Bill Text: IL HB5517 | 2023-2024 | 103rd General Assembly | Introduced

---

Bill Title: Creates the Protection Against Unnecessary Health Care Costs Act. Requires the State Comptroller to establish the Drug Discount Card Program to be made available for all residents of this State. Requires the Department of Insurance to report to the General Assembly and to the Governor recommendations for establishing an outreach and education program to inform licensed physicians on when a drug patent will expire and become available in generic form, and when generic alternatives exist for drugs whose patent recently expired. Provides that on and after October 1, 2025, a pharmaceutical manufacturer that employs an individual to perform the duties of a pharmaceutical sales representative shall register annually with the Department of Financial and Professional Regulation as a pharmaceutical marketing firm. Provides that each pharmaceutical marketing firm shall provide to the Department a list of all individuals employed by the pharmaceutical marketing firm as a pharmaceutical sales representative. Sets forth provisions concerning registration; registration fees; discipline of pharmaceutical marketing firms; the Department posting a list of all individuals employed by the pharmaceutical marketing firm as a pharmaceutical sales representative; and reports by pharmaceutical marketing firms to the Department. Requires the Department of Public Health to report to the General Assembly and the Governor, an analysis of pharmacy benefit managers' practices of prescription drug distribution. Requires the Department of Public Health to prepare a list of not more than 10 outpatient prescription drugs that the Director of Public Health, in the Director's discretion, determines are provided at substantial cost to the State or critical to public health. Requires the pharmaceutical manufacturer of an outpatient prescription drug included on that list to provide specified information to the Department of Public Health. Sets forth provisions concerning hearings; violations of the Act by health care facilities; civil penalties; and a report of the utilization management and provider payment practices of Medicare Advantage plans. Makes other changes. Amends the Illinois Health Facilities Planning Act. Requires a health care facility to post notice of its intent to file an application for a certificate of need. Effective immediately.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2024-04-05 - House Committee Amendment No. 2 Rule 19(c) / Re-referred to Rules Committee [HB5517 Detail]

Download: Illinois-2023-HB5517-Introduced.html

---

103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5517 Introduced , by Rep. Jenn Ladisch Douglass SYNOPSIS AS INTRODUCED:
See Index
Creates the Protection Against Unnecessary Health Care Costs Act. Requires the State Comptroller to establish the Drug Discount Card Program to be made available for all residents of this State. Requires the Department of Insurance to report to the General Assembly and to the Governor recommendations for establishing an outreach and education program to inform licensed physicians on when a drug patent will expire and become available in generic form, and when generic alternatives exist for drugs whose patent recently expired. Provides that on and after October 1, 2025, a pharmaceutical manufacturer that employs an individual to perform the duties of a pharmaceutical sales representative shall register annually with the Department of Financial and Professional Regulation as a pharmaceutical marketing firm. Provides that each pharmaceutical marketing firm shall provide to the Department a list of all individuals employed by the pharmaceutical marketing firm as a pharmaceutical sales representative. Sets forth provisions concerning registration; registration fees; discipline of pharmaceutical marketing firms; the Department posting a list of all individuals employed by the pharmaceutical marketing firm as a pharmaceutical sales representative; and reports by pharmaceutical marketing firms to the Department. Requires the Department of Public Health to report to the General Assembly and the Governor, an analysis of pharmacy benefit managers' practices of prescription drug distribution. Requires the Department of Public Health to prepare a list of not more than 10 outpatient prescription drugs that the Director of Public Health, in the Director's discretion, determines are provided at substantial cost to the State or critical to public health. Requires the pharmaceutical manufacturer of an outpatient prescription drug included on that list to provide specified information to the Department of Public Health. Sets forth provisions concerning hearings; violations of the Act by health care facilities; civil penalties; and a report of the utilization management and provider payment practices of Medicare Advantage plans. Makes other changes. Amends the Illinois Health Facilities Planning Act. Requires a health care facility to post notice of its intent to file an application for a certificate of need. Effective immediately.
LRB103 38605 RPS 68741 b
A BILL FOR
HB5517 LRB103 38605 RPS 68741 b
AN ACT concerning regulation.
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
Protection Against Unnecessary Health Care Costs Act.
Section 5. Drug Discount Card Program.
(a) In this Section, "volume discount contracting" means a
negotiated purchase of a prescription drug in a large quantity
for a decreased cost.
(b) The State Comptroller shall establish the Drug
Discount Card Program to be made available for all residents
of this State. To further the purpose of the program, the State
Comptroller may cooperate with other states and territories of
the United States, or regional consortia to pool prescription
drug purchasing power to (1) lower prescription drug costs,
(2) negotiate discounts with prescription drug manufacturers,
(3) centralize the purchasing of prescription drugs, and (4)
establish volume discount contracting.
(c) The State Comptroller shall study the feasibility of
centralizing statewide contracts to consolidate the purchasing
of prescription and physician-administered drugs by State
agencies, State hospitals, State-operated community mental
health centers, and other public entities, as necessary. The

