Full Text of SB2579 093rd General Assembly
SB2579eng 93RD GENERAL ASSEMBLY
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| AN ACT concerning health facilities.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the | 5 |
| Hospital Charity Assistance Act. | 6 |
| Section 5. Applicability. | 7 |
| (a) This Act does not apply to a hospital that does not | 8 |
| charge for its services. | 9 |
| (b) The obligations of hospitals under this Act shall apply | 10 |
| to services provided on or after the first day of the first | 11 |
| month that begins at least 180 days after the effective date of | 12 |
| this Act. | 13 |
| Section 10. Definitions. In this Act: | 14 |
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"Cost of providing services" means a hospital's published | 15 |
| charges at the time of billing of an uninsured patient, | 16 |
| multiplied by the hospital's most recent relationship of costs | 17 |
| to charges taken from the most recently audited Medicare cost | 18 |
| report. | 19 |
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"Department" means the Illinois Department of Public | 20 |
| Health.
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| "Federal poverty level" means the poverty guidelines | 22 |
| updated periodically in the Federal Register by the United | 23 |
| States Department of Health and Human Services under authority | 24 |
| of subsection (2) of Section 9902 of Title 42 of the United | 25 |
| States Code. | 26 |
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"Financially qualified uninsured patient" means a patient | 27 |
| who is uninsured, whose family income is less than 200% of the | 28 |
| federal poverty level, and who satisfies the requirements under | 29 |
| a hospital's charity assistance policy under Section 20 of this | 30 |
| Act.
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| "Hospital" means any facility that is required to be |
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| licensed under the Hospital Licensing Act.
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| "Medically necessary service" means any inpatient or | 3 |
| outpatient hospital service that is covered by and considered | 4 |
| to be medically necessary under Title XVIII of the federal | 5 |
| Social Security Act. Medically necessary services do not | 6 |
| include any of the following: | 7 |
| (1) Non-medical services such as social, educational, | 8 |
| and vocational services. | 9 |
| (2) Cosmetic surgery. | 10 |
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"Uninsured discount" means, with respect to medically | 11 |
| necessary services rendered to a financially qualified | 12 |
| uninsured patient, a discount that is applied after the | 13 |
| hospital's charges are imposed on the patient, due to the | 14 |
| patient's determined financial inability to pay the charges. | 15 |
| "Uninsured patient" means a patient who has been an | 16 |
| Illinois resident for at least one year, who does not have | 17 |
| third-party coverage from a health insurer, a health care | 18 |
| service plan, Medicare, or Medicaid, and whose injury is not | 19 |
| compensable for purposes of workers' compensation, automobile | 20 |
| insurance, or other insurance as determined and documented by | 21 |
| the hospital. The term does not include any patient who had an | 22 |
| opportunity to obtain third-party coverage through his or her | 23 |
| employer but did not obtain such coverage.
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| Section 15. Charity assistance policy. Every hospital | 25 |
| must adopt a charity assistance policy specifying how the | 26 |
| hospital will determine the financial liability for medically | 27 |
| necessary services rendered to financially qualified uninsured | 28 |
| patients. Every hospital must specify in its policy how the | 29 |
| hospital will determine and apply uninsured discounts for | 30 |
| services provided to financially qualified uninsured patients. | 31 |
| The policy must include: | 32 |
| (1) Financial eligibility criteria. | 33 |
| (2) Responsibilities and information required of the | 34 |
| uninsured patient. | 35 |
| (3) A summary of the decision-making process. |
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| (4) A description of how the hospital will consider | 2 |
| assets available to the uninsured patient in determining | 3 |
| whether the uninsured patient qualifies for an uninsured | 4 |
| discount. The following are to be considered exempt and | 5 |
| shall not be considered in determining whether the | 6 |
| uninsured patient qualifies for an uninsured discount: | 7 |
| (A) Homestead property. | 8 |
| (B) $2,000 for the uninsured patient, or $3,000 for | 9 |
| the uninsured patient and one dependant residing | 10 |
| together. | 11 |
| (C) $50 for each additional dependant residing in | 12 |
| the same household. | 13 |
| (D) Personal effects and household goods that have | 14 |
| a total value of less than $2,000. | 15 |
| (E) A wedding and engagement ring and items | 16 |
| required due to medical or physical condition. | 17 |
| (F) One automobile with fair market value of $4,500 | 18 |
| or less. | 19 |
| If the uninsured patient satisfies the requirements | 20 |
