SB1665 EnrolledLRB103 27577 KTG 53953 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Hospital Uninsured Patient Discount Act is
5amended by changing Sections 5, 10, and 15 as follows:
 
6    (210 ILCS 89/5)
7    Sec. 5. Definitions. As used in this Act:
8    "Community health center" means a federally qualified
9health center as defined in Section 1905(l)(2)(B) of the
10federal Social Security Act or a federally qualified health
11center look-alike.
12    "Cost to charge ratio" means the ratio of a hospital's
13costs to its charges taken from its most recently filed
14Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
15Inpatient Ratios).
16    "Critical Access Hospital" means a hospital that is
17designated as such under the federal Medicare Rural Hospital
18Flexibility Program.
19    "Family income" means the sum of a family's annual
20earnings and cash benefits from all sources before taxes, less
21payments made for child support.
22    "Federal poverty income guidelines" means the poverty
23guidelines updated periodically in the Federal Register by the

 

 

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1United States Department of Health and Human Services under
2authority of 42 U.S.C. 9902(2).
3    "Financial assistance" means a discount provided to a
4patient under the terms and conditions a hospital offers to
5qualified patients or as required by law.
6    "Free and charitable clinic" means a 501(c)(3) tax-exempt
7health care organization providing health services to
8low-income uninsured or underinsured individuals that is
9recognized by either the Illinois Association of Free and
10Charitable Clinics or the National Association of Free and
11Charitable Clinics.
12    "Guaranteed income program" means a publicly or privately
13funded program that provides one-time or recurring
14unconditional cash transfers or payments, or gifts to
15individuals or households, for a defined number of months or
16years for the purposes of reducing poverty, promoting economic
17mobility, or increasing the financial stability of Illinois
18residents.
19    "Health care services" means any medically necessary
20inpatient or outpatient hospital service, including
21pharmaceuticals or supplies provided by a hospital to a
22patient.
23    "Hospital" means any facility or institution required to
24be licensed pursuant to the Hospital Licensing Act or operated
25under the University of Illinois Hospital Act.
26    "Illinois resident" means any person who lives in Illinois

 

 

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1and who intends to remain living in Illinois indefinitely.
2Relocation to Illinois for the sole purpose of receiving
3health care benefits does not satisfy the residency
4requirement under this Act.
5    "Medically necessary" means any inpatient or outpatient
6hospital service, including pharmaceuticals or supplies
7provided by a hospital to a patient, covered under Title XVIII
8of the federal Social Security Act for beneficiaries with the
9same clinical presentation as the uninsured patient. A
10"medically necessary" service does not include any of the
11following:
12        (1) Non-medical services such as social and vocational
13    services.
14        (2) Elective cosmetic surgery, but not plastic surgery
15    designed to correct disfigurement caused by injury,
16    illness, or congenital defect or deformity.
17    "Rural hospital" means a hospital that is located outside
18a metropolitan statistical area.
19    "Uninsured discount" means a hospital's charges multiplied
20by the uninsured discount factor.
21    "Uninsured discount factor" means 1.0 less the product of
22a hospital's cost to charge ratio multiplied by 1.35.
23    "Uninsured patient" means an Illinois resident who is a
24patient of a hospital and is not covered under a policy of
25health insurance and is not a beneficiary under a public or
26private health insurance, health benefit, or other health

 

 

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1coverage program, including high deductible health insurance
2plans, workers' compensation, accident liability insurance, or
3other third party liability.
4(Source: P.A. 102-581, eff. 1-1-22.)
 
