Public Act 103-0323
HB2719 EnrolledLRB103 27682 AWJ 54059 b HB2719 Enrolled LRB103 27682 AWJ 54059 b
HB2719 Enrolled LRB103 27682 AWJ 54059 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Community Benefits Act is amended by
changing Section 22 as follows:
(210 ILCS 76/22)
Sec. 22. Public reports.
(a) In order to increase transparency and accessibility of
charity care and financial assistance data, a hospital shall
make the annual hospital community benefits plan report
submitted to the Attorney General under Section 20 available
to the public by publishing the information on the hospital's
website in the same location where annual reports are posted
or on a prominent location on the homepage of the hospital's
website. A hospital is not required to post its audited
financial statements. Information made available to the public
shall include, but shall not be limited to, the following:
(1) The reporting period.
(2) Charity care costs consistent with the reporting
requirements in paragraph (3) of subsection (a) of Section
20. Charity care costs associated with services provided
in a hospital's emergency department shall be reported as
a subset of total charity care costs.
HB2719 Enrolled LRB103 27682 AWJ 54059 b
(3) Total net patient revenue, reported separately by
hospital if the reporting health system includes more than
one hospital.
(4) Total community benefits spending. If a hospital
is owned or operated by a health system, total community
benefits spending may be reported as a health system.
(5) Data on financial assistance applications
consistent with the reporting requirements in paragraph
(3) of subsection (a) of Section 20, including:
(A) the number of applications submitted to the
hospital, both complete and incomplete;
(B) the number of applications approved; and
(C) the number of applications denied and the 5
most frequent reasons for denial; and .
(D) the number of uninsured patients who have
declined or failed to respond to the screening
described in subsection (a) of Section 16 of the Fair
Patient Billing Act and the 5 most frequent reasons
for declining.
(6) To the extent that race, ethnicity, sex, or
preferred language is collected and available for
financial assistance applications, the data outlined in
paragraph (5) shall be reported by race, ethnicity, sex,
and preferred language. If this data is not provided by
the patient, the hospital shall indicate this in its
reports. Public reporting of this information shall begin
with the community benefit report filed on or after July
1, 2022. A hospital that files a report without having a
full year of demographic data as required by this Act may
indicate this in its report.
(b) The Attorney General shall provide notice on the
Attorney General's website informing the public that, upon
request, the Attorney General will provide the annual reports
filed with the Attorney General under Section 20. The notice
shall include the contact information to submit a request.
(Source: P.A. 102-581, eff. 1-1-22.)
Section 10. The Fair Patient Billing Act is amended by
changing Sections 5, 10, 30, 45, and 70 and by adding Section
16 as follows:
(210 ILCS 88/5)
Sec. 5. Purpose; findings.
(a) The purpose of this Act is to advance the prompt and
accurate payment of health care services through fair and
reasonable billing and collection practices of hospitals.
(b) The General Assembly finds that:
(1) Medical debts are the cause of an increasing
number of bankruptcies in Illinois and are typically
associated with severe financial hardship incurred by
bankrupt persons and their families.
(2) Patients, hospitals, and government bodies alike
will benefit from clearly articulated standards regarding
fair billing and collection practices for all Illinois
hospitals.
(3) Hospitals should employ responsible standards when
collecting debt from their patients.
(4) Patients should be provided sufficient billing
information from hospitals to determine the accuracy of
the bills for which they may be financially responsible.
(5) Patients should be given a fair and reasonable
opportunity to discuss and assess the accuracy of their
bill.
(6) Hospitals should provide patients with timely and
meaningful access to any financial assistance available
through the hospital and any public health insurance
programs for which patients may be eligible to prevent
patients from ending up with avoidable medical debt.
Hospitals should assist patients who need financial
assistance to access it. Patients who are deemed eligible
for hospital financial assistance or public health
insurance programs should not be improperly billed,
steered into payment plans, or sent to collections
Patients should be provided information regarding the
hospital's policies regarding financial assistance options
the hospital may offer to qualified patients.
(7) Hospitals should offer patients the opportunity to
enter into a reasonable payment plan for their hospital
care.
(8) Patients have an obligation to pay for the
hospital services they receive subject to any discounts or
free care for which they are eligible under Illinois law.
(9) Hospitals have an obligation to screen uninsured
patients before pursuing collection action. To promote the
general welfare and to mitigate the negative impact that
medical debt has on accessing and using needed health
care, hospitals should not attempt to collect a debt from
an uninsured patient without first adequately screening
the patient for public health insurance programs and
financial assistance available to the patient and
assisting the patient in obtaining the hospital financial
assistance for which they are eligible.