HB5517 - 2 - LRB103 38605 RPS 68741 b
study shall include an evaluation of (1) the potential cost
savings, administrative feasibility, and other benefits and
risks of centralizing and consolidating contracts, and (2) any
additional staff and resources required by the State
Comptroller to centrally procure and administer those
contracts. Not later than November 1, 2026, each State agency,
State hospital, community mental health center, and other
public entity, as necessary, that procures prescription or
physician-administered drugs shall provide information
regarding the types, amount, and cost of those drugs to the
State Comptroller, in a form and manner prescribed by the
State Comptroller. Not later than February 1, 2027, the State
Comptroller shall submit a report regarding the findings of
the study to the Governor and the General Assembly.
Section 10. Physician outreach and education on drug
patents. Not later than January 1, 2026, the Department of
Insurance, in consultation with the Consumer Protection
Division of the Office of the Attorney General, shall report
to the General Assembly and to the Governor recommendations
for establishing an outreach and education program to inform
licensed physicians on: (1) when a drug patent will expire and
become available in generic form; and (2) when generic
alternatives exist for drugs whose patent recently expired.
Section 15. Definitions. For the purposes of this Section

HB5517 - 3 - LRB103 38605 RPS 68741 b
through the Section immediately preceding Section 35:
"Contact" means any communication to promote or provide
information relating to a legend drug that is transmitted in
person or by telephone, email, text message, or other
electronic means between a pharmaceutical representative and a
prescribing practitioner or pharmacist.
"Department" means the Department of Financial and
Professional Regulation.
"Legend drug" has the meaning given to that term in
Section 3.23 of the Illinois Food, Drug and Cosmetic Act.
"Pharmaceutical manufacturer" means: (1) a person, whether
within or outside the boundaries of the State, that produces,
prepares, cultivates, grows, propagates, compounds, converts,
or processes a drug, device, or cosmetic, directly or
indirectly, by extraction from substances of natural origin,
by means of chemical synthesis, or by a combination of
extraction and chemical synthesis, or that packages,
repackages, labels, or relabels a container under the
manufacturer's own trademark or label or any other trademark
or label, or a drug, device, or cosmetic for the purpose of
selling the drug, device, or cosmetic, or (2) a sterile
compounding pharmacy.
"Pharmaceutical manufacturer" includes a virtual
manufacturer.
"Pharmaceutical marketing firm" means a pharmaceutical
manufacturer that employs pharmaceutical representatives.

HB5517 - 4 - LRB103 38605 RPS 68741 b
"Pharmaceutical representative" means any person,
including, but not limited to, a sales representative, who
markets, promotes, or provides information regarding a legend
drug for human use to a prescribing practitioner and is
employed or compensated by a pharmaceutical manufacturer.
"Pharmacist" means an individual licensed to engage in the
practice of pharmacy under the Pharmacy Practice Act or
licensed to engage in the practice of pharmacy in another
state.
"Prescribing practitioner" means an individual authorized
by law to prescribe the usage of certain drugs for medical
purposes.
"Secretary" means the Secretary of Financial and
Professional Regulation.
"Tagline" means a short statement written in a non-English
language that indicates the availability of language
assistance services free of charge.
Section 20. Pharmaceutical marketing firm registration.
(a) On and after October 1, 2025, a pharmaceutical
manufacturer that employs an individual to perform the duties
of a pharmaceutical sales representative shall register
annually with the Department of Financial and Professional
Regulation as a pharmaceutical marketing firm, in a form and
manner prescribed by the Department. No pharmaceutical
manufacturer shall authorize an individual to perform such

HB5517 - 5 - LRB103 38605 RPS 68741 b
duties on the manufacturer's behalf unless the manufacturer
has obtained a registration from the Department pursuant to
this Section. Registrations issued pursuant to this Section
shall expire annually on June 30.
(b) The nonrefundable fee for registration as a
pharmaceutical marketing firm and for annual renewal of that
registration is $150. Any pharmaceutical marketing firm that
fails to renew its registration on or before June 30 shall pay
a late fee of $100 for each year that the pharmaceutical
marketing firm did not renew, in addition to the annual
renewal fee required under this Section.
(c) On the date of its initial registration, and annually
thereafter, each pharmaceutical marketing firm shall provide
to the Department a list of all individuals employed by the
pharmaceutical marketing firm as a pharmaceutical sales
representative. Each pharmaceutical marketing firm shall
notify the Department, in a form and manner prescribed by the
Department, of each individual who is no longer employed as a
pharmaceutical sales representative or who was hired after the
date on which the pharmaceutical marketing firm provided the
annual list, not later than 2 weeks after the individual left
employment or was hired.
(d) The Department shall prominently post on its website
the most recent list provided by each pharmaceutical marketing
firm pursuant to subsection (c) of this Section.
(e) Any person who is not identified to the Department