5    (210 ILCS 89/10)
6    Sec. 10. Uninsured patient discounts.
7    (a) Eligibility.
8        (1) A hospital, other than a rural hospital or
9    Critical Access Hospital, shall provide a discount from
10    its charges to any uninsured patient who applies for a
11    discount and has family income of not more than 600% of the
12    federal poverty income guidelines for all medically
13    necessary health care services exceeding $150 in any one
14    inpatient admission or outpatient encounter.
15        (2) A hospital, other than a rural hospital or
16    Critical Access Hospital, shall provide a charitable
17    discount of 100% of its charges for all medically
18    necessary health care services exceeding $150 in any one
19    inpatient admission or outpatient encounter to any
20    uninsured patient who applies for a discount and has
21    family income of not more than 200% of the federal poverty
22    income guidelines.
23        (3) A rural hospital or Critical Access Hospital shall
24    provide a discount from its charges to any uninsured
25    patient who applies for a discount and has annual family

 

 

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1    income of not more than 300% of the federal poverty income
2    guidelines for all medically necessary health care
3    services exceeding $300 in any one inpatient admission or
4    outpatient encounter.
5        (4) A rural hospital or Critical Access Hospital shall
6    provide a charitable discount of 100% of its charges for
7    all medically necessary health care services exceeding
8    $300 in any one inpatient admission or outpatient
9    encounter to any uninsured patient who applies for a
10    discount and has family income of not more than 125% of the
11    federal poverty income guidelines.
12        (5) In determining eligibility under this Act, a
13    hospital subject to this Act shall exclude from
14    consideration any unconditional cash transfers, payments,
15    or gifts received under a guaranteed income program if:
16            (A) such cash transfers, payments, or gifts are
17        excluded from consideration for determining
18        eligibility under public health insurance programs
19        administered by the State in which the State has the
20        authority to waive guaranteed income; and
21            (B) the guaranteed income program is a program for
22        a defined number of months or years designed to reduce
23        poverty, promote social mobility, or increase
24        financial stability for program participants and if
25        there is an explicit plan to collect data.
26        This paragraph is inoperative on and after July 1,

 

 

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1    2026.
2    (b) Discount. For all health care services exceeding $300
3in any one inpatient admission or outpatient encounter, a
4hospital shall not collect from an uninsured patient, deemed
5eligible under subsection (a), more than its charges less the
6amount of the uninsured discount.
7    (c) Maximum Collectible Amount.
8        (1) The maximum amount that may be collected in a
9    12-month period for health care services provided by the
10    hospital from a patient determined by that hospital to be
11    eligible under subsection (a) is 20% of the patient's
12    family income, and is subject to the patient's continued
13    eligibility under this Act.
14        (2) The 12-month period to which the maximum amount
15    applies shall begin on the first date, after the effective
16    date of this Act, an uninsured patient receives health
17    care services that are determined to be eligible for the
18    uninsured discount at that hospital.
19        (3) To be eligible to have this maximum amount applied
20    to subsequent charges, the uninsured patient shall inform
21    the hospital in subsequent inpatient admissions or
22    outpatient encounters that the patient has previously
23    received health care services from that hospital and was
24    determined to be entitled to the uninsured discount. The
25    availability of the maximum collectible amount shall be
26    included in the hospital's financial assistance

 

 

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1    information provided to uninsured patients.
2        (4) Hospitals may adopt policies to exclude an
3    uninsured patient from the application of subdivision
4    (c)(1) when the patient owns assets having a value in
5    excess of 600% of the federal poverty level for hospitals
6    in a metropolitan statistical area or owns assets having a
7    value in excess of 300% of the federal poverty level for
8    Critical Access Hospitals or hospitals outside a
9    metropolitan statistical area, not counting the following
10    assets: the uninsured patient's primary residence;
11    personal property exempt from judgment under Section
12    12-1001 of the Code of Civil Procedure; or any amounts
13    held in a pension or retirement plan, provided, however,
14    that distributions and payments from pension or retirement
15    plans may be included as income for the purposes of this
16    Act.
17    (d) Each hospital bill, invoice, or other summary of
18charges to an uninsured patient shall include with it, or on
19it, a prominent statement that an uninsured patient who meets
20certain income requirements may qualify for an uninsured
21discount and information regarding how an uninsured patient
22may apply for consideration under the hospital's financial
23assistance policy. The hospital's financial assistance
24application shall include language that directs the uninsured
25patient to contact the hospital's financial counseling
26department with questions or concerns, along with contact

 

 

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1information for the financial counseling department, and shall
2state: "Complaints or concerns with the uninsured patient
3discount application process or hospital financial assistance
4process may be reported to the Health Care Bureau of the
5Illinois Attorney General.". A website, phone number, or both
6provided by the Attorney General shall be included with this
7statement.
8(Source: P.A. 102-581, eff. 1-1-22.)
 
