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Public Act 094-0885 |
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AN ACT concerning collection practices.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. Short title. This Act may be cited as the Fair | ||||
Patient Billing Act.
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Section 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) 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.
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Section 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. | ||
"Patient" means the individual receiving services from the | ||
hospital and any individual who is the guarantor of the payment | ||
for such services.
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"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. | ||
"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.
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Section 15. Patient notification. | ||
(a) Each hospital shall post a sign with the following | ||
notice: | ||
"You may be eligible for financial assistance under | ||
the terms and conditions the hospital offers to qualified | ||
patients. For more information contact [hospital financial |
assistance representative]". | ||
(b) The sign under subsection (a) shall be posted | ||
conspicuously in the admission and registration areas of the | ||
hospital. | ||
(c) The sign 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. | ||
(d) Each hospital that has a website must post a notice in | ||
a prominent place on its website that financial assistance is | ||
available at the hospital, a description of the financial | ||
assistance application process, and a copy of the financial | ||
assistance application. | ||
(e) Each hospital must make available information | ||
regarding financial assistance from the hospital in the form of | ||
either a brochure, an application for financial assistance, or | ||
other written material in the hospital admission or | ||
registration area. | ||
Section 20. Bill information.
If a hospital bills a patient | ||
for health care services, the hospital shall provide with its | ||
bill the following information:
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(1) the date or dates that health care services were | ||
provided to the patient; | ||
(2) a brief description of the hospital services; | ||
(3) the amount owed for hospital services; | ||
(4) hospital contact information for addressing | ||
billing inquiries; | ||
(5) a statement regarding how an uninsured patient may | ||
apply for consideration under the hospital's financial | ||
assistance policy on or with each hospital bill sent to an | ||
uninsured patient; and | ||
(6) notice that the patient may obtain an itemized bill | ||
upon request.
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If a hospital bills a patient, then the hospital must | ||
provide an itemized statement of charges for the inpatient and | ||
outpatient services rendered by the hospital upon receiving a |
request from the patient.
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Section 25. Bill inquiries. | ||
(a) A hospital must implement a process for patients to | ||
inquire about or dispute a bill. Such process must include a | ||
telephone number for billing inquiries and disputes and may | ||
include any of the following options: | ||
(1) a toll-free telephone number that the patient may | ||
call;
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(2) an address to which he or she may write;
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(3) a department or identified individual within the | ||
hospital he or she may call or write, with appropriate | ||
contact information; or
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(4) a website or e-mail address.
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(b) All hospital bills and collection notices must provide | ||
a telephone number allowing the patient to inquire about or | ||
dispute a bill.
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(c) The hospital must return calls made by patients as | ||
promptly as possible, but no later than 2 business days after | ||
the call is made. If the hospital's billing inquiry process | ||
involves correspondence from the patient, the hospital must | ||
respond within 10 business days of receipt of the patient | ||
correspondence. For purposes of this Section, "business day" | ||
means a day on which the hospital's billing office is open for | ||
regular business.
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Section 30. Pursuing collection action.
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(a) Hospitals and their agents may pursue collection action | ||
against an uninsured patient only if the following conditions | ||
are met: | ||
(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. |
(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. | ||
(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 60 days following | ||
the date of discharge or receipt of outpatient care to | ||
submit an application for financial assistance. | ||
(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. | ||
(5) If the uninsured patient informs the hospital that | ||
he or she has applied for health care coverage under | ||
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.
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(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 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 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 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.
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Section 35. Collection limitations. The hospital shall not | ||
pursue legal action for non-payment of a hospital bill against | ||
uninsured patients who have clearly demonstrated that they have | ||
neither sufficient income nor assets to meet their financial | ||
obligations provided the patient has complied with Section 45 | ||
of this Act.
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Section 40. Hospital agents. The hospital must ensure that | ||
any external collection agency, law firm, or individual engaged | ||
by the hospital to obtain payment of outstanding bills for | ||
hospital services agrees in writing to comply with the | ||
collections provisions of this Act.
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Section 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 by | ||
providing the hospital with all of the reasonably requested | ||
financial and other relevant information and documentation | ||
needed to determine the patient's eligibility under the | ||
hospital's financial assistance policy 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.
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Section 50. Notification concerning out-of-network | ||
providers.
During the admission or as soon as practicable | ||
thereafter, the hospital must provide an insured patient with | ||
written notice that: | ||
(1) the patient may receive separate bills for services | ||
provided by health care professionals affiliated with the | ||
hospital; | ||
(2) if applicable, some hospital staff members may not | ||
be participating providers in the same insurance plans and | ||
networks as the hospital; | ||
(3) if applicable, the patient may have a greater | ||
financial responsibility for services provided by health | ||
care professionals at the hospital who are not under | ||
contract with the patient's health care plan; and | ||
(4) questions about coverage or benefit levels should | ||
be directed to the patient's health care plan and the | ||
patient's certificate of coverage.