HB5517 - 6 - LRB103 38605 RPS 68741 b
pursuant to subsection (c) of this Section shall not perform
the duties of a pharmaceutical sales representative on behalf
of the pharmaceutical marketing firm for any prescribing
practitioner in this State.
(f) Not later than July 1, 2025, and annually thereafter,
each pharmaceutical marketing firm shall provide the Secretary
with the following information regarding the performance for
the previous calendar year of each of its pharmaceutical sales
representatives identified to the Department pursuant to
subsection (c) of this Section at any time during the previous
calendar year, in a form and manner prescribed by the
Department:
(1) the aggregate number of contacts the
pharmaceutical sales representative had with prescribing
practitioners and pharmacists;
(2) the specialty of each prescribing practitioner and
pharmacist with whom the pharmaceutical sales
representative made contact;
(3) whether product samples, materials, or gifts of
any value were provided to a prescribing practitioner or
the practitioner's staff in a prescribing practitioner's
office or to a pharmacist; and
(4) an aggregate report of all free samples, by drug
name and strength, in a form and manner prescribed by the
Department.
(g) The Department shall annually analyze the information

HB5517 - 7 - LRB103 38605 RPS 68741 b
submitted pursuant to this Section and compile a report on the
activities and pharmaceutical representatives in the State.
Not later than December 1, 2026, and annually thereafter, the
Department shall post the report on its website and submit the
report to the Governor and the General Assembly.
Section 25. Legend drug marketing. Each pharmaceutical
representative engaged in legend drug marketing in this State
shall disclose, in writing, to a prescribing practitioner or
pharmacist, at the time of each contact with the prescribing
practitioner or pharmacist, the following:
(1) the list price of a legend drug when the
pharmaceutical representative provides information
concerning the legend drug to the prescribing practitioner
or pharmacist based on the dose and quantity of the legend
drug as described in the medication package insert; and
(2) information on the variation efficacy of the
legend drug marketed to different racial and ethnic
groups, if that information is available.
Section 30. Discipline of pharmaceutical marketing firms.
(a) The Department may: (1) refuse to authorize the
issuance or renewal of a registration to operate as a
pharmaceutical marketing firm; (2) revoke, suspend, or place
conditions on a registration to operate as a pharmaceutical
marketing firm; and (3) assess a penalty of up to $1,000 for

HB5517 - 8 - LRB103 38605 RPS 68741 b
each violation of any provision of Section 20 or 25, or take
other action permitted by law, if the applicant or holder of
the registration fails to comply with the requirements set
forth in Section 20 or 25.
(b) The Department may adopt rules as necessary to
implement this Section.
Section 35. Report of pharmacy benefit managers'
practices. Not later than January 1, 2026, the Department of
Public Health, in consultation with the Department of
Insurance, shall report to the General Assembly and the
Governor, its analysis of pharmacy benefit managers' practices
of prescription drug distribution, including, but not limited
to, spread pricing arrangements, manufacturing rebates and
transparency, fees charged, financial incentives for adding
drugs to health plan formularies and an evaluation of
prescription drug distribution practices conducted by pharmacy
benefit managers in other states. The report shall provide
recommendations (1) to reduce prescription drug costs for
consumers, and (2) for the regulation of pharmacy benefit
managers in this State.
Section 40. List of outpatient prescription drugs.
(a) On or before January 1, 2025, and annually thereafter,
the Director of Public Health, in consultation with the State
Comptroller and the Department of Insurance, shall prepare a

HB5517 - 9 - LRB103 38605 RPS 68741 b
list of not more than 10 outpatient prescription drugs that
the Director of Public Health, in the Director of Public
Health's discretion, determines are (A) provided at
substantial cost to the State, considering the net cost of
such drugs, or (B) critical to public health. The list shall
include outpatient prescription drugs from different
therapeutic classes of outpatient prescription drugs and not
less than one generic outpatient prescription drug.
(b) Prior to publishing the annual list pursuant to
subsection (a) of this Section, the Director of Public Health
shall prepare a preliminary list that includes outpatient
prescription drugs that the Director of Public Health plans to
include on the annual list. The Director of Public Health
shall make the preliminary list available for public comment
for not less than 30 days. During the public comment period,
any manufacturer of an outpatient prescription drug included
on the preliminary list may produce documentation, as
permitted by federal law, to the Director of Public Health to
establish that the wholesale acquisition cost of such drug,
less all rebates paid to the State for that outpatient
prescription drug during the immediately preceding calendar
year, does not exceed the limits established in subsection (c)
of this Section. If the documentation establishes, to the
satisfaction of the Director of Public Health, that the
wholesale acquisition cost of the drug, less all rebates paid
to the State for that drug during the immediately preceding

