Full Text of SB2080 103rd General Assembly
SB2080 103RD GENERAL ASSEMBLY |
| | 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 | |
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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.
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| | A BILL FOR |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Fair Patient Billing Act is amended by | 5 | | changing Sections 5, 10, and 30 and by adding Section 16 as | 6 | | follows: | 7 | | (210 ILCS 88/5)
| 8 | | Sec. 5. Purpose; findings. | 9 | | (a) The purpose of this Act is to advance the prompt and | 10 | | accurate payment of health care services through fair and | 11 | | reasonable 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 | 9 | | collection agency or law firm to collect payment for services | 10 | | from a patient or a patient's guarantor for hospital services. | 11 | | "Culturally competent" or "cultural competency" means | 12 | | providing services, support, or other assistance in a manner | 13 | | that has the greatest likelihood of ensuring maximum | 14 | | participation and is responsive to the beliefs, interpersonal | 15 | | styles, attitudes, languages, and behaviors of individuals who | 16 | | receive services. | 17 | | "Health care plan" means a health insurance company, | 18 | | health maintenance organization, preferred provider | 19 | | arrangement, or third party administrator authorized in this | 20 | | State to issue policies or subscriber contracts or administer | 21 | | those policies and contracts that reimburse for inpatient and | 22 | | outpatient services provided in a hospital. Health care plan, | 23 | | however, does not include any government-funded program such | 24 | | as Medicare or Medicaid, workers' compensation, and accident | 25 | | liability insurers. |
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| 1 | | "Insured patient" means a patient who is insured by a | 2 | | health care plan. | 3 | | "Medical debt" means a debt arising from the receipt of | 4 | | health care services. | 5 | | "Patient" means the individual receiving services from the | 6 | | hospital and any individual who is the guarantor of the | 7 | | payment for such services.
| 8 | | "Reasonable payment plan" means a plan to pay a hospital | 9 | | bill that is offered to the patient or the patient's legal | 10 | | representative and takes into account the patient's available | 11 | | income and assets, the amount owed, and any prior payments. | 12 | | "Reasonable payment plan" does not include a payment plan that | 13 | | requires a patient to pay moneys that the hospital knows or | 14 | | should know are eligible for a discount under the Hospital | 15 | | Uninsured Patient Discount Act. | 16 | | "Screen" or "screening" means a process whereby a hospital | 17 | | engages with an uninsured patient to review whether the | 18 | | patient's circumstances are conducive with eligibility | 19 | | criteria for financial assistance that is offered by the | 20 | | hospital or known to the hospital, public health insurance, or | 21 | | discounted care. "Screen" or "screening" includes, but is not | 22 | | limited to, informing the patient of the hospital's | 23 | | assessment, documenting the circumstances of the screening in | 24 | | the patient's file, and either assisting with the | 25 | | application's completion or providing information to the | 26 | | patient about how he or she can enroll or otherwise apply for |
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| 1 | | the assistance. | 2 | | "Uninsured patient" means a patient who is not insured by | 3 | | a health care plan and is not a beneficiary under a | 4 | | government-funded program, workers' compensation, or accident | 5 | | liability 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 | 9 | | assistance; sale of medical debt; enforcement. | 10 | | (a) A hospital shall screen each uninsured patient for | 11 | | eligibility 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, | 7 | | including, but not limited to, initial screenings and follow | 8 | | up activities, must be culturally competent. All information | 9 | | provided to an uninsured patient for a screening must be in the | 10 | | uninsured patient's primary language, worded in a way that is | 11 | | easy to understand, and in an accessible format. Information | 12 | | from a screening that is provided to an uninsured patient | 13 | | verbally may include use of a professional interpretation | 14 | | service. Information from a screening that is provided to an | 15 | | uninsured patient in writing shall be in the uninsured | 16 | | patient's or the uninsured patient's legal representative's | 17 | | primary language, if applicable. | 18 | | (c) If an uninsured patient declines the screening | 19 | | described in subsection (a), the hospital shall document the | 20 | | uninsured patient's informed written consent to decline the | 21 | | screening and the date and method by which the uninsured | 22 | | patient declined it. An uninsured patient's decision to | 23 | | decline a screening is a defense to a claim brought by an | 24 | | uninsured patient under this Section if contemporaneous | 25 | | hospital documentation shows that the decision to decline the | 26 | | screening was an informed decision and presented in the |
