Section 4500.10  Definitions

 

As used in this Part, the term:

 

"Act" means the Fair Patient Billing Act [210 ILCS 88].

 

"Critical Access Hospital" means a hospital that is designated as a critical access hospital under the federal Medicare Rural Hospital Flexibility Program (42 U.S.C. 1395i-4).

 

"Electronic and Information Technology" or "EIT" means electronic information, software, systems and equipment used in the creation, manipulation, storage, display or transmission of data, including Internet and intranet systems, software applications, operating systems, video and multimedia, telecommunications products, kiosks, information transaction machines, copiers, printers and desktop and portable computers.

 

"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 federal poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of 42 U.S.C. 9902(2) and available at https://aspe.hhs.gov/poverty-guidelines.

 

"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 [210 ILCS 85] or operated under the University of Illinois Hospital Act [110 ILCS 330].

 

"Hospital Financial Assistance" means free or discounted health care services provided to patients who meet a hospital's criteria for financial assistance and are unable to pay for all or a portion of the health services. Hospital financial assistance does not include bad debt or uncollectible charges that the hospital recorded as revenue but wrote off due to a patient's failure to pay, or the cost of providing that care to patients; the difference between the cost of care provided under Medicaid or other means-tested government programs or under Medicare and the revenue derived from those programs; or contractual adjustments with any third party payors.

 

"Hospital Financial Assistance Application" means the form provided by a hospital and used by patients to apply for hospital financial assistance.

 

"Illinois Resident" means a 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 Part.

 

"Partner" means a person who has established a civil union pursuant to the Illinois Religious Freedom Protection and Civil Union Act [750 ILCS 75] or similar law.

 

"Patient" means the individual receiving services from the hospital or any individual who is the guarantor of the payment for services received from a hospital.

 

"Presumptive Eligibility" means eligibility for hospital financial assistance determined by reference to criteria demonstrating financial need on the part of a patient.

 

"Presumptive Eligibility Criteria" means the categories identified as demonstrating financial need on the part of a patient used by the hospital in the implementation of presumptive eligibility.

 

"Presumptive Eligibility Policy" means a written document that sets forth the presumptive eligibility criteria by which a patient's financial need is determined and used by the hospital to deem a patient eligible for hospital financial assistance without further scrutiny by the hospital.

 

"Rural Hospital" means a hospital that is located outside a metropolitan statistical area as defined by the United States Office of Management and Budget.

 

"Women, Infants and Children Nutrition Program" and "WIC" mean the federal Special Supplemental Nutrition Program for Women, Infants and Children authorized by section 17 of the Child Nutrition Act of 1966, as amended (42 U.S.C. 1786).

 

(Source:  Amended at 47 Ill. Reg. 1305, effective January 11, 2023)

 

Section 4500.20  Referenced Materials

 

a)         The following State statutes are referenced in this Part:

 

1)         Fair Patient Billing Act [210 ILCS 88];

 

2)         Community Benefits Act [210 ILCS 76];

 

3)         Hospital Uninsured Patient Discount Act [210 ILCS 89].

 

b)         The following Illinois administrative rules are referenced in this Part:

 

1)         Supplemental Nutrition Assistance Program (SNAP) (89 Ill. Adm. Code 121);

 

2)         Illinois Free Lunch and Breakfast Programs (23 Ill. Adm. Code 305.10);

 

3)         Low Income Home Energy Assistance Program (47 Ill. Adm. Code 100);

 

4)         Illinois Housing Development Authority's Rental Housing Support Program (47 Ill. Adm. Code 380);

 

5)         Temporary Assistance for Needy Families (TANF) (89 Ill. Adm. Code 112).

 

Section 4500.30  Hospital Financial Assistance Application Requirements

 

Hospital financial assistance applications shall be provided to patients on forms that are submitted annually, in conjunction with a hospital's filing of its Community Benefits Report as required by the Community Benefits Act or filing of Worksheet C as required by the Hospital Uninsured Patient Discount Act, to the Office of the Attorney General for review of compliance with this Part.  Hospital Financial Assistance Applications for each hospital shall be in English and in any other language that is the primary language of at least 5% of the patients served by the hospital annually as identified for purposes of Section 15(c) of the Act.  Information requested on the application shall include:

 

a)         Opening Statement, which shall contain the following paragraphs:

 

Important:  YOU MAY BE ABLE TO RECEIVE FREE OR DISCOUNTED CARE:  Completing this application will help ____ Hospital determine if you can receive free or discounted services or other public programs that can help pay for your healthcare.  Please submit this application to the hospital.