HB5517 - 10 - LRB103 38605 RPS 68741 b
calendar year, does not exceed the limits established in
subsection (c) of this Section, the Director of Public Health
shall, not later than 15 days after the closing of public
comment, remove that drug from the preliminary list before
publishing the annual list pursuant to subsection (a) of this
Section.
(c) The Director of Public Health shall not list any
outpatient prescription drugs under subsection (a) or (b) of
this Section unless the wholesale acquisition cost of that
outpatient prescription drug (A) increased by not less than
16% cumulatively during the immediately preceding 2 calendar
years, and (B) was not less than $40 for a course of treatment.
(d)(1) The pharmaceutical manufacturer of an outpatient
prescription drug included on a list prepared by the Director
of Public Health pursuant to subsection (a) of this Section
shall provide to the Department of Public Health, in a form and
manner specified by the Director of Public Health, (i) a
written, narrative description, suitable for public release,
of all factors that caused the increase in the wholesale
acquisition cost of the listed outpatient prescription drug,
and (ii) aggregate, company-level research and development
costs and such other capital expenditures that the Director of
Public Health, in the Director of Public Health's discretion,
deems relevant for the most recent year for which final
audited data are available.
(2) The quality and types of information and data that a

HB5517 - 11 - LRB103 38605 RPS 68741 b
pharmaceutical manufacturer submits to the office under this
subsection shall be consistent with the quality and types of
information and data that the pharmaceutical manufacturer
includes in (i) the pharmaceutical manufacturer's annual
consolidated report on Securities and Exchange Commission Form
10-K, or (ii) any other public disclosure.
(e) The Department of Public Health shall establish a
standardized form for reporting information and data pursuant
to this Section after consulting with pharmaceutical
manufacturers. The form shall be designed to minimize the
administrative burden and cost of reporting on the office and
pharmaceutical manufacturers.
Section 45. Hospital facility fees.
(a) As used in this Section:
"Affiliated provider" means a provider that is: (1)
employed by a hospital or health system; (2) under a
professional services agreement with a hospital or health
system that permits the hospital or health system to bill on
behalf of such provider; or (3) a clinical faculty member of a
medical school that is affiliated with a hospital or health
system in a manner that permits the hospital or health system
to bill on behalf of the clinical faculty member.
"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

HB5517 - 12 - LRB103 38605 RPS 68741 b
located within 250 yards of the main buildings; or (2) any
other area that has been determined on an individual case
basis by the Department of Public Health, the Department of
Human Services, or other State agency to be a part of a
hospital's campus.
"Facility fee" means any fee charged or billed by a
hospital or health system for outpatient services provided in
a hospital-based facility that is: (1) intended to compensate
the hospital or health system for the operational expenses of
the hospital or health system; and (2) separate and distinct
from a professional fee.
"Health care provider" means an individual, entity,
corporation, person or organization, whether for-profit or
not-for-profit, that furnishes bills or is paid for health
care service delivery in the normal course of business,
including, but not limited to, a health system, a hospital, a
hospital-based facility, a freestanding emergency department
and an urgent care center.
"Health system" means: (1) a parent corporation of one or
more hospitals and any entity affiliated with such parent
corporation through ownership, governance, membership, or
other means; or (2) a hospital and any entity affiliated with
the hospital through ownership, governance, membership, or
other means.
"Hospital" means an institution, place, building, or
agency located in this State that is licensed as a general

HB5517 - 13 - LRB103 38605 RPS 68741 b
acute hospital by the Department of Public Health under the
Hospital Licensing Act, whether public or private and whether
organized for profit or not-for-profit.
"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.
"Medicaid" means the federal medical assistance program
established under Title XIX of the Social Security Act.
"Observation" means services furnished by a hospital on
the hospital's campus, regardless of the length of stay,
including use of a bed and periodic monitoring by the
hospital's nursing or other staff to evaluate an outpatient's
condition or determine the need for admission to the hospital
as an inpatient.
"Payer mix" means the proportion of different sources of
payment received by a hospital or health system, including,
but not limited to, Medicare, Medicaid, other
government-provided insurance, private insurance, and self-pay
patients.
"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 not-for-profit,
whose primary purpose is to provide professional medical

HB5517 - 14 - LRB103 38605 RPS 68741 b
services.
(b) If a hospital or health system charges a facility fee
using a current procedural terminology evaluation (CPT E/M)
code or assessment and management (CPT A/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 that includes the following information:
(1) that the hospital-based facility is part of a
hospital or health system and that the hospital or health
system charges a facility fee that is in addition to and
separate from the professional fee charged by the
provider;
(2)(A) the amount of the patient's potential financial
liability, including any facility fee likely to be
charged, and, where professional medical services are
provided by an affiliated provider, any professional fee
likely to be charged, or, 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 financial liability based on typical or average
charges for visits to the hospital-based facility,
including the facility fee, (B) a statement that the
patient's actual financial liability will depend on the
professional medical services actually provided to the

