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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Hospital Uninsured Patient Discount Act is
5 amended by changing Sections 5, 10, and 15 as follows:
6 (210 ILCS 89/5)
7 Sec. 5. Definitions. As used in this Act:
8 "Community health center" means a federally qualified
9 health center as defined in Section 1905(l)(2)(B) of the
10 federal Social Security Act or a federally qualified health
11 center look-alike.
12 "Cost to charge ratio" means the ratio of a hospital's
13 costs to its charges taken from its most recently filed
14 Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
15 Inpatient Ratios).
16 "Critical Access Hospital" means a hospital that is
17 designated as such under the federal Medicare Rural Hospital
18 Flexibility Program.
19 "Family income" means the sum of a family's annual
20 earnings and cash benefits from all sources before taxes, less
21 payments made for child support.
22 "Federal poverty income guidelines" means the poverty
23 guidelines updated periodically in the Federal Register by the
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1 United States Department of Health and Human Services under
2 authority of 42 U.S.C. 9902(2).
3 "Financial assistance" means a discount provided to a
4 patient under the terms and conditions a hospital offers to
5 qualified patients or as required by law.
6 "Free and charitable clinic" means a 501(c)(3) tax-exempt
7 health care organization providing health services to
8 low-income uninsured or underinsured individuals that is
9 recognized by either the Illinois Association of Free and
10 Charitable Clinics or the National Association of Free and
11 Charitable Clinics.
12 "Guaranteed income program" means a publicly or privately
13 funded program that provides one-time or recurring
14 unconditional cash transfers or payments, or gifts to
15 individuals or households, for a defined number of months or
16 years for the purposes of reducing poverty, promoting economic
17 mobility, or increasing the financial stability of Illinois
18 residents.
19 "Health care services" means any medically necessary
20 inpatient or outpatient hospital service, including
21 pharmaceuticals or supplies provided by a hospital to a
22 patient.
23 "Hospital" means any facility or institution required to
24 be licensed pursuant to the Hospital Licensing Act or operated
25 under the University of Illinois Hospital Act.
26 "Illinois resident" means any person who lives in Illinois
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1 and who intends to remain living in Illinois indefinitely.
2 Relocation to Illinois for the sole purpose of receiving
3 health care benefits does not satisfy the residency
4 requirement under this Act.
5 "Medically necessary" means any inpatient or outpatient
6 hospital service, including pharmaceuticals or supplies
7 provided by a hospital to a patient, covered under Title XVIII
8 of the federal Social Security Act for beneficiaries with the
9 same clinical presentation as the uninsured patient. A
10 "medically necessary" service does not include any of the
11 following:
12 (1) Non-medical services such as social and vocational
13 services.
14 (2) Elective cosmetic surgery, but not plastic surgery
15 designed to correct disfigurement caused by injury,
16 illness, or congenital defect or deformity.
17 "Rural hospital" means a hospital that is located outside
18 a metropolitan statistical area.
19 "Uninsured discount" means a hospital's charges multiplied
20 by the uninsured discount factor.
21 "Uninsured discount factor" means 1.0 less the product of
22 a hospital's cost to charge ratio multiplied by 1.35.
23 "Uninsured patient" means an Illinois resident who is a
24 patient of a hospital and is not covered under a policy of
25 health insurance and is not a beneficiary under a public or
26 private health insurance, health benefit, or other health
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1 coverage program, including high deductible health insurance
2 plans, workers' compensation, accident liability insurance, or
3 other third party liability.
4 (Source: P.A. 102-581, eff. 1-1-22.)
5 (210 ILCS 89/10)
6 Sec. 10. Uninsured patient discounts.
7 (a) Eligibility.
8 (1) A hospital, other than a rural hospital or
9 Critical Access Hospital, shall provide a discount from
10 its charges to any uninsured patient who applies for a
11 discount and has family income of not more than 600% of the
12 federal poverty income guidelines for all medically
13 necessary health care services exceeding $150 in any one
14 inpatient admission or outpatient encounter.
15 (2) A hospital, other than a rural hospital or
16 Critical Access Hospital, shall provide a charitable
17 discount of 100% of its charges for all medically
18 necessary health care services exceeding $150 in any one
19 inpatient admission or outpatient encounter to any
20 uninsured patient who applies for a discount and has
21 family income of not more than 200% of the federal poverty
22 income guidelines.
