Bill Text: IL HB3593 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Fair Patient Billing Act. Requires that a hospital's obligation to patients under the Act shall cover all health care services, including, but not limited to, on-site health care services provided by a non-hospital entity. Provides that, in the event the hospital outsources health care services to an individual or entity that is separate from the hospital within the hospital facility or otherwise on the hospital site, the hospital's obligations under the Act continue as though the hospital had provided the health care services. Requires a hospital to ensure that the individual or entity contracted to provide health care services agrees in writing to operate under the hospital's financial assistance policy, screening obligations, collections provisions, and all other provisions of the Act, and requires a hospital to ensure that a hospital agent or on-site provider of outsourced health care services complies with the Act. Amends the Hospital Uninsured Patient Discount Act to establish similar requirements for hospitals. Provides that a hospital shall include charges from the third-party individual or entity when calculating the charge, discount, or collectible amount applicable under the Act.

Sponsorship: Partisan Bill (Democrat 7)

Status: (Introduced - Dead) 2025-04-11 - House Floor Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee [HB3593 Detail]

Download: Illinois-2025-HB3593-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3593 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED:
210 ILCS 88/5
210 ILCS 88/10
210 ILCS 88/40
210 ILCS 89/5
210 ILCS 89/10
Amends the Fair Patient Billing Act. Requires that a hospital's obligation to patients under the Act shall cover all health care services, including, but not limited to, on-site health care services provided by a non-hospital entity. Provides that, in the event the hospital outsources health care services to an individual or entity that is separate from the hospital within the hospital facility or otherwise on the hospital site, the hospital's obligations under the Act continue as though the hospital had provided the health care services. Requires a hospital to ensure that the individual or entity contracted to provide health care services agrees in writing to operate under the hospital's financial assistance policy, screening obligations, collections provisions, and all other provisions of the Act, and requires a hospital to ensure that a hospital agent or on-site provider of outsourced health care services complies with the Act. Amends the Hospital Uninsured Patient Discount Act to establish similar requirements for hospitals. Provides that a hospital shall include charges from the third-party individual or entity when calculating the charge, discount, or collectible amount applicable under the Act.
LRB104 09784 BAB 19850 b
A BILL FOR
HB3593 LRB104 09784 BAB 19850 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Fair Patient Billing Act is amended by
changing Sections 5, 10, and 40 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

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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.
(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

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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.
(10) Hospitals are increasingly outsourcing on-site
health care services to third-party individuals or
entities without extending the screening, billing, and
collections protections afforded to hospital patients
under this Act. A hospital's obligation to patients under
this Act should continue when a hospital has outsourced or
otherwise contracted with a third-party individual or
entity to provide specific health care services within the
hospital building, or otherwise on the hospital site.
(Source: P.A. 103-323, eff. 1-1-24.)
(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,

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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.
"Outsource" or "outsourcing" means a business arrangement
where the hospital has contracted services or functions to be
performed by an external individual or entity on a contract
basis, although the services or functions may still be
performed on the hospital site. "Outsourced" or "outsourcing"
is distinct from an in-network or out-of-network contracted
relationship with an insurer described in Section 50.
"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

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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. 103-323, eff. 1-1-24.)
(210 ILCS 88/40)
Sec. 40. Hospital agents; outsourced health care services
on-site.
(a) 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.
(b) The hospital's obligation to patients under this Act
shall cover all health care services, including, but not
limited to, on-site health care services provided by a

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non-hospital entity.
(c) In the event the hospital outsources health care
services to an individual or entity that is separate from the
hospital within the hospital facility or otherwise on the
hospital site, the hospital's obligations under this Act
continue as though the hospital had provided the health care
services.
(d) The hospital must ensure that the individual or entity
contracted to provide health care services agrees in writing
to operate under the hospital's financial assistance policy,
screening obligations, collections provisions, and all other
provisions of this Act.
(e) The hospital is responsible for ensuring a hospital
agent or on-site provider of outsourced health care services
complies with this Act.
(Source: P.A. 94-885, eff. 1-1-07.)
Section 10. The Hospital Uninsured Patient Discount Act is
amended by changing Sections 5 and 10 as follows:
(210 ILCS 89/5)
Sec. 5. Definitions. As used in this Act:
"Community health center" means a federally qualified
health center as defined in Section 1905(l)(2)(B) of the
federal Social Security Act or a federally qualified health
center look-alike.

