Illinois General Assembly - Full Text of SB1840
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Full Text of SB1840  102nd General Assembly




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1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Community Benefits Act is amended by
5changing Sections 10, 15, and 20 and by adding Section 22 as
7    (210 ILCS 76/10)
8    Sec. 10. Definitions. As used in this Act:
9    "Bad debt" means the current period charge for actual or
10expected doubtful accounting resulting from the extension of
12    "Charity care" means care provided by a health care
13provider for which the provider does not expect to receive
14payment from the patient or a third party payer. "Charity
15care" includes the actual cost of services provided based upon
16the total cost to charge ratio derived from a nonprofit
17hospital's most recently filed Medicare cost report Worksheet
18C and not based upon the charges for the services. "Charity
19care" does not include bad debt.
20    "Community benefits" means the unreimbursed cost to a
21hospital or health system of providing charity care, language
22assistant services, government-sponsored indigent health care,
23donations, volunteer services, education,



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1government-sponsored program services, research, and
2subsidized health services and collecting bad debts.
3"Community benefits" does not include the cost of paying any
4taxes or other governmental assessments.
5    "Financial assistance" means a discount provided to a
6patient under the terms and conditions the hospital offers to
7qualified patients or as required by law.
8    "Government-sponsored Government sponsored indigent
9health care" means the unreimbursed cost to a hospital or
10health system of Medicare, providing health care services to
11recipients of Medicaid, and other federal, State, or local
12indigent health care programs, eligibility for which is based
13on financial need.
14    "Health system" means an entity that owns or operates at
15least one hospital.
16    "Net patient revenue" means gross service revenue less
17provisions for contractual adjustments with third-party
18payors, courtesy and policy discounts, or other adjustments
19and deductions, excluding charity care.
20    "Nonprofit hospital" means a hospital that is organized as
21a nonprofit corporation, including religious organizations, or
22a charitable trust under Illinois law or the laws of any other
23state or country.
24    "Subsidized health services" means those services provided
25by a hospital in response to community needs for which the
26reimbursement is less than the hospital's cost of providing



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1the services that must be subsidized by other hospital or
2nonprofit supporting entity revenue sources. "Subsidized
3health services" includes, but is not limited to, emergency
4and trauma care, neonatal intensive care, community health
5clinics, and collaborative efforts with local government or
6private agencies to prevent illness and improve wellness, such
7as immunization programs.
8(Source: P.A. 93-480, eff. 8-8-03.)
9    (210 ILCS 76/15)
10    Sec. 15. Organizational mission statement; community
11benefits plan. A nonprofit hospital shall develop:
12        (1) an organizational mission statement that
13    identifies the hospital's commitment to serving the health
14    care needs of the community; and
15        (2) a community benefits plan defined as an
16    operational plan for serving the community's health care
17    needs that:
18            (A) sets out goals and objectives for providing
19        community benefits that include charity care and
20        government-sponsored government sponsored indigent
21        health care; and
22            (B) identifies the populations and communities
23        served by the hospital; and .
24            (C) describes activities the hospital is
25        undertaking to address health equity, reduce health



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1        disparities, and improve community health. This may
2        include, but is not limited to:
3                (i) efforts to recruit and promote a racially
4            and culturally diverse and representative
5            workforce;
6                (ii) efforts to procure goods and services
7            locally and from historically underrepresented
8            communities;
9                (iii) training that addresses cultural
10            competency and implicit bias; and
11                (iv) partnerships and investments to address
12            social needs such as food, housing, and community
13            safety.
14(Source: P.A. 93-480, eff. 8-8-03.)
15    (210 ILCS 76/20)
16    Sec. 20. Annual report for community benefits plan.
17    (a) Each nonprofit hospital shall prepare an annual report
18of the community benefits plan. The report must include, in
19addition to the community benefits plan itself, all of the
20following background information:
21        (1) The hospital's mission statement.
22        (2) A disclosure of the health care needs of the
23    community that were considered in developing the
24    hospital's community benefits plan.
25        (3) A disclosure of the amount and types of community



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1    benefits actually provided, including charity care, and
2    details about financial assistance applications received
3    and processed by the hospital as specified in paragraph
4    (5) of subsection (a) of Section 22. Charity care must be
5    reported separate from other community benefits. In
6    reporting charity care, the hospital must report the
7    actual cost of services provided, based on the total cost
8    to charge ratio derived from the hospital's Medicare cost
9    report (CMS 2552-96 Worksheet C, Part 1, PPS Inpatient
10    Ratios), not the charges for the services. For a health
11    system that includes more than one hospital, charity care
12    spending and financial assistance application data must be
13    reported separately for each individual hospital within
14    the health system.
15        (4) Audited annual financial reports for its most
16    recently completed fiscal year.
17    (b) Each nonprofit hospital shall annually file a report
18of the community benefits plan with the Attorney General. The
19report must be filed not later than the last day of the sixth
20month after the close of the hospital's fiscal year, beginning
21with the hospital fiscal year that ends in 2004.
22    (c) Each nonprofit hospital shall prepare a statement that
23notifies the public that the annual report of the community
24benefits plan is:
25        (1) public information;
26        (2) filed with the Attorney General; and