 

IF YOU ARE UNINSURED, A SOCIAL SECURITY NUMBER IS NOT REQUIRED TO QUALIFY FOR FREE OR DISCOUNTED CARE.  However, a Social Security Number is required for some public programs, including Medicaid.  Providing a Social Security Number is not required but will help the hospital determine whether you qualify for any public programs.

 

Please complete this form and submit it to the hospital in person, by mail, by electronic mail, or by fax to apply for free or discounted care within 60 days following the date of discharge or receipt of outpatient care.

 

Patient acknowledges that he or she has made a good faith effort to provide all information requested in the application to assist the hospital in determining whether the patient is eligible for financial assistance.

 

NOTE:  The requirement to complete and submit this form within 60 days following the date of discharge or receipt of outpatient care referenced in the Opening Statement may be increased by the hospital, but may not be decreased.

 

b)         Patient information, which shall be limited to the following:

 

1)         Patient name;

 

2)         Patient date of birth;

 

3)         Patient address;

 

4)         Whether patient was an Illinois resident when care was rendered by the hospital;

 

5)         Whether patient was involved in an alleged accident;

 

6)         Whether patient was a victim of an alleged crime;

 

7)         Patient Social Security Number (not required if you are uninsured);

 

8)         Patient telephone number or cell phone number;

 

9)         Patient e-mail address;

 

10)         In cases in which a spouse or partner is guarantor for the patient or in which a parent or guardian is guarantor for a minor, the name, address and telephone number of the guarantor.

 

              NOTE:  The hospital may choose to not include the information in this subsection (b)(10).

 

c)         Family/household information, which shall be limited to the following:

 

1)         Number of persons in the patient's family/household;

 

2)         Number of persons who are dependents of the patient;

 

3)         Ages of patient's dependents.

 

d)         Patient's family income and employment information, which shall be limited to the following:

 

1)         Whether patient or patient's spouse or partner is currently employed;

 

2)         If patient is a minor, whether patient's parents or guardians are currently employed;

 

3)         If patient or patient's spouse or partner is employed, name, address and telephone number of all employers;

 

4)         If a minor patient's parents or guardians are employed, name, address and telephone number of all employers;

 

5)         If patient is divorced or separated or was a party to a dissolution proceeding, whether the former spouse or partner is financially responsible for patient's medical care per the dissolution or separation agreement;

 

6)         Gross monthly family income, including cases in which a spouse or partner is guarantor for the patient or in which a parent or guardian is guarantor for a minor, from sources such as:

 

A)        Wages;

 

B)        Self-employment;

 

C)        Unemployment compensation;

 

D)        Social Security;

 

E)        Social Security Disability;

 

F)         Veterans' pension;

 

G)        Veterans' disability;

 

H)        Private disability;

 

I)         Workers' compensation;

 

J)         Temporary Assistance for Needy Families;

 

K)        Retirement income;

 

L)        Child support, alimony or other spousal support;

 

M)       Other income;

 

7)         Documentation of family income from paycheck stubs, benefit statements, award letters, court orders, federal tax returns, or other documentation provided by the patient.

 

e)         Insurance/benefit information, including but not limited to:

 

1)         Health insurance;

 

2)         Medicare;

 

3)         Medicare Part D;

 

4)         Medicare Supplement;

 

5)         Medicaid;

 

6)         Veterans' benefits.

 

f)         Asset and estimated asset value information, which shall be limited to the following:

 

1)         Checking;

 

2)         Savings;

 

3)         Stocks;

 

4)         Certificates of deposit;

 

5)         Mutual funds;

 

6)         Automobiles or other vehicles;

 

7)         Real property;

 

8)         Health savings/Flexible Spending Account.

 

g)         Monthly expense information and estimated expense figures, which shall be limited to the following:

 

1)         Housing;

 

2)         Utilities;

 

3)         Food;

 

4)         Transportation;

 

5)         Child care;

 

6)         Loans;

 

7)         Medical expenses;

 

8)         Other expenses.