9    (210 ILCS 89/15)
10    Sec. 15. Patient responsibility.
11    (a) Hospitals may make the availability of a discount and
12the maximum collectible amount under this Act contingent upon
13the uninsured patient first applying for coverage under public
14health insurance programs, such as Medicare, Medicaid,
15AllKids, the State Children's Health Insurance Program, the
16Health Benefits for Immigrants program, or any other program,
17if there is a reasonable basis to believe that the uninsured
18patient may be eligible for such program.
19    (b) Hospitals shall permit an uninsured patient to apply
20for a discount within 90 days of the date of discharge or date
21of service.
22    Hospitals shall offer uninsured patients who receive
23community-based primary care provided by a community health
24center or a free and charitable clinic, are referred by such an
25entity to the hospital, and seek access to nonemergency

 

 

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1hospital-based health care services with an opportunity to be
2screened for and assistance with applying for public health
3insurance programs if there is a reasonable basis to believe
4that the uninsured patient may be eligible for a public health
5insurance program. An uninsured patient who receives
6community-based primary care provided by a community health
7center or free and charitable clinic and is referred by such an
8entity to the hospital for whom there is not a reasonable basis
9to believe that the uninsured patient may be eligible for a
10public health insurance program shall be given the opportunity
11to apply for hospital financial assistance when hospital
12services are scheduled.
13        (1) Income verification. Hospitals may require an
14    uninsured patient who is requesting an uninsured discount
15    to provide documentation of family income. Acceptable
16    family income documentation shall include any one of the
17    following:
18            (A) a copy of the most recent tax return;
19            (B) a copy of the most recent W-2 form and 1099
20        forms;
21            (C) copies of the 2 most recent pay stubs;
22            (D) written income verification from an employer
23        if paid in cash; or
24            (E) one other reasonable form of third party
25        income verification deemed acceptable to the hospital.
26        (2) Asset verification. Hospitals may require an

 

 

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1    uninsured patient who is requesting an uninsured discount
2    to certify the existence or absence of assets owned by the
3    patient and to provide documentation of the value of such
4    assets, except for those assets referenced in paragraph
5    (4) of subsection (c) of Section 10. Acceptable
6    documentation may include statements from financial
7    institutions or some other third party verification of an
8    asset's value. If no third party verification exists, then
9    the patient shall certify as to the estimated value of the
10    asset.
11        (3) Illinois resident verification. Hospitals may
12    require an uninsured patient who is requesting an
13    uninsured discount to verify Illinois residency.
14    Acceptable verification of Illinois residency shall
15    include any one of the following:
16            (A) any of the documents listed in paragraph (1);
17            (B) a valid state-issued identification card;
18            (C) a recent residential utility bill;
19            (D) a lease agreement;
20            (E) a vehicle registration card;
21            (F) a voter registration card;
22            (G) mail addressed to the uninsured patient at an
23        Illinois address from a government or other credible
24        source;
25            (H) a statement from a family member of the
26        uninsured patient who resides at the same address and

 

 

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1        presents verification of residency;
2            (I) a letter from a homeless shelter, transitional
3        house or other similar facility verifying that the
4        uninsured patient resides at the facility; or
5            (J) a temporary visitor's drivers license.
6    (c) Hospital obligations toward an individual uninsured
7patient under this Act shall cease if that patient
8unreasonably fails or refuses to provide the hospital with
9information or documentation requested under subsection (b) or
10to apply for coverage under public programs when requested
11under subsection (a) within 30 days of the hospital's request.
12    (d) In order for a hospital to determine the 12 month
13maximum amount that can be collected from a patient deemed
14eligible under Section 10, an uninsured patient shall inform
15the hospital in subsequent inpatient admissions or outpatient
16encounters that the patient has previously received health
17care services from that hospital and was determined to be
18entitled to the uninsured discount.
19    (e) Hospitals may require patients to certify that all of
20the information provided in the application is true. The
21application may state that if any of the information is
22untrue, any discount granted to the patient is forfeited and
23the patient is responsible for payment of the hospital's full
24charges.
25    (f) Hospitals shall ask for an applicant's race,
26ethnicity, sex, and preferred language on the financial

 

 

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1assistance application. However, the questions shall be
2clearly marked as optional responses for the patient and shall
3note that responses or nonresponses by the patient will not
4have any impact on the outcome of the application.
5(Source: P.A. 102-581, eff. 1-1-22.)
 
