97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3434

 

Introduced 2/24/2011, by Rep. Ann Williams

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 89/5
210 ILCS 89/10
210 ILCS 89/15

    Amends the Hospital Uninsured Patient Discount Act. Makes changes to the definition for "uninsured patient". In the provision concerning uninsured patient discounts, provides that the discount shall apply and the maximum collectible amount shall not apply to a patient who would otherwise be considered to be uninsured and eligible for a discount under the Act, except for the patient being eligible for compensation for health care services under the Crime Victims Compensation Act. Provides that a hospital that accepts payment for health care services under the Crime Victims Compensation Act on behalf of an otherwise uninsured crime victim shall be required to waive the remaining patient balance for that service and may not pursue the patient for any additional payment for the service. Makes changes in the provision concerning patient responsibility. Provides that the changes made by the amendatory Act are intended to be declarative of existing law. Effective immediately.


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A BILL FOR

 

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1    AN ACT concerning health facilities.
 
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    "Cost to charge ratio" means the ratio of a hospital's
9costs to its charges taken from its most recently filed
10Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
11Inpatient Ratios).
12    "Critical Access Hospital" means a hospital that is
13designated as such under the federal Medicare Rural Hospital
14Flexibility Program.
15    "Family income" means the sum of a family's annual earnings
16and cash benefits from all sources before taxes, less payments
17made for child support.
18    "Federal poverty income guidelines" means the poverty
19guidelines updated periodically in the Federal Register by the
20United States Department of Health and Human Services under
21authority of 42 U.S.C. 9902(2).
22    "Health care services" means any medically necessary
23inpatient or outpatient hospital service, including

 

 

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

 

 

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1    "Uninsured discount factor" means 1.0 less the product of a
2hospital's cost to charge ratio multiplied by 1.35.
3    "Uninsured patient" means an Illinois resident who is a
4patient of a hospital and is not covered under a policy of
5health insurance and is not a beneficiary under a public or
6private health insurance, health benefit, or other health
7coverage program, including high deductible health insurance
8plans, workers' compensation, accident liability insurance, or
9other third party liability and is not eligible for
10compensation for health care services under any other
11government program, including, but not limited to, the Crime
12Victims Compensation Act. The changes made to this Section by
13this amendatory Act of the 97th General Assembly are intended
14to be declarative of existing law.
15(Source: P.A. 95-965, eff. 12-22-08.)
 
16    (210 ILCS 89/10)
17    Sec. 10. Uninsured patient discounts.
18    (a) Eligibility.
19        (1) A hospital, other than a rural hospital or Critical
20    Access Hospital, shall provide a discount from its charges
21    to any uninsured patient who applies for a discount and has
22    family income of not more than 600% of the federal poverty
23    income guidelines for all medically necessary health care
24    services exceeding $300 in any one inpatient admission or
25    outpatient encounter.

 

 

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1        (2) A rural hospital or Critical Access Hospital shall
2    provide a discount from its charges to any uninsured
3    patient who applies for a discount and has annual family
4    income of not more than 300% of the federal poverty income
5    guidelines for all medically necessary health care
6    services exceeding $300 in any one inpatient admission or
7    outpatient encounter.
8    (b) Discount. For all health care services exceeding $300
9in any one inpatient admission or outpatient encounter, a
10hospital shall not collect from an uninsured patient, deemed
11eligible under subsection (a), more than its charges less the
12amount of the uninsured discount. This discount shall apply to
13a patient who would otherwise be considered to be uninsured and
14eligible for a discount under this Act, except for the patient
15being eligible for compensation for health care services under
16the Crime Victims Compensation Act.
17    (c) Maximum Collectible Amount.
18        (1) The maximum amount that may be collected in a 12
19    month period for health care services provided by the
20    hospital from a patient determined by that hospital to be
21    eligible under subsection (a) is 25% of the patient's
22    family income, and is subject to the patient's continued
23    eligibility under this Act. The maximum collectible amount
24    shall not apply to a patient who would otherwise be
25    considered to be uninsured and eligible for a discount
26    under this Act, except for the patient being eligible for

 

 

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1    compensation for health care services under the Crime
2    Victims Compensation Act. A hospital that accepts payment
3    for health care services under the Crime Victims
4    Compensation Act on behalf of an otherwise uninsured crime
5    victim shall be required to waive the remaining patient
6    balance for that service and may not pursue the patient for
7    any additional payment for the service. The changes made to
8    this Section by this amendatory Act of the 97th General
9    Assembly are intended to be declarative of existing law.
10        (2) The 12 month period to which the maximum amount
11    applies shall begin on the first date, after the effective
12    date of this Act, an uninsured patient receives health care
13    services that are determined to be eligible for the
14    uninsured discount at that hospital.
15        (3) To be eligible to have this maximum amount applied
16    to subsequent charges, the uninsured patient shall inform
17    the hospital in subsequent inpatient admissions or
18    outpatient encounters that the patient has previously
19    received health care services from that hospital and was
20    determined to be entitled to the uninsured discount.
21        (4) Hospitals may adopt policies to exclude an
22    uninsured patient from the application of subdivision
23    (c)(1) when the patient owns assets having a value in
24    excess of 600% of the federal poverty level for hospitals
25    in a metropolitan statistical area or owns assets having a
26    value in excess of 300% of the federal poverty level for