| established by the hospital to qualify for an uninsured | 21 |
| discount and the family income of the uninsured patient is | 22 |
| equal to or less than the federal poverty level, the uninsured | 23 |
| discount shall be 100% of the charges for the medically | 24 |
| necessary services provided to the uninsured patient. | 25 |
| If the uninsured patient satisfies the requirements | 26 |
| established by the hospital to qualify for an uninsured | 27 |
| discount and the family income of the uninsured patient is | 28 |
| greater than 100% of the federal poverty level, but less than | 29 |
| 200% of the federal poverty level, the uninsured discount shall | 30 |
| be at least equal to the difference between the charge for | 31 |
| medically necessary services and the cost of providing | 32 |
| services. | 33 |
| Section 20. Patient responsibilities. | 34 |
| (a) A hospital's charity assistance policy may require the | 35 |
| cooperation of the uninsured patient, as a condition of |
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| receiving assistance. That cooperation may include, but need | 2 |
| not be limited to, the following: | 3 |
| (1) The uninsured patient must cooperate with the | 4 |
| hospital in providing information on third-party coverage. | 5 |
| If the hospital finds that there is a reasonable basis to | 6 |
| believe that the patient may qualify for such assistance, | 7 |
| the patient must cooperate in applying for third-party | 8 |
| coverage that may be available to pay for the uninsured | 9 |
| patient's medically necessary care, including coverage | 10 |
| from a health insurer, a health care service plan, | 11 |
| Medicare, Medicaid, KidCare, FamilyCare, automobile | 12 |
| insurance, worker's compensation, or other insurance. | 13 |
| (2) The uninsured patient must provide the hospital | 14 |
| with financial and other information requested by the | 15 |
| hospital to determine eligibility for charity assistance | 16 |
| through the hospital. | 17 |
| (3) The uninsured patient or a person acting on his or | 18 |
| her behalf must request assistance from the hospital. | 19 |
| (4) The uninsured patient who has a payment obligation | 20 |
| to the hospital must cooperate with the hospital to | 21 |
| establish and comply with a payment plan. The uninsured | 22 |
| patient who enters into a payment plan with the hospital | 23 |
| shall promptly inform the hospital of any change in | 24 |
| circumstances that will impair his or her ability to comply | 25 |
| with the payment plan. | 26 |
| (b) An uninsured patient who fails to satisfy his or her | 27 |
| responsibilities under subsection (a) may be billed by the | 28 |
| hospital and is subject to collection activities consistent | 29 |
| with the hospital's billing and collection policies and | 30 |
| practices for patients who do not qualify for assistance under | 31 |
| its charity assistance policy. | 32 |
| (c) A financially qualified uninsured patient who fails to | 33 |
| comply with a payment plan may be billed by the hospital and is | 34 |
| subject to collection activities consistent with the | 35 |
| hospital's billing and collection policies and practices for | 36 |
| the portion of the bill remaining after the uninsured discount |
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| has been applied. | 2 |
| Section 25. Notice of policy. | 3 |
| (a)
Notice of the hospital's charity assistance policy must | 4 |
| be clearly and conspicuously posted in locations that are | 5 |
| visible to the public, including, but not limited to, all of | 6 |
| the following: | 7 |
| (1) The emergency department, if any. | 8 |
| (2) The billing office. | 9 |
| (3) The admissions office. | 10 |
| (b)
Notice of the hospital's charity assistance policy must | 11 |
| be available in brochures that are available to the public in | 12 |
| the hospital. | 13 |
| (c)
The following information must be included on or with | 14 |
| the bill sent to an uninsured patient: | 15 |
| (1) A request that the patient inform the hospital if | 16 |
| the patient has health insurance coverage, Medicare, | 17 |
| Medicaid, or other insurance. | 18 |
| (2) A statement that if the patient does not have | 19 |
| health insurance he or she may be eligible for Medicare, | 20 |
| Medicaid, FamilyCare, KidCare, or the hospital's charity | 21 |
| assistance program. | 22 |
| (3) A statement indicating how the patient may obtain | 23 |
| information on how to apply for Medicare, Medicaid, | 24 |
| FamilyCare, KidCare, and the hospital's charity assistance | 25 |
| program. | 26 |
| (4) The hospital contact and phone number for financial | 27 |
| assistance programs. | 28 |
| (d) The written notices required under this Section shall | 29 |
| be available in English and any other language that is the | 30 |
| primary language of at least 5% of the patients served by the | 31 |
| hospital annually.
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| Section 30. Application forms.
Every hospital must make | 33 |
| available, upon request by a member of the public, a copy of | 34 |
| the application used by the hospital to determine a patient's |
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| eligibility for charity assistance.
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| Section 35. Billing.