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| 1 | | uninsured patient's primary language. | 2 | | (d) A hospital must screen an uninsured patient at the | 3 | | earliest reasonable moment, which in all circumstances means | 4 | | before issuing a bill to the uninsured patient. After the | 5 | | screening, the hospital shall inform the uninsured patient of | 6 | | the hospital's assessment of his or her circumstances. | 7 | | (e) If a screening indicates that the uninsured patient | 8 | | may be eligible for financial assistance, the hospital shall | 9 | | assist the uninsured patient with applying for financial | 10 | | assistance in accordance with Section 27. | 11 | | (f) If a screening indicates that the uninsured patient | 12 | | may be eligible for financial assistance, the hospital shall | 13 | | provide information to the uninsured patient detailing how the | 14 | | uninsured patient can enroll in the financial assistance, | 15 | | including, but not limited to, referring the uninsured patient | 16 | | to health care navigators who provide free and unbiased | 17 | | eligibility and enrollment assistance such as Federally | 18 | | Qualified Health Centers (FQHCs), programs offered by the | 19 | | Department of Human Services, or any other resource that is | 20 | | recognized by the State as being designed to assist uninsured | 21 | | individuals in obtaining health care coverage. | 22 | | (g) The date that an uninsured patient's screening takes | 23 | | place, or the date on which a decision regarding the uninsured | 24 | | patient's eligibility for financial assistance described under | 25 | | subsection (a) is pending, whichever is applicable, is the | 26 | | starting date of any deadline for the uninsured patient to |
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| 1 | | file an application with the hospital for financial | 2 | | assistance. If the uninsured patient's application is | 3 | | approved, the hospital shall bill the entity providing the | 4 | | financial assistance and shall not pursue a collection action | 5 | | against the uninsured patient. If the uninsured patient's | 6 | | application is denied, the hospital shall screen the uninsured | 7 | | patient again, and the deadline to file an application for | 8 | | financial assistance shall begin anew. | 9 | | (h) If a hospital is contacted by an insured patient in | 10 | | response to a bill issued by the hospital to the insured | 11 | | patient, the hospital shall screen the insured patient for | 12 | | discounted care at the earliest reasonable moment if (i) the | 13 | | insured patient requests the screening, (ii) the insured | 14 | | patient provides information suggesting his or her inability | 15 | | to pay the bill, (iii) the hospital obtains information | 16 | | suggesting the insured patient's inability to pay, or (iv) | 17 | | circumstances suggest the insured patient's inability to pay | 18 | | the bill. | 19 | | (i) A hospital shall develop an operational plan for | 20 | | implementing the screening requirements under this Section. | 21 | | The operational plan shall describe hospital activities to | 22 | | adopt and actively implement policies and training to ensure | 23 | | compliance with this Section, including, but not limited to, | 24 | | training 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 | 5 | | training required under this subsection, including, but not | 6 | | limited to, staff required to receive the training and | 7 | | ensuring compliance with this Section. Each hospital employee | 8 | | shall receive the training, as applicable, required for that | 9 | | employee's position at least once each year. | 10 | | (j) An uninsured patient may apply for financial | 11 | | assistance at any time before, during, or after a hospital has | 12 | | initiated any legal process to collect the uninsured patient's | 13 | | medical debt. | 14 | | (k) A hospital shall not sell an obligation due to the | 15 | | hospital as an uninsured patient's medical debt. | 16 | | (l) A hospital may demonstrate compliance with this | 17 | | Section by submitting the hospital's chief financial | 18 | | officer's, or the chief financial officer's designee's, sworn | 19 | | affidavit affirming that the uninsured patient does not meet | 20 | | the required criteria for financial assistance and listing the | 21 | | specific 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 | 15 | | action against an uninsured patient only if the following | 16 | | conditions 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 | 16 | | charity care options available to uninsured patients, | 17 | | regardless of their immigration status or residency. | 18 | | (b) A hospital may not refer a bill, or portion thereof, to | 19 | | a collection agency or attorney for collection action against | 20 | | the insured patient, without first offering the patient the | 21 | | opportunity to request a reasonable payment plan for the | 22 | | amount personally owed by the patient. Such an opportunity | 23 | | shall be made available for the 30 days following the date of | 24 | | the initial bill. If the insured patient requests a reasonable | 25 | | payment plan, but fails to agree to a plan within 30 days of | 26 | | the request, the hospital may proceed with collection action |