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1        (3) available to the public on request from the
2    Attorney General.
3    This statement shall be made available to the public.
4    (d) The obligations of a hospital under this Act, except
5for the filing of its audited financial report, shall take
6effect beginning with the hospital's fiscal year that begins
7after the effective date of this Act. Within 60 days of the
8effective date of this Act, a hospital shall file the audited
9annual financial report that has been completed for its most
10recently completed fiscal year. Thereafter, a hospital shall
11include its audited annual financial report for its most
12recently completed fiscal year in its annual report of its
13community benefits plan.
14(Source: P.A. 93-480, eff. 8-8-03.)
15    (210 ILCS 76/22 new)
16    Sec. 22. Public reports.
17    (a) In order to increase transparency and accessibility of
18charity care and financial assistance data, a hospital shall
19make the annual hospital community benefits plan report
20submitted to the Attorney General under Section 20 available
21to the public by publishing the information on the hospital's
22website in the same location where annual reports are posted
23or on a prominent location on the homepage of the hospital's
24website. A hospital is not required to post its audited
25financial statements. Information made available to the public



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1shall include, but shall not be limited to, the following:
2        (1) The reporting period.
3        (2) Charity care costs consistent with the reporting
4    requirements in paragraph (3) of subsection (a) of Section
5    20. Charity care costs associated with services provided
6    in a hospital's emergency department shall be reported as
7    a subset of total charity care costs.
8        (3) Total net patient revenue, reported separately by
9    hospital if the reporting health system includes more than
10    one hospital.
11        (4) Total community benefits spending. If a hospital
12    is owned or operated by a health system, total community
13    benefits spending may be reported as a health system.
14        (5) Data on financial assistance applications
15    consistent with the reporting requirements in paragraph
16    (3) of subsection (a) of Section 20, including:
17            (A) the number of applications submitted to the
18        hospital, both complete and incomplete;
19            (B) the number of applications approved; and
20            (C) the number of applications denied and the 5
21        most frequent reasons for denial.
22        (6) To the extent that race, ethnicity, sex, or
23    preferred language is collected and available for
24    financial assistance applications, the data outlined in
25    paragraph (5) shall be reported by race, ethnicity, sex,
26    and preferred language. If this data is not provided by



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1    the patient, the hospital shall indicate this in its
2    reports. Public reporting of this information shall begin
3    with the community benefit report filed on or after July
4    1, 2022. A hospital that files a report without having a
5    full year of demographic data as required by this Act may
6    indicate this in its report.
7    (b) The Attorney General shall provide notice on the
8Attorney General's website informing the public that, upon
9request, the Attorney General will provide the annual reports
10filed with the Attorney General under Section 20. The notice
11shall include the contact information to submit a request.
12    Section 10. The Hospital Uninsured Patient Discount Act is
13amended by changing Sections 5, 10, 15, and 25 as follows:
14    (210 ILCS 89/5)
15    Sec. 5. Definitions. As used in this Act:
16    "Community health center" means a federally qualified
17health center as defined in Section 1905(l)(2)(B) of the
18federal Social Security Act or a federally qualified health
19center look-alike.
20    "Cost to charge ratio" means the ratio of a hospital's
21costs to its charges taken from its most recently filed
22Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
23Inpatient Ratios).
24    "Critical Access Hospital" means a hospital that is



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1designated as such under the federal Medicare Rural Hospital
2Flexibility Program.
3    "Family income" means the sum of a family's annual
4earnings and cash benefits from all sources before taxes, less
5payments made for child support.
6    "Federal poverty income guidelines" means the poverty
7guidelines updated periodically in the Federal Register by the
8United States Department of Health and Human Services under
9authority of 42 U.S.C. 9902(2).
10    "Financial assistance" means a discount provided to a
11patient under the terms and conditions a hospital offers to
12qualified patients or as required by law.
13    "Free and charitable clinic" means a 501(c)(3) tax-exempt
14health care organization providing health services to
15low-income uninsured or underinsured individuals that is
16recognized by either the Illinois Association of Free and
17Charitable Clinics or the National Association of Free and
18Charitable Clinics.
19    "Health care services" means any medically necessary
20inpatient or outpatient hospital service, including
21pharmaceuticals or supplies provided by a hospital to a
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 a person who lives in



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1Illinois and who intends to remain living in Illinois
2indefinitely. Relocation to Illinois for the sole purpose of
3receiving health 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
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. 95-965, eff. 12-22-08.)
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 $300 in any
14    one 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 $300 in any
19    one 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    (b) Discount. For all health care services exceeding $300
13in any one inpatient admission or outpatient encounter, a
14hospital shall not collect from an uninsured patient, deemed
15eligible under subsection (a), more than its charges less the
16amount of the uninsured discount.
17    (c) Maximum Collectible Amount.
18        (1) The maximum amount that may be collected in a
19    12-month 12 month period for health care services provided
20    by the hospital from a patient determined by that hospital
21    to be eligible under subsection (a) is 20% 25% of the
22    patient's family income, and is subject to the patient's
23    continued eligibility under this Act.
24        (2) The 12-month 12 month period to which the maximum
25    amount applies shall begin on the first date, after the
26    effective date of this Act, an uninsured patient receives



