093_SB0552sam001

 










                                     LRB093 03367 AMC 12200 a

 1                    AMENDMENT TO SENATE BILL 552

 2        AMENDMENT NO.     .   Amend  Senate  Bill  552  replacing
 3    everything after the enacting clause with the following:

 4        "Section  1.  Short  title.  This Act may be cited as the
 5    Discriminatory Pricing Act

 6        Section 5.  Definitions. As used in this Act:
 7        "Charge" means the uniform price for a  specific  service
 8    charged by a hospital.
 9        "Cost of providing services" means a hospital's published
10    charges  at  the  time  of  billing  of an uninsured patient,
11    multiplied by the  hospital's  most  recent  relationship  of
12    costs to charges as taken from the Medicaid cost report.
13        "Hospital"  means  a  health care facility licensed under
14    the Hospital  Licensing  Act.  "Hospital"  does  not  include
15    health  care  facilities  whose  most  recent relationship of
16    costs to charges as taken from the Medicaid  cost  report  is
17    one or greater.
18        "Income"  means  income defined as federal adjusted gross
19    income from the previous year. Patients  who  are  unemployed
20    may  request  a  determination  based on an estimate of their
21    current year income.
22        "Medically needy patient" means any person  or  household
 
                            -2-      LRB093 03367 AMC 12200 a
 1    with  total  medical  bills  for  medically necessary medical
 2    services that were not  covered  by  any  medical  or  health
 3    coverage that exceed 20% of their income in the previous year
 4    and   who   (A)  have  previously  applied  and  been  denied
 5    eligibility for any medical or health care coverage  provided
 6    under  the general assistance program or the Medicaid program
 7    due  to  failure  to  satisfy  income  or  other  eligibility
 8    requirements, and (B)  are  not  eligible  for  coverage  for
 9    hospital services under the Medicare or under any Medicaid or
10    health   insurance   program  of  any  other  nation,  state,
11    territory, or commonwealth, or under any  other  governmental
12    or  privately  sponsored  health  or  accident  insurance  or
13    benefit  program  including,  but  not  limited  to, workers'
14    compensation and awards, settlements,  or  judgments  arising
15    from  claims,  suits,  or proceedings involving motor vehicle
16    accidents or alleged negligence.
17        "Uninsured patient" means a person whose income is at  or
18    below  300%  of  the  poverty  income  guidelines who (A) has
19    previously  applied  and  been  denied  eligibility  for  any
20    medical or health care coverage provided  under  the  general
21    assistance  program or the Medicaid program due to failure to
22    satisfy income or other eligibility requirements, and (B)  is
23    not  eligible  for  coverage  for hospital services under the
24    Medicare or under any Medicaid or health insurance program of
25    any other nation, state, territory, or commonwealth, or under
26    any other  governmental  or  privately  sponsored  health  or
27    accident  insurance  or  benefit  program  including, but not
28    limited to, workers' compensation and awards, settlements, or
29    judgments  arising  from  claims,   suits,   or   proceedings
30    involving motor vehicle accidents or alleged negligence.
31        "Medically  necessary  service"  means  a service that is
32    reasonably  expected  to  prevent,  diagnose,   prevent   the
33    worsening  of,  alleviate,  correct,  or cure conditions that
34    endanger  life,  cause  suffering  or  pain,  cause  physical
 
                            -3-      LRB093 03367 AMC 12200 a
 1    deformity or malfunction, threaten to cause or to aggravate a
 2    handicap, or  result  in  illness  or  infirmity.  "Medically
 3    necessary  service"  shall  include  inpatient and outpatient
 4    services as mandated under Title XIX of  the  Federal  Social
 5    Security Act. "Medically necessary service" shall not include
 6    non-medical   services,  such  as  social,  educational,  and
 7    vocational services, or cosmetic surgery.

 8        Section 10.  Uninsured or medically  needy  patients.  No
 9    hospital  that  has  provided  health  care  services  to  an
10    uninsured patient or medically needy patient may collect from
11    the  uninsured  or medically needy patient more than the cost
12    of providing services.

13        Section 15.  Debt collection  activities  prohibited.  No
14    hospital  may  initiate  debt collection activities against a
15    patient until a determination has been made as to whether the
16    patient qualifies as an uninsured or medically needy patient.

17        Section 20.  Compliance. The Department of Public  Health
18    must  develop appropriate reporting mechanisms to enforce the
19    provisions of this Act.

20        Section 25.  Penalties. A determination that  a  hospital
21    has  violated  the  provisions  of this Act may result in the
22    termination of licensure under the Hospital Licensing Act.

