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Public Act 094-0885


 

Public Act 0885 94TH GENERAL ASSEMBLY



 


 
Public Act 094-0885
 
HB4999 Enrolled LRB094 15918 LCT 51656 b

    AN ACT concerning collection practices.
 
    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 Fair
Patient Billing Act.
 
    Section 5. Purpose; findings.
    (a) The purpose of this Act is to advance the prompt and
accurate payment of health care services through fair and
reasonable billing and collection practices of hospitals.
    (b) The General Assembly finds that:
        (1) Medical debts are the cause of an increasing number
    of bankruptcies in Illinois and are typically associated
    with severe financial hardship incurred by bankrupt
    persons and their families.
        (2) Patients, hospitals, and government bodies alike
    will benefit from clearly articulated standards regarding
    fair billing and collection practices for all Illinois
    hospitals.
        (3) Hospitals should employ responsible standards when
    collecting debt from their patients.
        (4) Patients should be provided sufficient billing
    information from hospitals to determine the accuracy of the
    bills for which they may be financially responsible.
        (5) Patients should be given a fair and reasonable
    opportunity to discuss and assess the accuracy of their
    bill.
        (6) Patients should be provided information regarding
    the hospital's policies regarding financial assistance
    options the hospital may offer to qualified patients.
        (7) Hospitals should offer patients the opportunity to
    enter into a reasonable payment plan for their hospital
    care.
        (8) Patients have an obligation to pay for the hospital
    services they receive.
 
    Section 10. Definitions. As used in this Act:
     "Collection action" means any referral of a bill to a
collection agency or law firm to collect payment for services
from a patient or a patient's guarantor for hospital services.
    "Health care plan" means a health insurance company, health
maintenance organization, preferred provider arrangement, or
third party administrator authorized in this State to issue
policies or subscriber contracts or administer those policies
and contracts that reimburse for inpatient and outpatient
services provided in a hospital. Health care plan, however,
does not include any government-funded program such as Medicare
or Medicaid, workers' compensation, and accident liability
insurers.
    "Insured patient" means a patient who is insured by a
health care plan.
    "Patient" means the individual receiving services from the
hospital and any individual who is the guarantor of the payment
for such services.
    "Reasonable payment plan" means a plan to pay a hospital
bill that is offered to the patient or the patient's legal
representative and takes into account the patient's available
income and assets, the amount owed, and any prior payments.
    "Uninsured patient" means a patient who is not insured by a
health care plan and is not a beneficiary under a
government-funded program, workers' compensation, or accident
liability insurance.
 
    Section 15. Patient notification.
    (a) Each hospital shall post a sign with the following
notice:
         "You may be eligible for financial assistance under
    the terms and conditions the hospital offers to qualified
    patients. For more information contact [hospital financial
    assistance representative]".
    (b) The sign under subsection (a) shall be posted
conspicuously in the admission and registration areas of the
hospital.
    (c) The sign shall be in English, and in any other language
that is the primary language of at least 5% of the patients
served by the hospital annually.
    (d) Each hospital that has a website must post a notice in
a prominent place on its website that financial assistance is
available at the hospital, a description of the financial
assistance application process, and a copy of the financial
assistance application.
    (e) Each hospital must make available information
regarding financial assistance from the hospital in the form of
either a brochure, an application for financial assistance, or
other written material in the hospital admission or
registration area.
 
    Section 20. Bill information. If a hospital bills a patient
for health care services, the hospital shall provide with its
bill the following information:
        (1) the date or dates that health care services were
    provided to the patient;
        (2) a brief description of the hospital services;
        (3) the amount owed for hospital services;
        (4) hospital contact information for addressing
    billing inquiries;
        (5) a statement regarding how an uninsured patient may
    apply for consideration under the hospital's financial
    assistance policy on or with each hospital bill sent to an
    uninsured patient; and
        (6) notice that the patient may obtain an itemized bill
    upon request.
    If a hospital bills a patient, then the hospital must
provide an itemized statement of charges for the inpatient and
outpatient services rendered by the hospital upon receiving a
request from the patient.
 
    Section 25. Bill inquiries.
    (a) A hospital must implement a process for patients to
inquire about or dispute a bill. Such process must include a
telephone number for billing inquiries and disputes and may
include any of the following options:
        (1) a toll-free telephone number that the patient may
    call;
        (2) an address to which he or she may write;
        (3) a department or identified individual within the
    hospital he or she may call or write, with appropriate
    contact information; or
        (4) a website or e-mail address.
    (b) All hospital bills and collection notices must provide
a telephone number allowing the patient to inquire about or
dispute a bill.
    (c) The hospital must return calls made by patients as
promptly as possible, but no later than 2 business days after
the call is made. If the hospital's billing inquiry process
involves correspondence from the patient, the hospital must
respond within 10 business days of receipt of the patient
correspondence. For purposes of this Section, "business day"
means a day on which the hospital's billing office is open for
regular business.
 