HB5517 - 15 - LRB103 38605 RPS 68741 b
patient, (C) an explanation that the patient may incur
financial liability that is greater than the patient would
incur if the professional medical services were not
provided by a hospital-based facility, and (D) a telephone
number the patient may call for additional information
regarding the patient's potential financial liability,
including an estimate of the facility fee likely to be
charged based on the scheduled professional medical
services; and
(3) that a patient covered by a health insurance
policy should contact the health insurer for additional
information regarding the hospital's or health system's
charges and fees, including the patient's potential
financial liability, if any, for such charges and fees.
(c) If a hospital or health system charges a facility fee
without using a current procedural terminology evaluation and
management (CPT E/M) code for outpatient services provided at
a hospital-based facility, located outside of the hospital
campus, the hospital or health system shall provide the
patient with a written notice that includes the following
information:
(1) that the hospital-based facility is part of a
hospital or health system and that the hospital or health
system charges a facility fee that may be in addition to
and separate from the professional fee charged by a
provider:

HB5517 - 16 - LRB103 38605 RPS 68741 b
(2)(A) a statement that the patient's actual financial
liability will depend on the professional medical services
actually provided to the patient, (B) an explanation that
the patient may incur financial liability that is greater
than the patient would incur if the hospital-based
facility was not hospital-based, and (C) a telephone
number the patient may call for additional information
regarding the patient's potential financial liability,
including an estimate of the facility fee likely to be
charged based on the scheduled professional medical
services; and
(3) that a patient covered by a health insurance
policy should contact the health insurer for additional
information regarding the hospital's or health system's
charges and fees, including the patient's potential
financial liability, if any, for such charges and fees.
(d) Each initial billing statement that includes a
facility fee shall: (1) clearly identify the fee as a facility
fee that is billed in addition to, or separately from, any
professional fee billed by the provider; (2) provide the
corresponding Medicare facility fee reimbursement rate for the
same service as a comparison or, if there is no corresponding
Medicare facility fee for such service, (A) the approximate
amount Medicare would have paid the hospital for the facility
fee on the billing statement, or (B) the percentage of the
hospital's charges that Medicare would have paid the hospital

HB5517 - 17 - LRB103 38605 RPS 68741 b
for the facility fee; (3) include a statement that the
facility fee is intended to cover the hospital's or health
system's operational expenses; (4) inform the patient that the
patient's financial liability may have been less if the
services had been provided at a facility not owned or operated
by the hospital or health system; and (5) include written
notice of the patient's right to request a reduction in the
facility fee or any other portion of the bill and a telephone
number that the patient may use to request such a reduction
without regard to whether such patient qualifies for, or is
likely to be granted, any reduction. Not later than January 1,
2025, and annually thereafter, each hospital, health system,
and hospital-based facility shall submit to the Department of
Public Health a sample of a billing statement issued by the
hospital, health system, or hospital-based facility that
complies with this subsection and that represents the format
of billing statements received by patients. The billing
statement shall not contain patient identifying information.
(e) The written notice described in subsections (b), (c),
(d), (h), (i), and (j) of this Section shall be in plain
language and in a form that may be reasonably understood by a
patient who does not possess special knowledge regarding
hospital or health system facility fee charges. On and after
January 1, 2025, the written notices shall include taglines in
at least the top 15 languages spoken in the State indicating
that the notice is available in each of those languages.

HB5517 - 18 - LRB103 38605 RPS 68741 b
(f)(1) For nonemergency 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 email, 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 or if the patient arrives
without an appointment, 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 in accordance with the federal Emergency Medical
Treatment and Active Labor Act, 42 U.S.C. 1395dd, or is
determined not to 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 unable to read the notice and understand and act on the
patient's rights, the notice shall be provided to the
patient's representative as soon as practicable.
(g) Subsections (b), (c), (d), (e), (f), and (l) of this
Section do not apply if a patient is insured by Medicare or
Medicaid.
(h) A hospital-based facility shall prominently display
written notice in locations that are readily accessible to and
visible by patients, including patient waiting or appointment

HB5517 - 19 - LRB103 38605 RPS 68741 b
check-in areas, stating: (1) that the hospital-based facility
is part of a hospital or health system; (2) the name of the
hospital or health system; and (3) that if the hospital-based
facility charges a facility fee, the patient may incur a
financial liability greater than the patient would incur if
the hospital-based facility was not hospital-based. On and
after January 1, 2025, such notices shall include tag lines in
at least the top 15 languages spoken in the State indicating
that the notice is available in each of those top 15 languages.
Not later than January 1, 2025, and annually thereafter, each
hospital-based facility shall submit a copy of the written
notice required by this subsection to the Department of Public
Health.
(i) 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, websites,
and stationery.
(j) A hospital-based facility shall, when scheduling
services for which a facility fee may be charged, inform the
patient: (1) that the hospital-based facility is part of a
hospital or health system; (2) of the name of the hospital or
health system; (3) that the hospital or health system may
charge a facility fee in addition to and separate from the
professional fee charged by the provider; and (4) of the
telephone number the patient may call for additional