23 (3) A rural hospital or Critical Access Hospital shall
24 provide a discount from its charges to any uninsured
25 patient who applies for a discount and has annual family
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1 income of not more than 300% of the federal poverty income
2 guidelines for all medically necessary health care
3 services exceeding $300 in any one inpatient admission or
4 outpatient encounter.
5 (4) A rural hospital or Critical Access Hospital shall
6 provide a charitable discount of 100% of its charges for
7 all medically necessary health care services exceeding
8 $300 in any one inpatient admission or outpatient
9 encounter to any uninsured patient who applies for a
10 discount and has family income of not more than 125% of the
11 federal poverty income guidelines.
12 (5) In determining eligibility under this Act, a
13 hospital subject to this Act shall exclude from
14 consideration any unconditional cash transfers, payments,
15 or gifts received under a guaranteed income program if:
16 (A) such cash transfers, payments, or gifts are
17 excluded from consideration for determining
18 eligibility under public health insurance programs
19 administered by the State in which the State has the
20 authority to waive guaranteed income; and
21 (B) the guaranteed income program is a program for
22 a defined number of months or years designed to reduce
23 poverty, promote social mobility, or increase
24 financial stability for program participants and if
25 there is an explicit plan to collect data.
26 This paragraph is inoperative on and after July 1,
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1 2026.
2 (b) Discount. For all health care services exceeding $300
3 in any one inpatient admission or outpatient encounter, a
4 hospital shall not collect from an uninsured patient, deemed
5 eligible under subsection (a), more than its charges less the
6 amount of the uninsured discount.
7 (c) Maximum Collectible Amount.
8 (1) The maximum amount that may be collected in a
9 12-month period for health care services provided by the
10 hospital from a patient determined by that hospital to be
11 eligible under subsection (a) is 20% of the patient's
12 family income, and is subject to the patient's continued
13 eligibility under this Act.
14 (2) The 12-month period to which the maximum amount
15 applies shall begin on the first date, after the effective
16 date of this Act, an uninsured patient receives health
17 care services that are determined to be eligible for the
18 uninsured discount at that hospital.
19 (3) To be eligible to have this maximum amount applied
20 to subsequent charges, the uninsured patient shall inform
21 the hospital in subsequent inpatient admissions or
22 outpatient encounters that the patient has previously
23 received health care services from that hospital and was
24 determined to be entitled to the uninsured discount. The
25 availability of the maximum collectible amount shall be
26 included in the hospital's financial assistance
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1 information provided to uninsured patients.
2 (4) Hospitals may adopt policies to exclude an
3 uninsured patient from the application of subdivision
4 (c)(1) when the patient owns assets having a value in
5 excess of 600% of the federal poverty level for hospitals
6 in a metropolitan statistical area or owns assets having a
7 value in excess of 300% of the federal poverty level for
8 Critical Access Hospitals or hospitals outside a
9 metropolitan statistical area, not counting the following
10 assets: the uninsured patient's primary residence;
11 personal property exempt from judgment under Section
12 12-1001 of the Code of Civil Procedure; or any amounts
13 held in a pension or retirement plan, provided, however,
14 that distributions and payments from pension or retirement
15 plans may be included as income for the purposes of this
16 Act.
17 (d) Each hospital bill, invoice, or other summary of
18 charges to an uninsured patient shall include with it, or on
19 it, a prominent statement that an uninsured patient who meets
20 certain income requirements may qualify for an uninsured
21 discount and information regarding how an uninsured patient
22 may apply for consideration under the hospital's financial
23 assistance policy. The hospital's financial assistance
24 application shall include language that directs the uninsured
25 patient to contact the hospital's financial counseling
26 department with questions or concerns, along with contact
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1 information for the financial counseling department, and shall
2 state: "Complaints or concerns with the uninsured patient
3 discount application process or hospital financial assistance
4 process may be reported to the Health Care Bureau of the
5 Illinois Attorney General.". A website, phone number, or both
6 provided by the Attorney General shall be included with this
7 statement.
