Public Act 103-0492
SB1665 EnrolledLRB103 27577 KTG 53953 b SB1665 Enrolled LRB103 27577 KTG 53953 b
SB1665 Enrolled LRB103 27577 KTG 53953 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Hospital Uninsured Patient Discount Act is
amended by changing Sections 5, 10, and 15 as follows:
(210 ILCS 89/5)
Sec. 5. Definitions. As used in this Act:
"Community health center" means a federally qualified
health center as defined in Section 1905(l)(2)(B) of the
federal Social Security Act or a federally qualified health
center look-alike.
"Cost to charge ratio" means the ratio of a hospital's
costs to its charges taken from its most recently filed
Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
Inpatient Ratios).
"Critical Access Hospital" means a hospital that is
designated as such under the federal Medicare Rural Hospital
Flexibility Program.
"Family income" means the sum of a family's annual
earnings and cash benefits from all sources before taxes, less
payments made for child support.
"Federal poverty income guidelines" means the poverty
guidelines updated periodically in the Federal Register by the
SB1665 Enrolled LRB103 27577 KTG 53953 b
United States Department of Health and Human Services under
authority of 42 U.S.C. 9902(2).
"Financial assistance" means a discount provided to a
patient under the terms and conditions a hospital offers to
qualified patients or as required by law.
"Free and charitable clinic" means a 501(c)(3) tax-exempt
health care organization providing health services to
low-income uninsured or underinsured individuals that is
recognized by either the Illinois Association of Free and
Charitable Clinics or the National Association of Free and
Charitable Clinics.
"Guaranteed income program" means a publicly or privately
funded program that provides one-time or recurring
unconditional cash transfers or payments, or gifts to
individuals or households, for a defined number of months or
years for the purposes of reducing poverty, promoting economic
mobility, or increasing the financial stability of Illinois
residents.
"Health care services" means any medically necessary
inpatient or outpatient hospital service, including
pharmaceuticals or supplies provided by a hospital to a
patient.
"Hospital" means any facility or institution required to
be licensed pursuant to the Hospital Licensing Act or operated
under the University of Illinois Hospital Act.
"Illinois resident" means any person who lives in Illinois
and who intends to remain living in Illinois indefinitely.
Relocation to Illinois for the sole purpose of receiving
health care benefits does not satisfy the residency
requirement under this Act.
"Medically necessary" means any inpatient or outpatient
hospital service, including pharmaceuticals or supplies
provided by a hospital to a patient, covered under Title XVIII
of the federal Social Security Act for beneficiaries with the
same clinical presentation as the uninsured patient. A
"medically necessary" service does not include any of the
following:
(1) Non-medical services such as social and vocational
services.
(2) Elective cosmetic surgery, but not plastic surgery
designed to correct disfigurement caused by injury,
illness, or congenital defect or deformity.
"Rural hospital" means a hospital that is located outside
a metropolitan statistical area.
"Uninsured discount" means a hospital's charges multiplied
by the uninsured discount factor.
"Uninsured discount factor" means 1.0 less the product of
a hospital's cost to charge ratio multiplied by 1.35.
"Uninsured patient" means an Illinois resident who is a
patient of a hospital and is not covered under a policy of
health insurance and is not a beneficiary under a public or
private health insurance, health benefit, or other health
coverage program, including high deductible health insurance
plans, workers' compensation, accident liability insurance, or
other third party liability.
(Source: P.A. 102-581, eff. 1-1-22.)
(210 ILCS 89/10)
Sec. 10. Uninsured patient discounts.
(a) Eligibility.
(1) A hospital, other than a rural hospital or
Critical Access Hospital, shall provide a discount from
its charges to any uninsured patient who applies for a
discount and has family income of not more than 600% of the
federal poverty income guidelines for all medically
necessary health care services exceeding $150 in any one
inpatient admission or outpatient encounter.
(2) A hospital, other than a rural hospital or
Critical Access Hospital, shall provide a charitable
discount of 100% of its charges for all medically
necessary health care services exceeding $150 in any one
inpatient admission or outpatient encounter to any
uninsured patient who applies for a discount and has
family income of not more than 200% of the federal poverty
income guidelines.
(3) A rural hospital or Critical Access Hospital shall
provide a discount from its charges to any uninsured
patient who applies for a discount and has annual family
income of not more than 300% of the federal poverty income
guidelines for all medically necessary health care
services exceeding $300 in any one inpatient admission or
outpatient encounter.
(4) A rural hospital or Critical Access Hospital shall
provide a charitable discount of 100% of its charges for
all medically necessary health care services exceeding
$300 in any one inpatient admission or outpatient
encounter to any uninsured patient who applies for a
discount and has family income of not more than 125% of the
federal poverty income guidelines.
(5) In determining eligibility under this Act, a
hospital subject to this Act shall exclude from
consideration any unconditional cash transfers, payments,
or gifts received under a guaranteed income program if:
(A) such cash transfers, payments, or gifts are
excluded from consideration for determining
eligibility under public health insurance programs
administered by the State in which the State has the
authority to waive guaranteed income; and
(B) the guaranteed income program is a program for
a defined number of months or years designed to reduce
poverty, promote social mobility, or increase
financial stability for program participants and if
there is an explicit plan to collect data.
This paragraph is inoperative on and after July 1,
2026.
(b) Discount. For all health care services exceeding $300
in any one inpatient admission or outpatient encounter, a
hospital shall not collect from an uninsured patient, deemed
eligible under subsection (a), more than its charges less the
amount of the uninsured discount.
(c) Maximum Collectible Amount.