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| 1 | | against the patient. | 2 | | (c) No collection agency, law firm, or individual may | 3 | | initiate legal action for non-payment of a hospital bill | 4 | | against a patient without the written approval of an | 5 | | authorized hospital employee who reasonably believes that the | 6 | | conditions for pursuing collection action under this Section | 7 | | have been met. | 8 | | (d) Nothing in this Section prohibits a hospital from | 9 | | engaging an outside third party agency, firm, or individual to | 10 | | manage the process of implementing the hospital's financial | 11 | | assistance and reasonable payment plan programs and policies | 12 | | so long as such agency, firm, or individual is contractually | 13 | | bound 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 | 16 | | amended 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 | 20 | | the maximum collectible amount under this Act contingent upon | 21 | | the uninsured patient first applying for coverage under public | 22 | | health insurance programs, such as Medicare, Medicaid, | 23 | | AllKids, the State Children's Health Insurance Program, or any | 24 | | other program, if there is a reasonable basis to believe that |
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| 1 | | the uninsured patient may be eligible for such program , unless | 2 | | the patient declines to apply for a public health insurance | 3 | | program on the basis of concern for immigration-related | 4 | | consequences to the patient, which shall not be grounds for | 5 | | the hospital to deny financial assistance under the hospital's | 6 | | financial assistance policy . | 7 | | (b) Hospitals shall permit an uninsured patient to apply | 8 | | for a discount within 90 days of the date of discharge or date | 9 | | of service. | 10 | | Hospitals shall offer uninsured patients who receive | 11 | | community-based primary care provided by a community health | 12 | | center or a free and charitable clinic, are referred by such an | 13 | | entity to the hospital, and seek access to nonemergency | 14 | | hospital-based health care services with an opportunity to be | 15 | | screened for and assistance with applying for public health | 16 | | insurance programs if there is a reasonable basis to believe | 17 | | that the uninsured patient may be eligible for a public health | 18 | | insurance program. An uninsured patient who receives | 19 | | community-based primary care provided by a community health | 20 | | center or free and charitable clinic and is referred by such an | 21 | | entity to the hospital for whom there is not a reasonable basis | 22 | | to believe that the uninsured patient may be eligible for a | 23 | | public health insurance program shall be given the opportunity | 24 | | to apply for hospital financial assistance when hospital | 25 | | services 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 | 20 | | patient under this Act shall cease if that patient | 21 | | unreasonably fails or refuses to provide the hospital with | 22 | | information or documentation requested under subsection (b) or | 23 | | to apply for coverage under public programs when requested | 24 | | under subsection (a) within 30 days of the hospital's request. | 25 | | (d) In order for a hospital to determine the 12 month | 26 | | maximum amount that can be collected from a patient deemed |
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| 1 | | eligible under Section 10, an uninsured patient shall inform | 2 | | the hospital in subsequent inpatient admissions or outpatient | 3 | | encounters that the patient has previously received health | 4 | | care services from that hospital and was determined to be | 5 | | entitled to the uninsured discount. | 6 | | (e) Hospitals may require patients to certify that all of | 7 | | the information provided in the application is true. The | 8 | | application may state that if any of the information is | 9 | | untrue, any discount granted to the patient is forfeited and | 10 | | the patient is responsible for payment of the hospital's full | 11 | | charges. | 12 | | (f) Hospitals shall ask for an applicant's race, | 13 | | ethnicity, sex, and preferred language on the financial | 14 | | assistance application. However, the questions shall be | 15 | | clearly marked as optional responses for the patient and shall | 16 | | note that responses or nonresponses by the patient will not | 17 | | have any impact on the outcome of the application.
| 18 | | (Source: P.A. 102-581, eff. 1-1-22 .)
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