 

 

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1    Critical Access Hospitals or hospitals outside a
2    metropolitan statistical area, not counting the following
3    assets: the uninsured patient's primary residence;
4    personal property exempt from judgment under Section
5    12-1001 of the Code of Civil Procedure; or any amounts held
6    in a pension or retirement plan, provided, however, that
7    distributions and payments from pension or retirement
8    plans may be included as income for the purposes of this
9    Act.
10    (d) Each hospital bill, invoice, or other summary of
11charges to an uninsured patient shall include with it, or on
12it, a prominent statement that an uninsured patient who meets
13certain income requirements may qualify for an uninsured
14discount and information regarding how an uninsured patient may
15apply for consideration under the hospital's financial
16assistance policy.
17(Source: P.A. 95-965, eff. 12-22-08.)
 
18    (210 ILCS 89/15)
19    Sec. 15. Patient responsibility.
20    (a) Hospitals may make the availability of a discount and
21the maximum collectible amount under this Act contingent upon
22the uninsured patient first applying for coverage under public
23programs, such as Medicare, Medicaid, AllKids, the State
24Children's Health Insurance Program, or any other program,
25including, but not limited to, the Crime Victims Compensation

 

 

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1Act, if there is a reasonable basis to believe that the
2uninsured patient may be eligible for such program. The changes
3made to this Section by this amendatory Act of the 97th General
4Assembly are intended to be declarative of existing law.
5    (b) Hospitals shall permit an uninsured patient to apply
6for a discount within 60 days of the date of discharge or date
7of service.
8        (1) Income verification. Hospitals may require an
9    uninsured patient who is requesting an uninsured discount
10    to provide documentation of family income. Acceptable
11    family income documentation shall include any one of the
12    following:
13            (A) a copy of the most recent tax return;
14            (B) a copy of the most recent W-2 form and 1099
15        forms;
16            (C) copies of the 2 most recent pay stubs;
17            (D) written income verification from an employer
18        if paid in cash; or
19            (E) one other reasonable form of third party income
20        verification deemed acceptable to the hospital.
21        (2) Asset verification. Hospitals may require an
22    uninsured patient who is requesting an uninsured discount
23    to certify the existence of assets owned by the patient and
24    to provide documentation of the value of such assets.
25    Acceptable documentation may include statements from
26    financial institutions or some other third party

 

 

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1    verification of an asset's value. If no third party
2    verification exists, then the patient shall certify as to
3    the estimated value of the asset.
4        (3) Illinois resident verification. Hospitals may
5    require an uninsured patient who is requesting an uninsured
6    discount to verify Illinois residency. Acceptable
7    verification of Illinois residency shall include any one of
8    the following:
9            (A) any of the documents listed in paragraph (1);
10            (B) a valid state-issued identification card;
11            (C) a recent residential utility bill;
12            (D) a lease agreement;
13            (E) a vehicle registration card;
14            (F) a voter registration card;
15            (G) mail addressed to the uninsured patient at an
16        Illinois address from a government or other credible
17        source;
18            (H) a statement from a family member of the
19        uninsured patient who resides at the same address and
20        presents verification of residency; or
21            (I) a letter from a homeless shelter, transitional
22        house or other similar facility verifying that the
23        uninsured patient resides at the facility.
24    (c) Hospital obligations toward an individual uninsured
25patient under this Act shall cease if that patient unreasonably
26fails or refuses to provide the hospital with information or

 

 

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1documentation requested under subsection (b) or to apply for
2coverage under public programs when requested under subsection
3(a) within 30 days of the hospital's request.
4    (d) In order for a hospital to determine the 12 month
5maximum amount that can be collected from a patient deemed
6eligible under Section 10, an uninsured patient shall inform
7the hospital in subsequent inpatient admissions or outpatient
8encounters that the patient has previously received health care
9services from that hospital and was determined to be entitled
10to the uninsured discount.
11    (e) Hospitals may require patients to certify that all of
12the information provided in the application is true. The
13application may state that if any of the information is untrue,
14any discount granted to the patient is forfeited and the
15patient is responsible for payment of the hospital's full
16charges.
17(Source: P.A. 95-965, eff. 12-22-08.)
 
18    Section 99. Effective date. This Act takes effect upon
19becoming law.