HB5517 - 20 - LRB103 38605 RPS 68741 b
information regarding such patient's potential financial
liability.
(k)(1) If any business transaction results in the
establishment of a hospital-based facility at which facility
fees may be billed, where such a hospital-based facility did
not previously exist, the purchaser in such transaction shall,
not later than 30 days after such transaction, provide written
notice, by first-class mail, of the transaction to each
patient served within the 3 years preceding the date of the
transaction by the health care facility that has been
purchased as part of the transaction.
(2) Such notice shall include the following information:
(A) A statement that the health care facility is now a
hospital-based facility and is part of a hospital or
health system, the health care facility's full legal and
business name and the date of such facility's acquisition
by a hospital or health system.
(B) The name, business address, and phone number of
the hospital or health system that is the purchaser of the
health care facility.
(C) A statement that the hospital-based facility
bills, or is likely to bill, patients a facility fee that
may be in addition to, and separate from, any professional
fee billed by a health care provider at the hospital-based
facility.
(D) A statement that the patient's actual financial

HB5517 - 21 - LRB103 38605 RPS 68741 b
liability will depend on the professional medical services
actually provided to the patient, and an explanation that
the patient may incur financial liability that is greater
than the patient would incur if the hospital-based
facility were not a hospital-based facility.
(E) The estimated amount or range of amounts the
hospital-based facility may bill for a facility fee or an
example of the average facility fee billed at the
hospital-based facility for the most common services
provided at the hospital-based facility.
(F) A statement that, prior to seeking services at the
hospital-based facility, a patient covered by a health
insurance policy should contact the patient's health
insurer for additional information regarding the
hospital-based facility fees, including the patient's
potential and financial liability, if any, for those
hospital-based facility fees.
(3) A copy of the written notice provided to patients in
accordance with this subsection shall be filed with the
Department of Insurance. A link to copies of these written
notices shall be conspicuously available on the Department's
website.
(4) A hospital, health system or hospital-based facility
shall not collect a facility fee for services provided at a
hospital-based facility that is subject to this subsection
from the date of transaction until at least 30 days after the

HB5517 - 22 - LRB103 38605 RPS 68741 b
written notice required pursuant to this subsection is mailed
to the patient or a copy of such notice is filed with the
Department of Public Health, whichever is later. A violation
of this subsection is a deceptive business practice under the
Consumer Fraud and Deceptive Business Practices Act.
(5) Not later than July 1, 2025, and annually thereafter,
each hospital-based facility that was the subject of a
transaction, as described in paragraph (1) of this subsection,
during the preceding calendar year shall report to the
Department of Insurance the number of patients served by the
hospital-based facility in the preceding 3 years.
(l)(1) Notwithstanding any other provision of this
Section, no hospital, health system, or hospital-based
facility shall collect a facility fee for (A) outpatient
health care services that use a current procedural terminology
evaluation and management (CPT E/M) code or assessment and
management (CPT A/M) code and are provided at a hospital-based
facility located off-site from a hospital campus, or (B)
outpatient health care services provided at a hospital-based
facility located off-site from a hospital campus received by a
patient who is uninsured of more than the Medicare rate.
(2) Notwithstanding any other provision of this Section,
on and after July 1, 2025, no hospital or health system shall
collect a facility fee for outpatient health care services
that use a current procedural terminology evaluation and
management (CPT E/M) code or assessment and management (CPT

HB5517 - 23 - LRB103 38605 RPS 68741 b
A/M) code and are provided on the hospital campus. The
provisions of this paragraph do not apply to (A) an emergency
department located on a hospital campus, or (B) observation
stays on a hospital campus and (CPT E/M) and (CPT A/M) codes
when billed for the following services: (i) wound care, (ii)
orthopedics, (iii) anticoagulation, (iv) oncology, (v)
obstetrics, and (vi) solid organ transplant.
(3) Notwithstanding the provisions of paragraphs (1) and
(2) of this subsection, in circumstances when an insurance
contract that was in effect on or after July 1, 2025, provides
reimbursement for facility fees prohibited under the
provisions of paragraph (1) of this subsection, and in
circumstances when an insurance contract that is in effect on
July 1, 2025, provides reimbursement for facility fees
prohibited under the provisions of paragraph (2) of this
subsection, a hospital or health system may continue to
collect reimbursement from the health insurer for such
facility fees until the applicable date of expiration,
renewal, or amendment of such contract, whichever date is
earliest.
(4) The provisions of this subsection do not apply to a
freestanding emergency department. As used in this paragraph,
"freestanding emergency department" means a freestanding
facility that (A) is structurally separate and distinct from a
hospital, (B) provides emergency care, (C) is a department of
a hospital licensed under Hospital Licensing Act, and (D) has

