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(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.
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(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. |
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(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.)
|