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| (a) Every hospital must make reasonable efforts to obtain | 4 |
| from a patient or his or her representative information about | 5 |
| whether private or public health insurance or sponsorship may | 6 |
| fully or partially cover the charges for care rendered by the | 7 |
| hospital to the patient, including, but not limited to, any of | 8 |
| the following: | 9 |
| (1) Private health insurance. | 10 |
| (2) Medicare. | 11 |
| (3) Medicaid, FamilyCare, KidCare, or other | 12 |
| state-funded or county-funded programs designed to provide | 13 |
| health coverage.
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| (b) If a hospital bills a patient, then upon request from | 15 |
| the patient the hospital must provide an itemized statement of | 16 |
| charges for services rendered by the hospital within 70 days | 17 |
| after receiving the request.
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| Section 40. Debt collection activities. | 19 |
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(a) For at least 70 days after an uninsured patient's | 20 |
| discharge from a hospital, the hospital or its assignee or | 21 |
| billing service shall not file a lawsuit to collect payment on | 22 |
| the patient's bill. | 23 |
| (b)
If an uninsured patient complies with a payment plan | 24 |
| that has been agreed to by the hospital, the hospital shall not | 25 |
| otherwise pursue collection action against the uninsured | 26 |
| patient.
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| (c) If an uninsured patient informs the hospital that he or | 28 |
| she has applied for health care coverage in compliance with | 29 |
| subsection (a) of Section 20 of this Act, the hospital or its | 30 |
| assignee or billing service shall not pursue any collection | 31 |
| action against the uninsured patient until a decision has been | 32 |
| made on the application for health care coverage or until there | 33 |
| is no longer a reasonable basis to believe the patient may | 34 |
| qualify for such coverage, whichever is sooner. |
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| (d)
If an uninsured patient has requested charity | 2 |
| assistance from a hospital and is cooperating with the hospital | 3 |
| under Section 20 of this Act, the hospital or its assignee or | 4 |
| billing service shall not pursue any collection action against | 5 |
| the uninsured patient until a determination is made on the | 6 |
| uninsured patient's eligibility for charity assistance. | 7 |
| Section 45. Availability of policy.
Every hospital, upon | 8 |
| request, must provide any member of the public and the | 9 |
| Department with a copy of its charity assistance policy. | 10 |
| Section 50. Enforcement. | 11 |
| (a) The Department shall develop and implement a complaint | 12 |
| system through which the Department may receive complaints of | 13 |
| violations of this Act. The Department shall establish a | 14 |
| complaint system or utilize an existing Department complaint | 15 |
| system. The complaint system shall include (i) a complaint | 16 |
| verification process by which the Department determines the | 17 |
| validity of a complaint and (ii) an opportunity for a hospital | 18 |
| to resolve the complaint through an informal dispute resolution | 19 |
| process. | 20 |
| If the complaint is not resolved informally, then the | 21 |
| Department shall serve a notice of violation of this Act on the | 22 |
| hospital. The notice of violation shall be in writing and shall | 23 |
| specify the nature of the violation and the statutory provision | 24 |
| alleged to have been violated. The notice shall inform the | 25 |
| hospital of the action the Department may take under this Act, | 26 |
| the amount of any financial penalty to be imposed, and the | 27 |
| opportunity for the hospital to enter into a plan of | 28 |
| correction. The notice shall also inform the hospital of its | 29 |
| right to a hearing to contest the alleged violation under the | 30 |
| Illinois Administrative Procedure Act. | 31 |
| (b) If the Department finds that a hospital is in violation | 32 |
| of this Act, the hospital may submit to the Department, for the | 33 |
| Department's approval, a plan of correction. If a hospital | 34 |
| violates an approved plan of correction within 6 months of its |
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| submission, the Department may impose a monetary civil penalty | 2 |
| on the hospital. For a first violation of an approved plan of | 3 |
| correction, the Department may impose a penalty of up to $100. | 4 |
| For a second or subsequent violation of an approved plan of | 5 |
| correction, the Department may impose a penalty of up to $250. | 6 |
| The total penalties imposed under this Act against a hospital | 7 |
| in 12 month period may not exceed $5,000. | 8 |
| The Department may impose a civil penalty under this | 9 |
| Section only after it provides the following to the hospital: | 10 |
| (1) Written notice of the alleged violation. | 11 |
| (2) Written notice of the hospital's right to request | 12 |
| an administrative hearing on the question of the alleged | 13 |
| violation. | 14 |
| (3) An opportunity to present evidence, orally or in | 15 |
| writing or both, on the question of the alleged violation | 16 |