HB5517 - 24 - LRB103 38605 RPS 68741 b
been issued a certificate of need to operate as a freestanding
emergency department by the Health Facilities and Services
Review Board by showing the need for such a department in the
geographic area where the facility is situated.
(5)(A) On and after July 1, 2025, if the Director of Public
Health receives information and has a reasonable belief, after
evaluating such information, that any hospital, health system,
or hospital-based facility charged facility fees, other than
through isolated clerical or electronic billing errors, in
violation of any provision of this Section, or rule adopted
thereunder, such hospital, health system, or hospital-based
facility shall be subject to a civil penalty of up to $1,000.
The Director of Public Health may issue a notice of violation
and civil penalty by first-class mail or personal service.
Such notice shall include: (i) a reference to the Section of
the statutes, rule, or Section of the rules alleged to have
been violated; (ii) a short and plain language statement of
the matters asserted or charged; (iii) a description of the
activity to cease; (iv) a statement of the amount of the civil
penalty or penalties that may be imposed; (v) a statement
concerning the right to a hearing; and (vi) a statement that
the hospital, health system, or hospital-based facility may,
not later than 10 business days after receipt of the notice,
make a request for a hearing on the matters asserted.
(B) The hospital, health system, or hospital-based
facility to whom notice is provided pursuant to subparagraph

HB5517 - 25 - LRB103 38605 RPS 68741 b
(A) of this paragraph (5) may, not later than 10 business days
after receipt of such notice, make written application to the
Department of Public Health to request a hearing to
demonstrate that such violation did not occur. The failure to
make a timely request for a hearing shall result in the
issuance of a cease and desist order or civil penalty. All
hearings held under this subsection shall be conducted in
accordance with Illinois Administrative Procedure Act.
(C) Following any hearing pursuant to this paragraph, if
the Department of Public Health finds, by a preponderance of
the evidence, that the hospital, health system, or
hospital-based facility violated or is violating any provision
of this subsection, any rule adopted thereunder, or any order
issued by the Department of Public Health, the Department of
Public Health shall issue a final cease and desist order in
addition to any civil penalty the Department of Public Health
imposes.
(m)(1) Each hospital and health system shall report not
later than November 1, 2025, and thereafter not later than
July 1, 2026, and annually thereafter, to the Director of
Public Health, on a form prescribed by the Department of
Public Health, concerning facility fees charged or billed
during the preceding calendar year. The report shall include,
but need not be limited to: (A) the name and address of each
facility owned or operated by the hospital or health system
that provides services for which a facility fee is charged or

HB5517 - 26 - LRB103 38605 RPS 68741 b
billed, and an indication as to whether each facility is
located on or outside of the hospital or health system campus;
(B) the number of patient visits at each such facility for
which a facility fee was charged or billed; (C) the number,
total amount, and range of allowable facility fees paid at
each such facility disaggregated by payer mix; (D) for each
facility, the total amount of facility fees charged and the
total amount of revenue received by the hospital or health
system derived from facility fees, (E) the total amount of
facility fees charged and the total amount of revenue received
by the hospital or health system from all facilities derived
from facility fees; (F) a description of the 10 procedures or
services that generated the greatest amount of facility fee
gross revenue, disaggregated by current procedural terminology
category (CPT) code for each such procedure or service and,
for each such procedure or service, patient volume and the
total amount of gross and net revenue received by the hospital
or health system derived from facility fees, disaggregated by
on-campus and off-campus; and (G) the top 10 procedures or
services for which facility fees are charged based on patient
volume and the gross and net revenue received by the hospital
or health system for each such procedure or service,
disaggregated by on-campus and off-campus. For purposes of
this subsection, "facility" means a hospital-based facility
that is located on a hospital campus or outside a hospital
campus.

HB5517 - 27 - LRB103 38605 RPS 68741 b
(2) The Department of Public Health shall publish the
information reported pursuant to paragraph (1) of this
subsection or post a link to such information on the
Department of Public Health's website.
Section 50. Hearings.
(a) The Director of Public Health, or any agent authorized
by the Director of Public Health to conduct any inquiry,
investigation, or hearing under this Act, has the power to
administer oaths and take testimony under oath relative to the
matter of inquiry or investigation. At any hearing ordered by
the Department of Public Health, the Director of Public
Health, or an agent having authority by law to issue such
process may subpoena witnesses and require the production of
records, papers, and documents pertinent to the inquiry. If
any person disobeys the process or refuses to answer any
pertinent question put to that person by the Director of
Public Health or the Director of Public Health's authorized
agent or to produce any records and papers so requested, the
Director of Public Health or Director of Public Health's
authorized agent may apply to the Circuit Court for the
district wherein such person resides or where the business has
been conducted, setting forth the disobedience to the process
or refusal to answer, and said court shall order such person to
appear before that court and to answer the questions or
produce the records requested.

