HB1434 104TH GENERAL ASSEMBLY

LRB104 05783 BDA 15813 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB1434

Introduced 1/28/2025, by Rep. Janet Yang Rohr

SYNOPSIS AS INTRODUCED:

New Act
815 ILCS 505/2Z	from Ch. 121 1/2, par. 262Z

Creates the Health Care Facility Fee Transparency Act. Defines terms. Requires hospitals or health care systems to provide transparency, including written notices and proper signage, regarding facility fees, with certain requirements. Provides that a failure to comply with these requirements constitutes an unlawful practice under the Consumer Fraud and Deceptive Business Practices Act. Amends the Consumer Fraud and Deceptive Business Practices Act. Adds the Health Care Facility Fee Transparency Act to the list of other Acts that constitute a violation of the Consumer Fraud and Deceptive Business Practices Act.

A BILL FOR

AN ACT concerning business.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Health Care Facility Fee Transparency Act.

Section 5. Definitions. In this Act:

"Campus" means:

(1) the physical area immediately adjacent to a hospital's main buildings and other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main building; or

(2) any other building that is part of a hospital's campus.

"Facility Fee" means any fee charged or billed by a hospital or health system for outpatient hospital services provided in a hospital-based facility that is:

(1) intended to compensate the hospital or health system for its operational expenses; and

(2) separate and distinct from a professional fee charged or billed by a health care provider for professional medical services.

"Health care system" or "Health system" means:

(1) a parent corporation of one or more hospitals and any entity affiliated with such corporation through ownership, governance, membership, or other means; or

(2) a hospital and any entity affiliated with such hospital through ownership, governance, membership, or other means.

"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.

"Hospital-based facility" means a facility that is owned or operated, in whole or in part, by a hospital or health system where hospital or professional medical services are provided.

"Professional fee" means any fee charged or billed by a provider for professional medical services provided in a hospital-based facility.

"Provider" means an individual, entity, corporation, or health care provider, whether for profit or nonprofit, whose primary purpose is to provide professional medical services.

Section 10. Requirement of hospitals or health care systems to provide transparency regarding facility fees.

(a) If a hospital or health system charges a facility fee utilizing a current procedural terminology evaluation and management (CPT E/M) code for outpatient services provided at a hospital-based facility where a professional fee is also expected to be charged, the hospital or health system shall provide the patient with a written notice containing the following information:

(1) that the hospital-based facility fee is part of a hospital or health system which charges a facility fee in addition to and separate from the professional fee charged or billed by the provider;

(2) the amount of the patient's potential financial liability, including any facility fees likely to be charged and any professional fees likely to be charged; if the exact type and extent of the professional medical services needed are not known or the terms of a patient's health insurance coverage are not known with reasonable certainty, an estimate of the patient's potential financial liability shall be provided based on typical charges for the services provided to the patient at the hospital-based facility, including the cost of the facility fee;

(3) a statement that the patient's financial liability will depend on professional medical services provided;

(4) an explanation that the patient may incur a financial liability that is greater than if the professional medical services were provided by a facility that is not hospital-based; and

(5) that a patient covered by a health insurance policy should contact the patient's health insurance provider for additional information regarding the hospital's or health system's charges or fees, as well as the patient's potential financial liability for those charges and fees.

(b) If a hospital or health system charges a facility fee without using a current procedural terminology and management (CPT E/M) code for outpatient services provided at a hospital-based facility, located outside the boundaries of the hospital campus, the hospital or health system shall provide the patient with a written notice containing the following information:

(1) that the hospital-based facility is part of a hospital or health system which charges a facility fee in addition to and separate from the professional fee charged or billed by the provider;

(2) a statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient;

(3) an explanation that the patient may incur a financial liability that is greater than if the professional medical services were provided by a facility that is not hospital-based; and

(4) that a patient covered by a health insurance policy should contact the patient's health insurance provider for additional information regarding the hospital's or health system's charges of fees, as well as the patient's potential financial liability for those charges and fees.

(c) The written notice described in this Section shall be in simple language in a form that a patient who does not possess any knowledge regarding hospital or health system charges and fees would be able to understand.

(d) The notice described in this Section shall be provided to the patient in the following manner:

(1) For non-emergency care, if a patient's appointment is scheduled to occur 10 or more days after the appointment is made, written notice shall be sent to the patient by first class mail, encrypted electronic mail, or a secure patient Internet portal not less than 3 days after the appointment is made. If an appointment is scheduled to occur less than 10 days after the appointment is made, written notice shall be hand-delivered to the patient when the patient arrives at the hospital-based facility.

(2) For emergency care, written notice shall be provided to the patient as soon as practicable after the patient is stabilized or is determined to not have an emergency medical condition and before the patient leaves the hospital-based facility. If the patient is unconscious, under great duress, or for any other reason is unable to read the notice and act on the patient's rights, the notice shall be provided to the patient's representative as soon as practicable.

(e) A hospital-based facility shall prominently display written notices in locations that are readily accessible to and visible by patients, including patient waiting areas, stating that:

(1) the hospital-based facility is part of a hospital or health system; and

(2) if the hospital-based facility charges a facility fee, the patient may incur a financial liability greater than if the facility was not hospital-based.

(f) A hospital-based facility shall clearly hold itself out to the public and payers as being hospital based, including, at a minimum, by stating the name of the hospital or health system in its signage, marketing materials, Internet websites, and stationary.

(g) A failure by a health system, health facility, or hospital to comply with the requirements in this Act constitutes an unlawful practice under the Consumer Fraud and Deceptive Business Practices Act.

Section 15. The Consumer Fraud and Deceptive Business Practices Act is amended by changing Section 2Z as follows:

(815 ILCS 505/2Z) (from Ch. 121 1/2, par. 262Z)

Sec. 2Z. Violations of other Acts. Any person who knowingly violates the Automotive Repair Act, the Automotive Collision Repair Act, the Home Repair and Remodeling Act, the Dance Studio Act, the Physical Fitness Services Act, the Hearing Instrument Consumer Protection Act, the Illinois Union Label Act, the Installment Sales Contract Act, the Job Referral and Job Listing Services Consumer Protection Act, the Travel Promotion Consumer Protection Act, the Credit Services Organizations Act, the Automatic Telephone Dialers Act, the Pay-Per-Call Services Consumer Protection Act, the Telephone Solicitations Act, the Illinois Funeral or Burial Funds Act, the Cemetery Oversight Act, the Cemetery Care Act, the Safe and Hygienic Bed Act, the Illinois Pre-Need Cemetery Sales Act, the High Risk Home Loan Act, the Payday Loan Reform Act, the Predatory Loan Prevention Act, the Mortgage Rescue Fraud Act, subsection (a) or (b) of Section 3-10 of the Cigarette Tax Act, subsection (a) or (b) of Section 3-10 of the Cigarette Use Tax Act, the Electronic Mail Act, the Internet Caller Identification Act, paragraph (6) of subsection (k) of Section 6-305 of the Illinois Vehicle Code, Section 11-1431, 18d-115, 18d-120, 18d-125, 18d-135, 18d-150, or 18d-153 of the Illinois Vehicle Code, Article 3 of the Residential Real Property Disclosure Act, the Automatic Contract Renewal Act, the Reverse Mortgage Act, Section 25 of the Youth Mental Health Protection Act, the Personal Information Protection Act, or the Student Online Personal Protection Act, or the Health Care Facility Fee Transparency Act commits an unlawful practice within the meaning of this Act.

(Source: P.A. 100-315, eff. 8-24-17; 100-416, eff. 1-1-18; 100-863, eff. 8-14-18; 101-658, eff. 3-23-21.)