6    Section 10. The Illinois Public Aid Code is amended by
7changing Section 1-7 as follows:
 
8    (305 ILCS 5/1-7)  (from Ch. 23, par. 1-7)
9    Sec. 1-7. (a) For purposes of determining eligibility for
10assistance under this Code, the Illinois Department, County
11Departments, and local governmental units shall exclude from
12consideration restitution payments, including all income and
13resources derived therefrom, made to persons of Japanese or
14Aleutian ancestry pursuant to the federal Civil Liberties Act
15of 1988 and the Aleutian and Pribilof Island Restitution Act,
16P.L. 100-383.
17    (b) For purposes of any program or form of assistance
18where a person's income or assets are considered in
19determining eligibility or level of assistance, whether under
20this Code or another authority, neither the State of Illinois
21nor any entity or person administering a program wholly or
22partially financed by the State of Illinois or any of its
23political subdivisions shall include restitution payments,
24including all income and resources derived therefrom, made

 

 

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1pursuant to the federal Civil Liberties Act of 1988 and the
2Aleutian and Pribilof Island Restitution Act, P.L. 100-383, in
3the calculation of income or assets for determining
4eligibility or level of assistance.
5    (c) For purposes of determining eligibility for or the
6amount of assistance under this Code, except for the
7determination of eligibility for payments or programs under
8the TANF employment, education, and training programs and the
9Food Stamp Employment and Training Program, the Illinois
10Department, County Departments, and local governmental units
11shall exclude from consideration any financial assistance
12received under any student aid program administered by an
13agency of this State or the federal government, by a person who
14is enrolled as a full-time or part-time student of any public
15or private university, college, or community college in this
16State.
17    (d) For purposes of determining eligibility for or the
18amount of assistance under this Code, except for the
19determination of eligibility for payments or programs under
20the TANF employment, education, and training programs and the
21SNAP Employment and Training Program, the Illinois Department,
22County Departments, and local governmental units shall exclude
23from consideration, for a period of 36 months, any financial
24assistance, including wages, that is provided to a person who
25is enrolled in a demonstration project that is not funded with
26general revenue funds and that is intended as a bridge to

 

 

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1self-sufficiency by offering (i) intensive workforce support
2and training and (ii) support services for new and expectant
3parents that are intended to foster multi-generational healthy
4families as described in Section 12-4.51.
5    (e)(1) Notwithstanding any other provision of this Code,
6and to the maximum extent permitted by federal law, for
7purposes of determining eligibility and the amount of
8assistance under this Code, the Illinois Department and local
9governmental units shall exclude from consideration, for a
10period of no more than 60 months, any financial assistance,
11including wages, cash transfers, or gifts, that is provided to
12a person through a guaranteed income program. As used in this
13subsection, "guaranteed income program" means a publicly or
14privately funded program that provides one-time or recurring
15unconditional cash transfers or payments, or gifts to
16individuals or households, for a defined number of months or
17years for the purposes of reducing poverty, promoting economic
18mobility, or increasing the financial stability of Illinois
19residents. who is enrolled in a program or research project
20that is not funded with general revenue funds and that is
21intended to investigate the impacts of policies or programs
22designed to reduce poverty, promote social mobility, or
23increase financial stability for Illinois residents if there
24is an explicit plan to collect data and evaluate the program or
25initiative that is developed prior to participants in the
26study being enrolled in the program and if a research team has

 

 

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1been identified to oversee the evaluation.
2    (2) The Department shall choose State options and seek all
3necessary federal approvals or waivers to implement this
4subsection.
5(Source: P.A. 100-806, eff. 1-1-19; 101-415, eff. 8-16-19.)
 
6    Section 99. Effective date. This Act takes effect January
71, 2024.