    Section 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 given the uninsured patient the
    opportunity to:
            (A) assess the accuracy of the bill;
            (B) apply for financial assistance under the
        hospital's financial assistance policy; and
            (C) avail themselves of a reasonable payment plan.
        (2) If the uninsured patient has indicated an inability
    to pay the full amount of the debt in one payment, the
    hospital has offered the patient a reasonable payment plan.
    The hospital may require the uninsured patient to provide
    reasonable verification of his or her inability to pay the
    full amount of the debt in one payment.
        (3) To the extent the hospital provides financial
    assistance and the circumstances of the uninsured patient
    suggest the potential for eligibility for charity care, the
    uninsured patient has been given at least 60 days following
    the date of discharge or receipt of outpatient care to
    submit an application for financial assistance.
        (4) If the uninsured patient has agreed to a reasonable
    payment plan with the hospital, and the patient has failed
    to make payments in accordance with that reasonable payment
    plan.
        (5) If the uninsured patient informs the hospital that
    he or she has applied for health care coverage under
    Medicaid, Kidcare, or other government-sponsored health
    care program (and there is a reasonable basis to believe
    that the patient will qualify for such program) but the
    patient's application is denied.
    (b) A hospital may not refer a bill, or portion thereof, to
a collection agency or attorney for collection action against
the insured patient, without first offering the patient the
opportunity to request a reasonable payment plan for the amount
personally owed by the patient. Such an opportunity shall be
made available for the 30 days following the date of the
initial bill. If the insured patient requests a reasonable
payment plan, but fails to agree to a plan within 30 days of
the request, the hospital may proceed with collection action
against the patient.
    (c) No collection agency, law firm, or individual may
initiate legal action for non-payment of a hospital bill
against a patient without the written approval of an authorized
hospital employee who reasonably believes that the conditions
for pursuing collection action under this Section have been
met.
    (d) Nothing in this Section prohibits a hospital from
engaging an outside third party agency, firm, or individual to
manage the process of implementing the hospital's financial
assistance and reasonable payment plan programs and policies so
long as such agency, firm, or individual is contractually bound
to comply with the terms of this Act.
 
    Section 35. Collection limitations. The hospital shall not
pursue legal action for non-payment of a hospital bill against
uninsured patients who have clearly demonstrated that they have
neither sufficient income nor assets to meet their financial
obligations provided the patient has complied with Section 45
of this Act.
 
    Section 40. Hospital agents. The hospital must ensure that
any external collection agency, law firm, or individual engaged
by the hospital to obtain payment of outstanding bills for
hospital services agrees in writing to comply with the
collections provisions of this Act.
 
    Section 45. Patient responsibilities.
    (a) To receive the protection and benefits of this Act, a
patient responsible for paying a hospital bill must act
reasonably and cooperate in good faith with the hospital by
providing the hospital with all of the reasonably requested
financial and other relevant information and documentation
needed to determine the patient's eligibility under the
hospital's financial assistance policy and reasonable payment
plan options to qualified patients within 30 days of a request
for such information.
    (b) To receive the protection and benefits of this Act, a
patient responsible for paying a hospital bill shall
communicate to the hospital any material change in the
patient's financial situation that may affect the patient's
ability to abide by the provisions of an agreed upon reasonable
payment plan or qualification for financial assistance within
30 days of the change.
 
    Section 50. Notification concerning out-of-network
providers. During the admission or as soon as practicable
thereafter, the hospital must provide an insured patient with
written notice that:
        (1) the patient may receive separate bills for services
    provided by health care professionals affiliated with the
    hospital;
        (2) if applicable, some hospital staff members may not
    be participating providers in the same insurance plans and
    networks as the hospital;
        (3) if applicable, the patient may have a greater
    financial responsibility for services provided by health
    care professionals at the hospital who are not under
    contract with the patient's health care plan; and
        (4) questions about coverage or benefit levels should
    be directed to the patient's health care plan and the
    patient's certificate of coverage.
 