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Section 55. Enforcement.
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(a) The Attorney General is responsible for administering | ||
and ensuring compliance with this Act, including the | ||
development of any rules necessary for the implementation and | ||
enforcement of this Act. | ||
(b) The Attorney General shall develop and implement a | ||
process for receiving and handling complaints from individuals | ||
or hospitals regarding possible violations of this Act. | ||
(c) The Attorney General may conduct any investigation | ||
deemed necessary regarding possible violations of this Act by | ||
any hospital including, without limitation, the issuance of | ||
subpoenas to:
(i) require the hospital to file a statement or | ||
report or answer interrogatories in writing as to all | ||
information relevant to the alleged violations;
(ii) examine |
under oath any person who possesses knowledge or information | ||
directly related to the alleged violations; and
(iii) examine | ||
any record, book, document, account, or paper necessary to | ||
investigate the alleged violation. | ||
(d) If the Attorney General determines that there is a | ||
reason to believe that any hospital has violated the Act, the | ||
Attorney General may bring an action in the name of the People | ||
of the State against the hospital to obtain temporary, | ||
preliminary, or permanent injunctive relief for any act, | ||
policy, or practice by the hospital that violates this Act. | ||
Before bringing such an action, the Attorney General may permit | ||
the hospital to submit a Correction Plan for the Attorney | ||
General's approval. | ||
(e) This Section applies if: | ||
(i) a court orders a party to make payments to the | ||
Attorney General and the payments are to be used for the | ||
operations of the Office of the Attorney General; or | ||
(ii) a party agrees in a Correction Plan under this | ||
Act, to make payments to the Attorney General for the | ||
operations of the Office of the Attorney General. | ||
(f) Moneys paid under any of the conditions described in | ||
(e) shall be deposited into the Attorney General court ordered | ||
and Voluntary Compliance Payment Projects Fund. Moneys in the | ||
Fund shall be used, subject to appropriation, for the | ||
performance of any function pertaining to the exercise of the | ||
duties to the Attorney General including, but not limited to, | ||
enforcement of any law of this State and conducting public | ||
education programs; however, any moneys in the Fund that are | ||
required by the court to be used for a particular purpose shall | ||
be used for that purpose. | ||
(g) The Attorney General may seek the assessment of one or | ||
more of the following civil monetary penalties in any action | ||
filed under this Act where the hospital knowingly violates the | ||
Act:
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(1) For violations, involving a pattern or practice, of | ||
not providing the information to patients under Sections |
15, 20, 25, and 50, the civil monetary penalty shall not | ||
exceed $500 per violation. | ||
(2) For violations involving the failure to engage in | ||
or refrain from certain activities under Sections 30, 35 | ||
and 40, the civil monetary penalty shall not exceed $1000 | ||
per violation. | ||
(h) In the event a court grants a final order of relief | ||
against any hospital for a violation of this Act, the Attorney | ||
General may, after all appeal rights have been exhausted, refer | ||
the hospital to the Illinois Department of Public Health for | ||
possible adverse licensure action under the Hospital Licensing | ||
Act.
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Section 60. Limitations. Nothing in this Act shall be used | ||
by any private or public payer as a basis for reducing the | ||
third-party payer's rates, policies, or usual and customary | ||
charges for any health care service. Nothing in this Act shall | ||
be construed as imposing an obligation on a hospital to provide | ||
any particular service or treatment to an uninsured patient. | ||
Nothing in this Act shall be construed as imposing an | ||
obligation on a hospital to file a lawsuit to collect payment | ||
on a patient's bill. This Act establishes new and additional | ||
legal obligations for all hospitals in the State of Illinois. | ||
Nothing in this Act shall be construed as relieving or reducing | ||
any hospital of any other obligation under the Illinois | ||
Constitution or under any other statute or the common law | ||
including, without limitation, obligations of hospitals to | ||
furnish financial assistance or community benefits. No | ||
provision of this Act shall derogate from the common law or | ||
statutory authority of the Attorney General, nor shall any | ||
provision be construed as a limitation on the common law or | ||
statutory authority of the Attorney General to investigate | ||
hospitals or initiate enforcement actions against them | ||
including, without limitation, the authority to investigate at | ||
any time charitable trusts for the purpose of determining and | ||
ascertaining whether they are being administered in accordance |
with Illinois law and with the terms purposes thereof.
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Section 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.
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(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. | ||
Section 75. Home rule. A home rule unit may not regulate | ||
hospitals in a manner inconsistent with the provisions of this | ||
Act. This Section is a limitation under subsection (i) of | ||
Section 6 of the Article VII of the Illinois Constitution on | ||
the concurrent exercise by home rule units of powers and | ||
functions exercised by the State. | ||
Section 80. Administrative Procedure Act. The Illinois | ||
Administrative Procedure Act applies to all rules promulgated | ||
by the Attorney General under the Act.
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Section 999. Effective date. This Act takes effect January | ||
1, 2007. |