, or date
10of service, completion of the screening under the Fair Patient
11Billing Act, or denial of an application for a public health
12insurance program.
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;
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.)".