HB5517 - 28 - LRB103 38605 RPS 68741 b
(b) If the Director of Public Health or the Director of
Public Health's agent has received information and has a
reasonable belief that any person, health care facility, or
other institution has violated or is violating any provision
of this Act, or any rule or order of the Department of Public
Health, the Director of Public Health or the Director of
Public Health's agent may issue a notice pursuant to this
Section. The Department of Public Health shall notify the
person, health care facility, or institution against whom such
order is issued by first-class mail or personal service. The
notice shall include: (1) a reference to the Section of the
statutes, rule, or Section of the rules believed to have been
violated; (2) a short and plain language statement of the
matters asserted or charged; (3) a description of the activity
alleged to have violated a statute or rule pursuant to
paragraph (1) of this subsection; (4) a statement concerning
the right to a hearing of such person, health care facility, or
institution; and (5) a statement that the person, health care
facility, or institution may, not later than 10 business days
after receipt of the notice, make a written request for a
hearing on the matters asserted, to be sent to the executive
director of the health care facility or institution or the
agent of the executive director.
(c) The person, health care facility, or institution to
whom notice is provided under subsection (b) of this Section
may, not later than 10 business days after receipt of the

HB5517 - 29 - LRB103 38605 RPS 68741 b
notice, make written application to the unit to request a
hearing to demonstrate that such violation has not occurred,
or present other defenses applicable. A failure to make a
timely request for a hearing shall result in the Department
issuing a cease and desist order. Each hearing held under this
subsection shall be conducted and contested pursuant to
Illinois Administrative Procedure Act.
(d) If the Department finds, by a preponderance of the
evidence, following a hearing held under subsection (c) of
this Section that a person, health care facility, or
institution has violated or is violating any provision of this
Act, or any rule or order of the Department, the Department
shall issue a cease and desist order to such person, health
care facility, or institution that shall be considered a final
decision subject to appeal to the Circuit Court in accordance
with the Administrative Review Law of the Code of Civil
Procedure.
(e) Any cease and desist order issued under this Section
may be enforced by the Attorney General.
Section 55. Report of the utilization management and
provider payment practices of Medicare Advantage plans.
(a) Not later than January 1, 2026, the Department of
Insurance, in consultation with the Department of Public
Health, shall report to the Governor and to the General
Assembly an analysis of the utilization management and

HB5517 - 30 - LRB103 38605 RPS 68741 b
provider payment practices of Medicare Advantage plans,
including, but not limited to, (1) the impact of such
practices on the delivery of hospital outpatient and inpatient
services, including patient placement, discharges, transfers,
and other clinical plans, (2) the costs to hospitals and plan
members associated with such practices, (3) the effect of such
practices on commercial, non-Medicare payment rates and access
to services, including behavioral health services, and (4) a
comparison of claims denials, modifications, and reversals on
appeal among Medicare Advantage plans and with traditional
Medicare, Medicaid, and commercial non-Medicare product lines.
To the extent information and data are not available to
support specified areas of such analysis, such unavailability
shall be noted in the report.
(b) Based on the findings of the analysis such report
shall provide recommendations on (1) improving quality of and
access to care, (2) improving the timely delivery of care, (3)
reducing provider administrative costs associated with
utilization management, (4) addressing payment practices that
inappropriately reduce provider payments, (5) improving any
practices identified in the study contributing to unwarranted
changes to clinical care plans, (6) considering quarterly
monitoring of prior authorization requests, service denials
and payment denials by Medicare Advantage plans and comparing
such data with commercial plans and Medicaid, (7) addressing
the broad effect of Medicare Advantage plan practices on the

HB5517 - 31 - LRB103 38605 RPS 68741 b
health care delivery system, including costs borne by
non-Medicare Advantage consumers and plan sponsors, (8)
reducing costs for consumers, and (9) the extent to which
states have the authority to regulate Medicare Advantage
plans. To the extent the analysis does not support
recommendations in any of the specified areas, that outcome
should be noted in the report.
(c) The Department of Insurance may engage the services of
third-party professionals and specialists the Director of
Insurance deems necessary to assist the Director of Insurance
in fulfilling the requirements of this Section. The costs and
services shall be paid from the General Revenue Fund, subject
to appropriation.
Section 90. The Illinois Health Facilities Planning Act is
amended by adding Section 6.5 as follows:
(20 ILCS 3960/6.5 new)
Sec. 6.5. Notice of intent to file an application. Any
health care facility that intends to file an application for a
certificate of need with the Board shall, in advance of filing
such an application, post notice of the health care facility's
intent to file in a conspicuous location on its website, if
such a website exists. After filing an application for a
certificate of need, the health care facility shall post, in a
conspicuous location on its website, a notice of the

HB5517 - 32 - LRB103 38605 RPS 68741 b
application having been filed and a digital copy of the
application.
Section 99. Effective date. This Act takes effect upon
becoming law.
HB5517 - 33 - LRB103 38605 RPS 68741 b
INDEX
Statutes amended in order of appearance