8 (Source: P.A. 102-581, eff. 1-1-22.)
9 (210 ILCS 89/15)
10 Sec. 15. Patient responsibility.
11 (a) Hospitals may make the availability of a discount and
12 the maximum collectible amount under this Act contingent upon
13 the uninsured patient first applying for coverage under public
14 health insurance programs, such as Medicare, Medicaid,
15 AllKids, the State Children's Health Insurance Program, the
16 Health Benefits for Immigrants program, or any other program,
17 if there is a reasonable basis to believe that the uninsured
18 patient may be eligible for such program.
19 (b) Hospitals shall permit an uninsured patient to apply
20 for a discount within 90 days of the date of discharge or date
21 of service.
22 Hospitals shall offer uninsured patients who receive
23 community-based primary care provided by a community health
24 center or a free and charitable clinic, are referred by such an
25 entity to the hospital, and seek access to nonemergency
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1 hospital-based health care services with an opportunity to be
2 screened for and assistance with applying for public health
3 insurance programs if there is a reasonable basis to believe
4 that the uninsured patient may be eligible for a public health
5 insurance program. An uninsured patient who receives
6 community-based primary care provided by a community health
7 center or free and charitable clinic and is referred by such an
8 entity to the hospital for whom there is not a reasonable basis
9 to believe that the uninsured patient may be eligible for a
10 public health insurance program shall be given the opportunity
11 to apply for hospital financial assistance when hospital
12 services are scheduled.
13 (1) Income verification. Hospitals may require an
14 uninsured patient who is requesting an uninsured discount
15 to provide documentation of family income. Acceptable
16 family income documentation shall include any one of the
17 following:
18 (A) a copy of the most recent tax return;
19 (B) a copy of the most recent W-2 form and 1099
20 forms;
21 (C) copies of the 2 most recent pay stubs;
22 (D) written income verification from an employer
23 if paid in cash; or
24 (E) one other reasonable form of third party
25 income verification deemed acceptable to the hospital.
26 (2) Asset verification. Hospitals may require an
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1 uninsured patient who is requesting an uninsured discount
2 to certify the existence or absence of assets owned by the
3 patient and to provide documentation of the value of such
4 assets, except for those assets referenced in paragraph
5 (4) of subsection (c) of Section 10. Acceptable
6 documentation may include statements from financial
7 institutions or some other third party verification of an
8 asset's value. If no third party verification exists, then
9 the patient shall certify as to the estimated value of the
10 asset.
11 (3) Illinois resident verification. Hospitals may
12 require an uninsured patient who is requesting an
13 uninsured discount to verify Illinois residency.
14 Acceptable verification of Illinois residency shall
15 include any one of the following:
16 (A) any of the documents listed in paragraph (1);
17 (B) a valid state-issued identification card;
18 (C) a recent residential utility bill;
19 (D) a lease agreement;
20 (E) a vehicle registration card;
21 (F) a voter registration card;
22 (G) mail addressed to the uninsured patient at an
23 Illinois address from a government or other credible
24 source;
25 (H) a statement from a family member of the
26 uninsured patient who resides at the same address and
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1 presents verification of residency;
2 (I) a letter from a homeless shelter, transitional
3 house or other similar facility verifying that the
4 uninsured patient resides at the facility; or
5 (J) a temporary visitor's drivers license.
6 (c) Hospital obligations toward an individual uninsured
7 patient under this Act shall cease if that patient
8 unreasonably fails or refuses to provide the hospital with
9 information or documentation requested under subsection (b) or
10 to apply for coverage under public programs when requested
11 under subsection (a) within 30 days of the hospital's request.
12 (d) In order for a hospital to determine the 12 month
13 maximum amount that can be collected from a patient deemed
14 eligible under Section 10, an uninsured patient shall inform
15 the hospital in subsequent inpatient admissions or outpatient
16 encounters that the patient has previously received health
17 care services from that hospital and was determined to be
18 entitled to the uninsured discount.
19 (e) Hospitals may require patients to certify that all of
20 the information provided in the application is true. The
21 application may state that if any of the information is
22 untrue, any discount granted to the patient is forfeited and
23 the patient is responsible for payment of the hospital's full
24 charges.