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"Cost to charge ratio" means the ratio of a hospital's
costs to its charges taken from its most recently filed
Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
Inpatient Ratios).
"Critical Access Hospital" means a hospital that is
designated as such under the federal Medicare Rural Hospital
Flexibility Program.
"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 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).
"Financial assistance" means a discount provided to a
patient under the terms and conditions a hospital offers to
qualified patients or as required by law.
"Free and charitable clinic" means a 501(c)(3) tax-exempt
health care organization providing health services to
low-income uninsured or underinsured individuals that is
recognized by either the Illinois Association of Free and
Charitable Clinics or the National Association of Free and
Charitable Clinics.
"Guaranteed income program" means a publicly or privately
funded program that provides one-time or recurring
unconditional cash transfers or payments, or gifts to

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individuals or households, for a defined number of months or
years for the purposes of reducing poverty, promoting economic
mobility, or increasing the financial stability of Illinois
residents.
"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 or operated
under the University of Illinois Hospital Act.
"Illinois resident" means any 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 Act.
"Medically necessary" means any inpatient or outpatient
hospital service, including pharmaceuticals or supplies
provided by a hospital to a patient, covered under Title XVIII
of the federal Social Security Act for beneficiaries with the
same clinical presentation as the uninsured patient. A
"medically necessary" service does not include any of the
following:
(1) Non-medical services such as social and vocational
services.
(2) Elective cosmetic surgery, but not plastic surgery

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designed to correct disfigurement caused by injury,
illness, or congenital defect or deformity.
"Outsource" or "outsourcing" means a business arrangement
where the hospital has contracted services or functions to be
performed by an external individual or entity on a contract
basis, although the services or functions may still be
performed on the hospital site.
"Rural hospital" means a hospital that is located outside
a metropolitan statistical area.
"Uninsured discount" means a hospital's charges multiplied
by the uninsured discount factor.
"Uninsured discount factor" means 1.0 less the product of
a hospital's cost to charge ratio multiplied by 1.35.
"Uninsured patient" means an Illinois resident who is a
patient of a hospital and is not covered under a policy of
health insurance and is not a beneficiary under a public or
private health insurance, health benefit, or other health
coverage program, including high deductible health insurance
plans, workers' compensation, accident liability insurance, or
other third party liability.
(Source: P.A. 102-581, eff. 1-1-22; 103-492, eff. 1-1-24.)
(210 ILCS 89/10)
Sec. 10. Uninsured patient discounts.
(a) Eligibility.
(1) A hospital, other than a rural hospital or

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Critical Access Hospital, shall provide a discount from
its charges to any uninsured patient who applies for a
discount and has family income of not more than 600% of the
federal poverty income guidelines for all medically
necessary health care services exceeding $150 in any one
inpatient admission or outpatient encounter.
(2) A hospital, other than a rural hospital or
Critical Access Hospital, shall provide a charitable
discount of 100% of its charges for all medically
necessary health care services exceeding $150 in any one
inpatient admission or outpatient encounter to any
uninsured patient who applies for a discount and has
family income of not more than 200% of the federal poverty
income guidelines.
(3) A rural hospital or Critical Access Hospital shall
provide a discount from its charges to any uninsured
patient who applies for a discount and has annual family
income of not more than 300% of the federal poverty income
guidelines for all medically necessary health care
services exceeding $300 in any one inpatient admission or
outpatient encounter.
(4) A rural hospital or Critical Access Hospital shall
provide a charitable discount of 100% of its charges for
all medically necessary health care services exceeding
$300 in any one inpatient admission or outpatient
encounter to any uninsured patient who applies for a