(Source: P.A. 94-885, eff. 1-1-07.)
(210 ILCS 88/10)
Sec. 10. Definitions. As used in this Act:
"Collection action" means any referral of a bill to a
collection agency or law firm to collect payment for services
from a patient or a patient's guarantor for hospital services.
"Health care plan" means a health insurance company,
health maintenance organization, preferred provider
arrangement, or third party administrator authorized in this
State to issue policies or subscriber contracts or administer
those policies and contracts that reimburse for inpatient and
outpatient services provided in a hospital. Health care plan,
however, does not include any government-funded program such
as Medicare or Medicaid, workers' compensation, and accident
liability insurers.
"Insured patient" means a patient who is insured by a
health care plan.
"Medical debt" means a debt arising from the receipt of
health care services, products, or devices.
"Patient" means the individual receiving services from the
hospital and any individual who is the guarantor of the
payment for such services.
"Public health insurance program" means Medicare;
Medicaid; medical assistance under the Non-Citizen Victims of
Trafficking, Torture and Other Serious Crimes program; Health
Benefit for Immigrant Adults; Health Benefit for Immigrant
Seniors; All Kids; or other medical assistance programs
offered by the Department of Healthcare and Family Services.
"Reasonable payment plan" means a plan to pay a hospital
bill that is offered to the patient or the patient's legal
representative and takes into account the patient's available
income and assets, the amount owed, and any prior payments.
"Screen" or "screening" means a process whereby a hospital
engages with a patient to review and assess the patient's
potential eligibility for any financial assistance offered by
the hospital, public health insurance program, or other
discounted care known to the hospital; informs the patient of
the hospital's assessment; documents in the patient's record
the circumstances of the screening; and assists with the
application for hospital financial assistance.
"Uninsured patient" means a patient who is not insured by
a health care plan and is not a beneficiary under a
government-funded program, workers' compensation, or accident
liability insurance.
(Source: P.A. 94-885, eff. 1-1-07.)
(210 ILCS 88/16 new)
Sec. 16. Screening patients for health insurance and
financial assistance.
(a) All hospitals shall screen each uninsured patient,
upon the uninsured patient's agreement, at the earliest
reasonable moment for potential eligibility for both:
(1) public health insurance programs; and
(2) any financial assistance offered by the hospital.
(b) All screening activities, including initial screenings
and all follow-up assistance, must be provided in compliance
with the Language Assistance Services Act.
(c) If a patient declines or fails to respond to the
screening described in subsection (a), the hospital shall
document in the patient's record the patient's decision to
decline or failure to respond to the screening, confirming the
date and method by which the patient declined or failed to
respond.
(d) If a patient does not decline the screening described
in subsection (a), a hospital should screen an uninsured
patient during registration unless it would cause a delay of
care to the patient, otherwise a hospital must screen an
uninsured patient at the earliest reasonable moment.
(e) If a patient does not submit screening, financial
assistance application, or reasonable payment plan
documentation within 30 days after a request as required under
Section 45, the hospital shall document the lack of received
documentation, confirming the date that the screening took
place and that the 30-day timeline for responding to the
hospital's request has lapsed, but may be reopened within 90
days after the date of discharge, date of service, or
completion of the screening.
(f) If the screening indicates that the patient may be
eligible for a public health insurance program, the hospital
shall provide information to the patient about how the patient
can apply for the public health insurance program, including,
but not limited to, referral to health care navigators who
provide free and unbiased eligibility and enrollment
assistance, including health care navigators at federally
qualified health centers; local, State, or federal government
agencies; or any other resources that Illinois recognizes as
designed to assist uninsured individuals in obtaining health
coverage.
(g) If the uninsured patient's application for a public
health insurance program is approved, the hospital shall bill
the insuring entity and shall not pursue the patient for any
aspect of the bill, except for any required copayment,
coinsurance, or other similar payment for which the patient is
responsible under the insurance. If the uninsured patient's
application for public health insurance is denied, the
hospital shall again offer to screen the uninsured patient for
hospital financial assistance and the timeline for applying
for financial assistance under the Hospital Uninsured Patient
Discount Act shall begin again.
(h) A hospital shall offer to screen an insured patient
for hospital financial assistance under this Section if the
patient requests financial assistance screening, if the
hospital is contacted in response to a bill, if the hospital
learns information that suggests an inability to pay, or if
the circumstances otherwise suggest the patient's inability to
pay.