25 (f) Hospitals shall ask for an applicant's race,
26 ethnicity, sex, and preferred language on the financial
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1 assistance application. However, the questions shall be
2 clearly marked as optional responses for the patient and shall
3 note that responses or nonresponses by the patient will not
4 have any impact on the outcome of the application.
5 (Source: P.A. 102-581, eff. 1-1-22.)
6 Section 10. The Illinois Public Aid Code is amended by
7 changing Section 1-7 as follows:
8 (305 ILCS 5/1-7) (from Ch. 23, par. 1-7)
9 Sec. 1-7. (a) For purposes of determining eligibility for
10 assistance under this Code, the Illinois Department, County
11 Departments, and local governmental units shall exclude from
12 consideration restitution payments, including all income and
13 resources derived therefrom, made to persons of Japanese or
14 Aleutian ancestry pursuant to the federal Civil Liberties Act
15 of 1988 and the Aleutian and Pribilof Island Restitution Act,
16 P.L. 100-383.
17 (b) For purposes of any program or form of assistance
18 where a person's income or assets are considered in
19 determining eligibility or level of assistance, whether under
20 this Code or another authority, neither the State of Illinois
21 nor any entity or person administering a program wholly or
22 partially financed by the State of Illinois or any of its
23 political subdivisions shall include restitution payments,
24 including all income and resources derived therefrom, made
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1 pursuant to the federal Civil Liberties Act of 1988 and the
2 Aleutian and Pribilof Island Restitution Act, P.L. 100-383, in
3 the calculation of income or assets for determining
4 eligibility or level of assistance.
5 (c) For purposes of determining eligibility for or the
6 amount of assistance under this Code, except for the
7 determination of eligibility for payments or programs under
8 the TANF employment, education, and training programs and the
9 Food Stamp Employment and Training Program, the Illinois
10 Department, County Departments, and local governmental units
11 shall exclude from consideration any financial assistance
12 received under any student aid program administered by an
13 agency of this State or the federal government, by a person who
14 is enrolled as a full-time or part-time student of any public
15 or private university, college, or community college in this
16 State.
17 (d) For purposes of determining eligibility for or the
18 amount of assistance under this Code, except for the
19 determination of eligibility for payments or programs under
20 the TANF employment, education, and training programs and the
21 SNAP Employment and Training Program, the Illinois Department,
22 County Departments, and local governmental units shall exclude
23 from consideration, for a period of 36 months, any financial
24 assistance, including wages, that is provided to a person who
25 is enrolled in a demonstration project that is not funded with
26 general revenue funds and that is intended as a bridge to
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1 self-sufficiency by offering (i) intensive workforce support
2 and training and (ii) support services for new and expectant
3 parents that are intended to foster multi-generational healthy
4 families as described in Section 12-4.51.
5 (e)(1) Notwithstanding any other provision of this Code,
6 and to the maximum extent permitted by federal law, for
7 purposes of determining eligibility and the amount of
8 assistance under this Code, the Illinois Department and local
9 governmental units shall exclude from consideration, for a
10 period of no more than 60 months, any financial assistance,
11 including wages, cash transfers, or gifts, that is provided to
12 a person through a guaranteed income program. As used in this
13 subsection, "guaranteed income program" means a publicly or
14 privately funded program that provides one-time or recurring
15 unconditional cash transfers or payments, or gifts to
16 individuals or households, for a defined number of months or
17 years for the purposes of reducing poverty, promoting economic
18 mobility, or increasing the financial stability of Illinois
19 residents. who is enrolled in a program or research project
20 that is not funded with general revenue funds and that is
21 intended to investigate the impacts of policies or programs
22 designed to reduce poverty, promote social mobility, or
23 increase financial stability for Illinois residents if there
24 is an explicit plan to collect data and evaluate the program or
25 initiative that is developed prior to participants in the
26 study being enrolled in the program and if a research team has
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1 been identified to oversee the evaluation.
2 (2) The Department shall choose State options and seek all
3 necessary federal approvals or waivers to implement this
4 subsection.
5 (Source: P.A. 100-806, eff. 1-1-19; 101-415, eff. 8-16-19.)
6 Section 99. Effective date. This Act takes effect January
7 1, 2024.
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