| before an impartial hearing examiner appointed by the | 17 |
| Director. | 18 |
| (4) A written decision from the Director of Public | 19 |
| Health, based on the evidence introduced at the hearing and | 20 |
| the hearing examiner's recommendations, finding that the | 21 |
| hospital violated this Act and imposing the civil penalty. | 22 |
| The Attorney General may bring an action in the circuit | 23 |
| court to enforce the collection of a monetary penalty imposed | 24 |
| under this Section. | 25 |
| Moneys in payment of penalties imposed under this Act shall | 26 |
| be paid to the Department and deposited into the Nursing | 27 |
| Dedicated and Professional Fund. | 28 |
| (c) If the Department has a reasonable basis to believe | 29 |
| that a hospital has engaged in a pattern of violations of this | 30 |
| Act or has failed to adopt policies and procedures to comply | 31 |
| with this Act, the Department may issue a written certification | 32 |
| of the basis for that belief to the Attorney General. Upon | 33 |
| receiving such written certification, the Attorney General | 34 |
| may: | 35 |
| (1) Require the hospital to file a statement or report | 36 |
| in writing as to all information relevant to the alleged |
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| violations. | 2 |
| (2) Examine under oath any person in connection with | 3 |
| the alleged violations. | 4 |
| (3) Examine any record, book, document, account or | 5 |
| paper necessary to investigate such alleged violations. | 6 |
| (4) Bring an action in the name of the People of the | 7 |
| State against such hospital to restrain by preliminary or | 8 |
| permanent injunction the use of policies or practices that | 9 |
| violate this Act.
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| Section 55. Illinois Administrative Procedure Act. The | 11 |
| Illinois Administrative Procedure Act shall apply to all | 12 |
| administrative rules and procedures adopted by the Department | 13 |
| under this Act. | 14 |
| Section 60. Administrative Review Law. The Administrative | 15 |
| Review Law shall apply to and govern all proceedings for | 16 |
| judicial review of final administrative decisions of the | 17 |
| Department under this Act. | 18 |
| Section 65. Exemptions. The Department may grant an | 19 |
| exemption from this Act to a hospital that demonstrates that | 20 |
| compliance with the Act will, more likely than not, impose an | 21 |
| undue burden on the hospital. Factors to be considered by the | 22 |
| Department in deciding whether to grant an exemption include, | 23 |
| but are not limited to: the financial condition of the | 24 |
| hospital; the impact that compliance will have on the cost of | 25 |
| services provided by the hospital; the impact that compliance | 26 |
| will have on the quality of services provided by the hospital; | 27 |
| and the impact that compliance will have on the community's | 28 |
| access to health care services. | 29 |
| Section 70. Limitations. Nothing is this Act shall be used | 30 |
| by any private or public third-party payer as a basis for | 31 |
| reducing the third-party payer's rates or policies. Discounts | 32 |
| authorized under this Act shall not be used by any private or |
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| public third-party payer to determine a hospital's usual and | 2 |
| customary charges for any health care service.
Nothing in this | 3 |
| Act shall be construed as imposing an obligation on a hospital | 4 |
| to provide any particular service or treatment to an uninsured | 5 |
| patient.
Nothing in this Act shall prohibit hospitals from | 6 |
| providing discounts to patients who do not meet the criteria of | 7 |
| a financially qualified uninsured patient under this Act.
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| Nothing in this Act shall be construed as imposing an | 9 |
| obligation on a hospital to file a lawsuit to collect payment | 10 |
| on a patient's bill. | 11 |
| Section 75. Home rule. A home rule unit may not regulate | 12 |
| hospitals in a manner inconsistent with the provisions of this | 13 |
| Act. This Section is a limitation under subsection (i) of | 14 |
| Section 6 of Article VII of the Illinois Constitution on the | 15 |
| concurrent exercise by home rule units of powers and functions | 16 |
| exercised by the State. | 17 |
| Section 95. The Hospital Licensing Act is amended by | 18 |
| changing Section 7 as follows:
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| (210 ILCS 85/7) (from Ch. 111 1/2, par. 148)
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| Sec. 7. (a) The Director after notice and opportunity for | 21 |
| hearing to the
applicant or licensee may deny, suspend, or | 22 |
| revoke a permit to establish a
hospital or deny, suspend, or | 23 |
| revoke a license to open, conduct, operate,
and maintain a | 24 |
| hospital in any case in which he finds that there has been a
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| substantial failure to comply with the provisions of this Act ,
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| or the Hospital
Report Card Act , or the Hospital Charity | 27 |
| Assistance Act, or the standards, rules, and regulations | 28 |
| established by
virtue of any
either of those Acts.
