Public Act 103-0323
 
HB2719 EnrolledLRB103 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. 
        (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.)