(1) The maximum amount that may be collected in a
12-month period for health care services provided by the
hospital from a patient determined by that hospital to be
eligible under subsection (a) is 20% of the patient's
family income, and is subject to the patient's continued
eligibility under this Act.
(2) The 12-month period to which the maximum amount
applies shall begin on the first date, after the effective
date of this Act, an uninsured patient receives health
care services that are determined to be eligible for the
uninsured discount at that hospital.
(3) To be eligible to have this maximum amount applied
to subsequent charges, the 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. The
availability of the maximum collectible amount shall be
included in the hospital's financial assistance
information provided to uninsured patients.
(4) Hospitals may adopt policies to exclude an
uninsured patient from the application of subdivision
(c)(1) when the patient owns assets having a value in
excess of 600% of the federal poverty level for hospitals
in a metropolitan statistical area or owns assets having a
value in excess of 300% of the federal poverty level for
Critical Access Hospitals or hospitals outside a
metropolitan statistical area, not counting the following
assets: the uninsured patient's primary residence;
personal property exempt from judgment under Section
12-1001 of the Code of Civil Procedure; or any amounts
held in a pension or retirement plan, provided, however,
that distributions and payments from pension or retirement
plans may be included as income for the purposes of this
Act.
(d) Each hospital bill, invoice, or other summary of
charges to an uninsured patient shall include with it, or on
it, a prominent statement that an uninsured patient who meets
certain income requirements may qualify for an uninsured
discount and information regarding how an uninsured patient
may apply for consideration under the hospital's financial
assistance policy. The hospital's financial assistance
application shall include language that directs the uninsured
patient to contact the hospital's financial counseling
department with questions or concerns, along with contact
information for the financial counseling department, and shall
state: "Complaints or concerns with the uninsured patient
discount application process or hospital financial assistance
process may be reported to the Health Care Bureau of the
Illinois Attorney General.". A website, phone number, or both
provided by the Attorney General shall be included with this
statement.
(Source: P.A. 102-581, eff. 1-1-22.)
(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, the
Health Benefits for Immigrants program, or any other program,
if there is a reasonable basis to believe that the uninsured
patient may be eligible for such program.
(b) Hospitals shall permit an uninsured patient to apply
for a discount within 90 days of the date of discharge or date
of service.
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.)
Section 10. The Illinois Public Aid Code is amended by
changing Section 1-7 as follows:
(305 ILCS 5/1-7) (from Ch. 23, par. 1-7)
Sec. 1-7. (a) For purposes of determining eligibility for
assistance under this Code, the Illinois Department, County
Departments, and local governmental units shall exclude from
consideration restitution payments, including all income and
resources derived therefrom, made to persons of Japanese or
Aleutian ancestry pursuant to the federal Civil Liberties Act
of 1988 and the Aleutian and Pribilof Island Restitution Act,
P.L. 100-383.
(b) For purposes of any program or form of assistance
where a person's income or assets are considered in
determining eligibility or level of assistance, whether under
this Code or another authority, neither the State of Illinois
nor any entity or person administering a program wholly or
partially financed by the State of Illinois or any of its
political subdivisions shall include restitution payments,
including all income and resources derived therefrom, made
pursuant to the federal Civil Liberties Act of 1988 and the
Aleutian and Pribilof Island Restitution Act, P.L. 100-383, in
the calculation of income or assets for determining
eligibility or level of assistance.
(c) For purposes of determining eligibility for or the
amount of assistance under this Code, except for the
determination of eligibility for payments or programs under
the TANF employment, education, and training programs and the
Food Stamp Employment and Training Program, the Illinois
Department, County Departments, and local governmental units
shall exclude from consideration any financial assistance
received under any student aid program administered by an
agency of this State or the federal government, by a person who
is enrolled as a full-time or part-time student of any public
or private university, college, or community college in this
State.
(d) For purposes of determining eligibility for or the
amount of assistance under this Code, except for the
determination of eligibility for payments or programs under
the TANF employment, education, and training programs and the
SNAP Employment and Training Program, the Illinois Department,
County Departments, and local governmental units shall exclude
from consideration, for a period of 36 months, any financial
assistance, including wages, that is provided to a person who
is enrolled in a demonstration project that is not funded with
general revenue funds and that is intended as a bridge to
self-sufficiency by offering (i) intensive workforce support
and training and (ii) support services for new and expectant
parents that are intended to foster multi-generational healthy
families as described in Section 12-4.51.
(e)(1) Notwithstanding any other provision of this Code,
and to the maximum extent permitted by federal law, for
purposes of determining eligibility and the amount of
assistance under this Code, the Illinois Department and local
governmental units shall exclude from consideration, for a
period of no more than 60 months, any financial assistance,
including wages, cash transfers, or gifts, that is provided to
a person through a guaranteed income program. As used in this
subsection, "guaranteed income program" means a publicly or
privately funded program that provides one-time or recurring
unconditional cash transfers or payments, or gifts to
individuals or households, for a defined number of months or
years for the purposes of reducing poverty, promoting economic
mobility, or increasing the financial stability of Illinois
residents. who is enrolled in a program or research project
that is not funded with general revenue funds and that is
intended to investigate the impacts of policies or programs
designed to reduce poverty, promote social mobility, or
increase financial stability for Illinois residents if there
is an explicit plan to collect data and evaluate the program or
initiative that is developed prior to participants in the
study being enrolled in the program and if a research team has
been identified to oversee the evaluation.
(2) The Department shall choose State options and seek all
necessary federal approvals or waivers to implement this
subsection.
(Source: P.A. 100-806, eff. 1-1-19; 101-415, eff. 8-16-19.)
Section 99. Effective date. This Act takes effect January
1, 2024.