(i) Any hospital that submits an annual hospital community
benefits plan report to the Attorney General shall include in
that report the number of uninsured patients who have declined
or failed to respond to screening under subsection (a) of
Section 16 and the 5 most frequent reasons for declining.
(210 ILCS 88/30)
Sec. 30. Pursuing collection action.
(a) Hospitals and their agents may pursue collection
action against an uninsured patient only if the following
conditions are met:
(1) The hospital has complied with the screening
requirements set forth in Section 16 and applied and
exhausted any discount available to a patient under
Section 10 of the Hospital Uninsured Patient Discount Act.
(2) (1) The hospital has given the uninsured patient
the opportunity to:
(A) assess the accuracy of the bill;
(B) apply for financial assistance under the
hospital's financial assistance policy; and
(C) avail themselves of a reasonable payment plan.
(3) (2) If the uninsured patient has indicated an
inability to pay the full amount of the debt in one
payment, the hospital has offered the patient a reasonable
payment plan. The hospital may require the uninsured
patient to provide reasonable verification of his or her
inability to pay the full amount of the debt in one
payment.
(4) (3) To the extent the hospital provides financial
assistance and the circumstances of the uninsured patient
suggest the potential for eligibility for charity care,
the uninsured patient has been given at least 90 60 days
following the date of discharge or receipt of outpatient
care to submit an application for financial assistance and
shall be provided assistance with the application in
compliance with subsection (a) of Section 16 and Section
27.
(5) (4) If the uninsured patient has agreed to a
reasonable payment plan with the hospital, and the patient
has failed to make payments in accordance with that
reasonable payment plan.
(6) (5) If the uninsured patient informs the hospital
that he or she has applied for health care coverage under a
public health insurance program Medicaid, Kidcare, or
other government-sponsored health care program (and there
is a reasonable basis to believe that the patient will
qualify for such program) but the patient's application is
denied.
(a-5) A hospital shall proactively offer information on
charity care options available to uninsured patients,
regardless of their immigration status or residency.
(b) A hospital may not refer a bill, or portion thereof, to
a collection agency or attorney for collection action against
the insured patient, without first ensuring compliance with
Section 16 and offering the patient the opportunity to request
a reasonable payment plan for the amount personally owed by
the patient. Such an opportunity shall be made available for
the 90 30 days following the date of the initial bill. If the
insured patient requests a reasonable payment plan, but fails
to agree to a plan within 90 30 days of the request, the
hospital may proceed with collection action against the
patient.
(c) No collection agency, law firm, or individual may
initiate legal action for non-payment of a hospital bill
against a patient without the written approval of an
authorized hospital employee who reasonably believes that the
conditions for pursuing collection action under this Section
have been met.
(d) Nothing in this Section prohibits a hospital from
engaging an outside third party agency, firm, or individual to
manage the process of implementing the hospital's financial
assistance and reasonable payment plan programs and policies
so long as such agency, firm, or individual is contractually
bound to comply with the terms of this Act.
(Source: P.A. 102-504, eff. 12-1-21.)
(210 ILCS 88/45)
Sec. 45. Patient responsibilities.
(a) To receive the protection and benefits of this Act, a
patient responsible for paying a hospital bill must act
reasonably and cooperate in good faith with the hospital in
the screening process by providing the hospital with all of
the reasonably requested financial and other relevant
information and documentation needed to determine the
patient's potential eligibility for coverage under a public
health insurance program, under the hospital's financial
assistance policy, or for a and reasonable payment plan
options to qualified patients within 30 days of a request for
such information.
(b) To receive the protection and benefits of this Act, a
patient responsible for paying a hospital bill shall
communicate to the hospital any material change in the
patient's financial situation that may affect the patient's
ability to abide by the provisions of an agreed upon
reasonable payment plan or qualification for financial
assistance within 30 days of the change.
(Source: P.A. 94-885, eff. 1-1-07.)
(210 ILCS 88/70)
Sec. 70. Application.
(a) This Act applies to all hospitals licensed under the
Hospital Licensing Act or the University of Illinois Hospital
Act. This Act does not apply to a hospital that does not charge
for its services.
(b) The obligations of hospitals under this Act shall take
effect for services provided on or after the first day of the
month that begins 180 days after the effective date of this
Act.
(c) The obligations of hospitals under this amendatory Act
of the 103rd General Assembly shall apply to services provided
on or after the first day of the month that begins 180 days
after the effective date of this amendatory Act of the 103rd
General Assembly.