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| (b) Such notice shall be effected by registered mail or by | 30 |
| personal
service setting forth the particular reasons for the | 31 |
| proposed action and
fixing a date, not less than 15 days from | 32 |
| the date of such mailing or
service, at which time the | 33 |
| applicant or licensee shall be given an
opportunity for a |
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| hearing. Such hearing shall be conducted by the Director
or by | 2 |
| an employee of the Department designated in writing by the | 3 |
| Director
as Hearing Officer to conduct the hearing. On the | 4 |
| basis of any such
hearing, or upon default of the applicant or | 5 |
| licensee, the Director shall
make a determination specifying | 6 |
| his findings and conclusions. In case of a
denial to an | 7 |
| applicant of a permit to establish a hospital, such
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| determination shall specify the subsection of Section 6 under | 9 |
| which the
permit was denied and shall contain findings of fact | 10 |
| forming the basis of
such denial. A copy of such determination | 11 |
| shall be sent by registered mail
or served personally upon the | 12 |
| applicant or licensee. The decision denying,
suspending, or | 13 |
| revoking a permit or a license shall become final 35 days
after | 14 |
| it is so mailed or served, unless the applicant or licensee, | 15 |
| within
such 35 day period, petitions for review pursuant to | 16 |
| Section 13.
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| (c) The procedure governing hearings authorized by this | 18 |
| Section shall be
in accordance with rules promulgated by the | 19 |
| Department and approved by the
Hospital Licensing Board. A full | 20 |
| and complete record shall be kept of all
proceedings, including | 21 |
| the notice of hearing, complaint, and all other
documents in | 22 |
| the nature of pleadings, written motions filed in the
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| proceedings, and the report and orders of the Director and | 24 |
| Hearing Officer.
All testimony shall be reported but need not | 25 |
| be transcribed unless the
decision is appealed pursuant to | 26 |
| Section 13. A copy or copies of the
transcript may be obtained | 27 |
| by any interested party on payment of the cost
of preparing | 28 |
| such copy or copies.
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| (d) The Director or Hearing Officer shall upon his own | 30 |
| motion, or on the
written request of any party to the | 31 |
| proceeding, issue subpoenas requiring
the attendance and the | 32 |
| giving of testimony by witnesses, and subpoenas
duces tecum | 33 |
| requiring the production of books, papers, records, or
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| memoranda. All subpoenas and subpoenas duces tecum issued under | 35 |
| the terms
of this Act may be served by any person of full age. | 36 |
| The fees of witnesses
for attendance and travel shall be the |
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| same as the fees of witnesses before
the Circuit Court of this | 2 |
| State, such fees to be paid when the witness is
excused from | 3 |
| further attendance. When the witness is subpoenaed at the
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| instance of the Director, or Hearing Officer, such fees shall | 5 |
| be paid in
the same manner as other expenses of the Department, | 6 |
| and when the witness
is subpoenaed at the instance of any other | 7 |
| party to any such proceeding the
Department may require that | 8 |
| the cost of service of the subpoena or subpoena
duces tecum and | 9 |
| the fee of the witness be borne by the party at whose
instance | 10 |
| the witness is summoned. In such case, the Department in its
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| discretion, may require a deposit to cover the cost of such | 12 |
| service and
witness fees. A subpoena or subpoena duces tecum | 13 |
| issued as aforesaid shall
be served in the same manner as a | 14 |
| subpoena issued out of a court.
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| (e) Any Circuit Court of this State upon the application of | 16 |
| the
Director, or upon the application of any other party to the | 17 |
| proceeding,
may, in its discretion, compel the attendance of | 18 |
| witnesses, the production
of books, papers, records, or | 19 |
| memoranda and the giving of testimony before
the Director or | 20 |
| Hearing Officer conducting an investigation or holding a
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| hearing authorized by this Act, by an attachment for contempt, | 22 |
| or
otherwise, in the same manner as production of evidence may | 23 |
| be compelled
before the court.
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| (f) The Director or Hearing Officer, or any party in an | 25 |
| investigation or
hearing before the Department, may cause the | 26 |
| depositions of witnesses
within the State to be taken in the | 27 |
| manner prescribed by law for like
depositions in civil actions | 28 |
| in courts of this State, and to that end
compel the attendance | 29 |
| of witnesses and the production of books, papers,
records, or | 30 |
| memoranda.
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| (Source: P.A. 93-563, eff. 1-1-04.)
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| Section 99. Effective date. This Act takes effect upon | 33 |
| becoming law.
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