    Section 55. Enforcement.
    (a) The Attorney General is responsible for administering
and ensuring compliance with this Act, including the
development of any rules necessary for the implementation and
enforcement of this Act.
    (b) The Attorney General shall develop and implement a
process for receiving and handling complaints from individuals
or hospitals regarding possible violations of this Act.
    (c) The Attorney General may conduct any investigation
deemed necessary regarding possible violations of this Act by
any hospital including, without limitation, the issuance of
subpoenas to: (i) require the hospital to file a statement or
report or answer interrogatories in writing as to all
information relevant to the alleged violations; (ii) examine
under oath any person who possesses knowledge or information
directly related to the alleged violations; and (iii) examine
any record, book, document, account, or paper necessary to
investigate the alleged violation.
    (d) If the Attorney General determines that there is a
reason to believe that any hospital has violated the Act, the
Attorney General may bring an action in the name of the People
of the State against the hospital to obtain temporary,
preliminary, or permanent injunctive relief for any act,
policy, or practice by the hospital that violates this Act.
Before bringing such an action, the Attorney General may permit
the hospital to submit a Correction Plan for the Attorney
General's approval.
    (e) This Section applies if:
        (i) a court orders a party to make payments to the
    Attorney General and the payments are to be used for the
    operations of the Office of the Attorney General; or
        (ii) a party agrees in a Correction Plan under this
    Act, to make payments to the Attorney General for the
    operations of the Office of the Attorney General.
    (f) Moneys paid under any of the conditions described in
(e) shall be deposited into the Attorney General court ordered
and Voluntary Compliance Payment Projects Fund. Moneys in the
Fund shall be used, subject to appropriation, for the
performance of any function pertaining to the exercise of the
duties to the Attorney General including, but not limited to,
enforcement of any law of this State and conducting public
education programs; however, any moneys in the Fund that are
required by the court to be used for a particular purpose shall
be used for that purpose.
    (g) The Attorney General may seek the assessment of one or
more of the following civil monetary penalties in any action
filed under this Act where the hospital knowingly violates the
Act:
        (1) For violations, involving a pattern or practice, of
    not providing the information to patients under Sections
    15, 20, 25, and 50, the civil monetary penalty shall not
    exceed $500 per violation.
        (2) For violations involving the failure to engage in
    or refrain from certain activities under Sections 30, 35
    and 40, the civil monetary penalty shall not exceed $1000
    per violation.
    (h) In the event a court grants a final order of relief
against any hospital for a violation of this Act, the Attorney
General may, after all appeal rights have been exhausted, refer
the hospital to the Illinois Department of Public Health for
possible adverse licensure action under the Hospital Licensing
Act.
 
    Section 60. Limitations. Nothing in this Act shall be used
by any private or public payer as a basis for reducing the
third-party payer's rates, policies, or usual and customary
charges for any health care service. Nothing in this Act shall
be construed as imposing an obligation on a hospital to provide
any particular service or treatment to an uninsured patient.
Nothing in this Act shall be construed as imposing an
obligation on a hospital to file a lawsuit to collect payment
on a patient's bill. This Act establishes new and additional
legal obligations for all hospitals in the State of Illinois.
Nothing in this Act shall be construed as relieving or reducing
any hospital of any other obligation under the Illinois
Constitution or under any other statute or the common law
including, without limitation, obligations of hospitals to
furnish financial assistance or community benefits. No
provision of this Act shall derogate from the common law or
statutory authority of the Attorney General, nor shall any
provision be construed as a limitation on the common law or
statutory authority of the Attorney General to investigate
hospitals or initiate enforcement actions against them
including, without limitation, the authority to investigate at
any time charitable trusts for the purpose of determining and
ascertaining whether they are being administered in accordance
with Illinois law and with the terms purposes thereof.
 
    Section 70. Application.
    (a) This Act applies to all hospitals licensed under the
Hospital Licensing Act or the University of Illinois Hospital
Act. This Act does not apply to a hospital that does not charge
for its services.
    (b) The obligations of hospitals under this Act shall take
effect for services provided on or after the first day of the
month that begins 180 days after the effective date of this
Act.
 
    Section 75. Home rule. A home rule unit may not regulate
hospitals in a manner inconsistent with the provisions of this
Act. This Section is a limitation under subsection (i) of
Section 6 of the Article VII of the Illinois Constitution on
the concurrent exercise by home rule units of powers and
functions exercised by the State.
 
    Section 80. Administrative Procedure Act. The Illinois
Administrative Procedure Act applies to all rules promulgated
by the Attorney General under the Act.
 
    Section 999. Effective date. This Act takes effect January
1, 2007.

Effective Date: 1/1/2007