23        Section 90.  The Hospital Licensing  Act  is  amended  by
24    changing Section 7 as follows:

25        (210 ILCS 85/7) (from Ch. 111 1/2, par. 148)
26        Sec.  7.  (a)  The  Director after notice and opportunity
27    for hearing to the applicant or licensee may  deny,  suspend,
28    or  revoke a permit to establish a hospital or deny, suspend,
 
                            -4-      LRB093 03367 AMC 12200 a
 1    or revoke a license to open, conduct, operate, and maintain a
 2    hospital in any case in which he finds that there has been  a
 3    substantial failure to comply with the provisions of this Act
 4    or  the  standards,  rules,  and  regulations  established by
 5    virtue thereof or the Discriminatory Pricing Act or the rules
 6    established by virtue thereof.
 7        (b)  Such notice shall be effected by registered mail  or
 8    by  personal service setting forth the particular reasons for
 9    the proposed action and fixing a date, not less than 15  days
10    from  the  date of such mailing or service, at which time the
11    applicant or licensee shall be given  an  opportunity  for  a
12    hearing.  Such  hearing shall be conducted by the Director or
13    by an employee of the Department designated in writing by the
14    Director as Hearing Officer to conduct the  hearing.  On  the
15    basis  of  any such hearing, or upon default of the applicant
16    or  licensee,  the  Director  shall  make   a   determination
17    specifying  his findings and conclusions. In case of a denial
18    to an applicant of a permit to  establish  a  hospital,  such
19    determination shall specify the subsection of Section 6 under
20    which  the  permit  was  denied and shall contain findings of
21    fact forming the  basis  of  such  denial.  A  copy  of  such
22    determination  shall  be  sent  by  registered mail or served
23    personally upon  the  applicant  or  licensee.  The  decision
24    denying,  suspending, or revoking a permit or a license shall
25    become final 35 days after it is so mailed or served,  unless
26    the  applicant  or  licensee,  within  such  35  day  period,
27    petitions for review pursuant to Section 13.
28        (c)  The  procedure governing hearings authorized by this
29    Section shall be in accordance with rules promulgated by  the
30    Department  and  approved  by the Hospital Licensing Board. A
31    full and complete record shall be kept  of  all  proceedings,
32    including  the  notice  of  hearing, complaint, and all other
33    documents in the nature of pleadings, written  motions  filed
34    in the proceedings, and the report and orders of the Director
 
                            -5-      LRB093 03367 AMC 12200 a
 1    and Hearing Officer. All testimony shall be reported but need
 2    not  be  transcribed unless the decision is appealed pursuant
 3    to Section 13. A copy or copies  of  the  transcript  may  be
 4    obtained  by  any  interested party on payment of the cost of
 5    preparing such copy or copies.
 6        (d)  The Director or Hearing Officer shall upon  his  own
 7    motion,  or  on  the  written  request  of  any  party to the
 8    proceeding, issue subpoenas requiring the attendance and  the
 9    giving  of  testimony by witnesses, and subpoenas duces tecum
10    requiring  the  production  of  books,  papers,  records,  or
11    memoranda. All subpoenas and  subpoenas  duces  tecum  issued
12    under  the  terms  of this Act may be served by any person of
13    full age. The fees of witnesses  for  attendance  and  travel
14    shall be the same as the fees of witnesses before the Circuit
15    Court of this State, such fees to be paid when the witness is
16    excused   from   further  attendance.  When  the  witness  is
17    subpoenaed at  the  instance  of  the  Director,  or  Hearing
18    Officer,  such fees shall be paid in the same manner as other
19    expenses  of  the  Department,  and  when  the   witness   is
20    subpoenaed  at  the  instance  of any other party to any such
21    proceeding the  Department  may  require  that  the  cost  of
22    service  of  the subpoena or subpoena duces tecum and the fee
23    of the witness be borne by the party at  whose  instance  the
24    witness  is  summoned.  In  such  case, the Department in its
25    discretion, may require a deposit to cover the cost  of  such
26    service  and witness fees. A subpoena or subpoena duces tecum
27    issued as aforesaid shall be served in the same manner  as  a
28    subpoena issued out of a court.
29        (e)  Any Circuit Court of this State upon the application
30    of  the  Director, or upon the application of any other party
31    to  the  proceeding,  may,  in  its  discretion,  compel  the
32    attendance of witnesses, the  production  of  books,  papers,
33    records,  or memoranda and the giving of testimony before the
34    Director or Hearing Officer conducting  an  investigation  or
 
                            -6-      LRB093 03367 AMC 12200 a
 1    holding  a  hearing  authorized by this Act, by an attachment
 2    for contempt, or otherwise, in the same manner as  production
 3    of evidence may be compelled before the court.
 4        (f)  The  Director or Hearing Officer, or any party in an
 5    investigation or hearing before the Department, may cause the
 6    depositions of witnesses within the State to be taken in  the
 7    manner  prescribed  by  law  for  like  depositions  in civil
 8    actions in courts of this State, and to that end  compel  the
 9    attendance  of witnesses and the production of books, papers,
10    records, or memoranda.
11    (Source: Laws 1967, p. 3969.)

12        Section 99.  Effective date.  This Act takes effect  upon
13    becoming law.".