 

h)         Certification, which shall contain only the following paragraph:

 

I certify that the information in this application is true and correct to the best of my knowledge.  I will apply for any state, federal or local assistance for which I may be eligible to help pay for this hospital bill. I understand that the information provided may be verified by the hospital, and I authorize the hospital to contact third parties to verify the accuracy of the information provided in this application. I understand that if I knowingly provide untrue information in this application, I will be ineligible for financial assistance, any financial assistance granted to me may be reversed, and I will be responsible for the payment of the hospital bill.

 

Patient or Applicant Signature and Date.

 

i)          The application shall contain a notation that, if a patient meets the presumptive eligibility criteria established in Section 4500.40 or is otherwise presumptively eligible by virtue of the patient's family income, the patient shall not be required to complete the portions of the application addressing the monthly expense information and estimated expense figures set out in subsection (g).

 

(Source:  Amended at 38 Ill. Reg. 20263, effective October 10, 2014)

 

Section 4500.40  Presumptive Eligibility Criteria

 

a)         Each hospital shall develop and implement a Presumptive Eligibility Policy setting forth the presumptive eligibility criteria by which a patient's financial need is determined and used by the hospital to deem a patient eligible for hospital financial assistance without further scrutiny by the hospital. The presumptive eligibility criteria set forth in each hospital's Presumptive Eligibility Policy shall be applied to an uninsured patient as defined in Section 10 of the Act as soon as possible after receipt of health care services from a hospital by the patient and prior to the issuance of any bill for those health care services by the hospital.

 

b)         Patients in hospitals that are not Critical Access Hospitals or rural hospitals shall be deemed presumptively eligible for hospital financial assistance if the patient demonstrates one or more of the following, which shall be included in the presumptive eligibility criteria for those hospitals:

 

1)         Homelessness;

 

2)         Deceased with no estate;

 

3)         Mental incapacitation with no one to act on patient's behalf;

 

4)         Medicaid eligibility, but not on date of service or for non-covered service;

 

5)         Enrollment in the following assistance programs for low-income individuals having eligibility criteria at or below 200% of the federal poverty income guidelines:

 

A)        Women, Infants and Children Nutrition Program (WIC);

 

B)        Supplemental Nutrition Assistance Program (SNAP);

 

C)        Illinois Free Lunch and Breakfast Program;

 

D)        Low Income Home Energy Assistance Program (LIHEAP);

 

E)        Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as a criterion for membership;

 

F)         Receipt of grant assistance for medical services.

 

c)         Hospitals that are not Critical Access Hospitals or rural hospitals may include additional presumptive eligibility criteria, provided that the additional criteria are used for or have the effect of expanding a patient's presumptive eligibility for hospital financial assistance, which shall be included in the presumptive eligibility criteria for the particular hospital.  These additional criteria may include, but are not limited to:

 

1)         Recent personal bankruptcy;

 

2)         Incarceration in a penal institution;

 

3)         Affiliation with a religious order and vow of poverty;

 

4)         Enrollment in the following assistance programs for low-income individuals:

 

A)        Temporary Assistance for Needy Families (TANF);

 

B)        IHDA's Rental Housing Support Program.

 

d)         Patients in hospitals that are Critical Access Hospitals or rural hospitals shall be deemed presumptively eligible for hospital financial assistance if the patient demonstrates one or more of the following, which shall be included in the presumptive eligibility criteria for those hospitals:

 

1)         Homelessness;

 

2)         Deceased with no estate;

 

3)         Mental incapacitation with no one to act on patient's behalf;

 

4)         Medicaid eligibility, but not on date of service or for non-covered service.

 

e)         Hospitals that are Critical Access Hospitals or rural hospitals may include additional presumptive eligibility criteria, provided that the additional criteria are used for or have the effect of expanding a patient's presumptive eligibility for hospital financial assistance, which shall be included in the presumptive eligibility criteria for those hospitals, such as:

 

1)         Recent personal bankruptcy;

 

2)         Incarceration in a penal institution;

 

3)         Affiliation with a religious order and vow of poverty;

 

4)         Patients who receive grant assistance for medical services;

 

5)         Women, Infants and Children Nutrition Program (WIC);

 

6)         Supplemental Nutrition Assistance Program (SNAP);

 

7)         Illinois Free Lunch and Breakfast Programs;

 

8)         IHDA's Rental Housing Support Program;

 

9)         Low Income Home Energy Assistance Program (LIHEAP);

 

10)         Temporary Assistance for Needy Families (TANF);

 

11)         Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as a criterion for membership.