(Source: P.A. 94-885, eff. 1-1-07.)
Section 15. The Hospital Uninsured Patient Discount Act is
amended by changing Section 15 as follows:
(210 ILCS 89/15)
Sec. 15. Patient responsibility.
(a) Hospitals may make the availability of a discount and
the maximum collectible amount under this Act contingent upon
the uninsured patient first applying for coverage under public
health insurance programs, such as Medicare, Medicaid,
AllKids, the State Children's Health Insurance Program, or any
other program, if there is a reasonable basis to believe that
the uninsured patient may be eligible for such program. If the
patient declines to apply for a public health insurance
program on the basis of concern for immigration-related
consequences, the hospital may refer the patient to a free,
unbiased resource such as an Immigrant Family Resource Program
to address the patient's immigration-related concerns and
assist in enrolling the patient in a public health insurance
program. The hospital may still screen the patient for
eligibility under its financial assistance policy.
(b) Hospitals shall permit an uninsured patient to apply
for a discount within 90 days of the date of discharge, or date
of service, completion of the screening under the Fair Patient
Billing Act, or denial of an application for a public health
insurance program.
Hospitals shall offer uninsured patients who receive
community-based primary care provided by a community health
center or a free and charitable clinic, are referred by such an
entity to the hospital, and seek access to nonemergency
hospital-based health care services with an opportunity to be
screened for and assistance with applying for public health
insurance programs if there is a reasonable basis to believe
that the uninsured patient may be eligible for a public health
insurance program. An uninsured patient who receives
community-based primary care provided by a community health
center or free and charitable clinic and is referred by such an
entity to the hospital for whom there is not a reasonable basis
to believe that the uninsured patient may be eligible for a
public health insurance program shall be given the opportunity
to apply for hospital financial assistance when hospital
services are scheduled.
(1) Income verification. Hospitals may require an
uninsured patient who is requesting an uninsured discount
to provide documentation of family income. Acceptable
family income documentation shall include any one of the
following:
(A) a copy of the most recent tax return;
(B) a copy of the most recent W-2 form and 1099
forms;
(C) copies of the 2 most recent pay stubs;
(D) written income verification from an employer
if paid in cash; or
(E) one other reasonable form of third party
income verification deemed acceptable to the hospital.
(2) Asset verification. Hospitals may require an
uninsured patient who is requesting an uninsured discount
to certify the existence or absence of assets owned by the
patient and to provide documentation of the value of such
assets, except for those assets referenced in paragraph
(4) of subsection (c) of Section 10. Acceptable
documentation may include statements from financial
institutions or some other third party verification of an
asset's value. If no third party verification exists, then
the patient shall certify as to the estimated value of the
asset.
(3) Illinois resident verification. Hospitals may
require an uninsured patient who is requesting an
uninsured discount to verify Illinois residency.
Acceptable verification of Illinois residency shall
include any one of the following:
(A) any of the documents listed in paragraph (1);
(B) a valid state-issued identification card;
(C) a recent residential utility bill;
(D) a lease agreement;
(E) a vehicle registration card;
(F) a voter registration card;
(G) mail addressed to the uninsured patient at an
Illinois address from a government or other credible
source;
(H) a statement from a family member of the
uninsured patient who resides at the same address and
presents verification of residency;
(I) a letter from a homeless shelter, transitional
house or other similar facility verifying that the
uninsured patient resides at the facility; or
(J) a temporary visitor's drivers license.
(c) Hospital obligations toward an individual uninsured
patient under this Act shall cease if that patient
unreasonably fails or refuses to provide the hospital with
information or documentation requested under subsection (b) or
to apply for coverage under public programs when requested
under subsection (a) within 30 days of the hospital's request.
(d) In order for a hospital to determine the 12 month
maximum amount that can be collected from a patient deemed
eligible under Section 10, an uninsured patient shall inform
the hospital in subsequent inpatient admissions or outpatient
encounters that the patient has previously received health
care services from that hospital and was determined to be
entitled to the uninsured discount.
(e) Hospitals may require patients to certify that all of
the information provided in the application is true. The
application may state that if any of the information is
untrue, any discount granted to the patient is forfeited and
the patient is responsible for payment of the hospital's full
charges.
(f) Hospitals shall ask for an applicant's race,
ethnicity, sex, and preferred language on the financial
assistance application. However, the questions shall be
clearly marked as optional responses for the patient and shall
note that responses or nonresponses by the patient will not
have any impact on the outcome of the application.
(Source: P.A. 102-581, eff. 1-1-22.)