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discount and has family income of not more than 125% of the
federal poverty income guidelines.
(5) In determining eligibility under this Act, a
hospital subject to this Act shall exclude from
consideration any unconditional cash transfers, payments,
or gifts received under a guaranteed income program if:
(A) such cash transfers, payments, or gifts are
excluded from consideration for determining
eligibility under public health insurance programs
administered by the State in which the State has the
authority to waive guaranteed income; and
(B) the guaranteed income program is a program for
a defined number of months or years designed to reduce
poverty, promote social mobility, or increase
financial stability for program participants and if
there is an explicit plan to collect data.
This paragraph is inoperative on and after July 1,
2026.
(b) Discount. For all health care services exceeding $300
in any one inpatient admission or outpatient encounter, a
hospital shall not collect from an uninsured patient, deemed
eligible under subsection (a), more than its charges less the
amount of the uninsured discount.
(c) Maximum Collectible Amount.
(1) The maximum amount that may be collected in a
12-month period for health care services provided by the

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hospital from a patient determined by that hospital to be
eligible under subsection (a) is 20% of the patient's
family income, and is subject to the patient's continued
eligibility under this Act.
(2) The 12-month period to which the maximum amount
applies shall begin on the first date, after the effective
date of this Act, an uninsured patient receives health
care services that are determined to be eligible for the
uninsured discount at that hospital.
(3) To be eligible to have this maximum amount applied
to subsequent charges, the 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. The
availability of the maximum collectible amount shall be
included in the hospital's financial assistance
information provided to uninsured patients.
(4) Hospitals may adopt policies to exclude an
uninsured patient from the application of subdivision
(c)(1) when the patient owns assets having a value in
excess of 600% of the federal poverty level for hospitals
in a metropolitan statistical area or owns assets having a
value in excess of 300% of the federal poverty level for
Critical Access Hospitals or hospitals outside a
metropolitan statistical area, not counting the following

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assets: the uninsured patient's primary residence;
personal property exempt from judgment under Section
12-1001 of the Code of Civil Procedure; or any amounts
held in a pension or retirement plan, provided, however,
that distributions and payments from pension or retirement
plans may be included as income for the purposes of this
Act.
(d) Each hospital bill, invoice, or other summary of
charges to an uninsured patient shall include with it, or on
it, a prominent statement that an uninsured patient who meets
certain income requirements may qualify for an uninsured
discount and information regarding how an uninsured patient
may apply for consideration under the hospital's financial
assistance policy. The hospital's financial assistance
application shall include language that directs the uninsured
patient to contact the hospital's financial counseling
department with questions or concerns, along with contact
information for the financial counseling department, and shall
state: "Complaints or concerns with the uninsured patient
discount application process or hospital financial assistance
process may be reported to the Health Care Bureau of the
Illinois Attorney General.". A website, phone number, or both
provided by the Attorney General shall be included with this
statement.
(e) In the event the hospital contracts with a third-party
individual or entity that is separate from the hospital to

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provide health care services within the hospital facility or
otherwise on the hospital site, the hospital's obligations
under this Act continue as though the hospital itself provided
the health care services. The hospital shall include charges
from the third-party individual or entity when calculating the
charge, discount, or collectible amount applicable under this
Act.
(f) The hospital's obligation to patients under this Act
covers all health care services, including, but not limited
to, outsourced on-site health care services provided by a
non-hospital entity.
(g) The hospital must ensure that the individual or entity
contracted to provide health care services agrees in writing
to operate under the hospital's uninsured patient discount and
all other provisions of this Act.
(h) The hospital is responsible for ensuring a hospital
agent or on-site provider of outsourced health care services
complies with this Act.
(Source: P.A. 102-581, eff. 1-1-22; 103-492, eff. 1-1-24.)