 

(Source:  Amended at 38 Ill. Reg. 20263, effective October 10, 2014)

 

Section 4500.50  Hospital Financial Assistance Electronic and Information Technology

 

a)         Hospitals may utilize EIT in the implementation of Hospital Financial Assistance Application requirements set forth in this Part.

 

b)         Hospitals may utilize EIT in the implementation of presumptive eligibility criteria requirements set forth in this Part.

 

Section 4500.60  Hospital Financial Assistance Reporting Requirements

 

a)         Each hospital shall annually provide, in conjunction with the filing of its Community Benefits Report required by the Community Benefits Act or its Worksheet C Part I required by the Hospital Uninsured Patient Discount Act, a Hospital Financial Assistance Report to the Office of the Attorney General, which shall include the following:

 

1)         A copy of the Hospital Financial Assistance Application;

 

2)         A copy of the hospital's Presumptive Eligibility Policy, which shall identify each of the criteria used by the hospital to determine whether a patient is presumptively eligible for hospital financial assistance;

 

3)         Hospital financial assistance statistics, which shall include:

 

A)        The number of Hospital Financial Assistance Applications submitted to the hospital, both complete and incomplete, during the most recent fiscal year;

 

B)        The number of Hospital Financial Assistance Applications the hospital approved under its Presumptive Eligibility Policy during the most recent fiscal year;

 

C)        The number of Hospital Financial Assistance Applications the hospital approved outside its Presumptive Eligibility Policy during the most recent fiscal year;

 

D)        The number of Hospital Financial Assistance Applications denied by the hospital during the most recent fiscal year; and

 

E)        The total dollar amount of financial assistance provided by the hospital during the most recent fiscal year, based on actual cost of care.

 

b)         The Office of the Attorney General shall develop a Hospital Financial Assistance Report form and make it available to hospitals by October 1, 2013.

 

c)         Each hospital that annually files a Community Benefits Report with the Office of the Attorney General pursuant to the Community Benefits Act shall, at the same time, file its annual Hospital Financial Assistance Report jointly with its Community Benefits Report.

 

d)         Each hospital that is not required to annually file a Community Benefits Report with the Office of the Attorney General shall file its annual Hospital Financial Assistance Report jointly with the Worksheet C Part I from its Medicare Cost Report most recently filed pursuant to the Hospital Uninsured Patient Discount Act.

 

e)         Each hospital utilizing electronic and information technology in the implementation of the Hospital Financial Assistance Application requirements shall annually describe the EIT used and the source of the EIT to the Office of the Attorney General at the time of filing its Hospital Financial Assistance Report.  The hospital shall certify annually that each of the Hospital Financial Assistance Application requirements set forth in this Part are included in applications processed by EIT.

 

f)         Each hospital utilizing EIT in the implementation of the presumptive eligibility criteria shall annually describe the EIT used and the source of the EIT to the Office of the Attorney General at the time of filing its Hospital Financial Assistance Report.  The hospital shall certify annually that each of the presumptive eligibility criteria requirements set forth in this Part are included in applications processed by EIT.

 

g)         All records and certifications required to be filed under this Part in conjunction with the filing of a Community Benefits Report required by the Community Benefits Act shall be submitted to:

 

Charitable Trusts Bureau

Office of the Illinois Attorney General

100 West Randolph Street, 11^th Floor

Chicago, Illinois 60601

 

h)         All records and certifications required to be filed under this Part in conjunction with the filing of a Worksheet C required by the Hospital Uninsured Patient Discount Act shall be submitted to:

 

Health Care Bureau

Office of the Illinois Attorney General

100 West Randolph Street, 10^th Floor

Chicago, Illinois 60601

 

Section 4500.APPENDIX A   2022 Poverty Income Guidelines (Repealed)

 

(Source:  Repealed at 47 Ill. Reg. 1305, effective January 11, 2023)