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1    health care services that are determined to be eligible
2    for the uninsured discount at that hospital.
3        (3) To be eligible to have this maximum amount applied
4    to subsequent charges, the uninsured patient shall inform
5    the hospital in subsequent inpatient admissions or
6    outpatient encounters that the patient has previously
7    received health care services from that hospital and was
8    determined to be entitled to the uninsured discount. The
9    availability of the maximum collectible amount shall be
10    included in the hospital's financial assistance
11    information provided to uninsured patients.
12        (4) Hospitals may adopt policies to exclude an
13    uninsured patient from the application of subdivision
14    (c)(1) when the patient owns assets having a value in
15    excess of 600% of the federal poverty level for hospitals
16    in a metropolitan statistical area or owns assets having a
17    value in excess of 300% of the federal poverty level for
18    Critical Access Hospitals or hospitals outside a
19    metropolitan statistical area, not counting the following
20    assets: the uninsured patient's primary residence;
21    personal property exempt from judgment under Section
22    12-1001 of the Code of Civil Procedure; or any amounts
23    held in a pension or retirement plan, provided, however,
24    that distributions and payments from pension or retirement
25    plans may be included as income for the purposes of this
26    Act.



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1    (d) Each hospital bill, invoice, or other summary of
2charges to an uninsured patient shall include with it, or on
3it, a prominent statement that an uninsured patient who meets
4certain income requirements may qualify for an uninsured
5discount and information regarding how an uninsured patient
6may apply for consideration under the hospital's financial
7assistance policy. The hospital's financial assistance
8application shall include language that directs the uninsured
9patient to contact the hospital's financial counseling
10department with questions or concerns, along with contact
11information for the financial counseling department, and shall
12state: "Complaints or concerns with the uninsured patient
13discount application process or hospital financial assistance
14process may be reported to the Health Care Bureau of the
15Illinois Attorney General.". A website, phone number, or both
16provided by the Attorney General shall be included with this
18(Source: P.A. 97-690, eff. 6-14-12.)
19    (210 ILCS 89/15)
20    Sec. 15. Patient responsibility.
21    (a) Hospitals may make the availability of a discount and
22the maximum collectible amount under this Act contingent upon
23the uninsured patient first applying for coverage under public
24health insurance programs, such as Medicare, Medicaid,
25AllKids, the State Children's Health Insurance Program, or any



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1other program, if there is a reasonable basis to believe that
2the uninsured patient may be eligible for such program.
3    (b) Hospitals shall permit an uninsured patient to apply
4for a discount within 90 60 days of the date of discharge or
5date of service.
6    Hospitals shall offer uninsured patients who receive
7community-based primary care provided by a community health
8center or a free and charitable clinic, are referred by such an
9entity to the hospital, and seek access to nonemergency
10hospital-based health care services with an opportunity to be
11screened for and assistance with applying for public health
12insurance programs if there is a reasonable basis to believe
13that the uninsured patient may be eligible for a public health
14insurance program. An uninsured patient who receives
15community-based primary care provided by a community health
16center or free and charitable clinic and is referred by such an
17entity to the hospital for whom there is not a reasonable basis
18to believe that the uninsured patient may be eligible for a
19public health insurance program shall be given the opportunity
20to apply for hospital financial assistance when hospital
21services are scheduled.
22        (1) Income verification. Hospitals may require an
23    uninsured patient who is requesting an uninsured discount
24    to provide documentation of family income. Acceptable
25    family income documentation shall include any one of the
26    following:



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1            (A) a copy of the most recent tax return;
2            (B) a copy of the most recent W-2 form and 1099
3        forms;
4            (C) copies of the 2 most recent pay stubs;
5            (D) written income verification from an employer
6        if paid in cash; or
7            (E) one other reasonable form of third party
8        income verification deemed acceptable to the hospital.
9        (2) Asset verification. Hospitals may require an
10    uninsured patient who is requesting an uninsured discount
11    to certify the existence or absence of assets owned by the
12    patient and to provide documentation of the value of such
13    assets, except for those assets referenced in paragraph
14    (4) of subsection (c) of Section 10. Acceptable
15    documentation may include statements from financial
16    institutions or some other third party verification of an
17    asset's value. If no third party verification exists, then
18    the patient shall certify as to the estimated value of the
19    asset.
20        (3) Illinois resident verification. Hospitals may
21    require an uninsured patient who is requesting an
22    uninsured discount to verify Illinois residency.
23    Acceptable verification of Illinois residency shall
24    include any one of the following:
25            (A) any of the documents listed in paragraph (1);
26            (B) a valid state-issued identification card;



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1            (C) a recent residential utility bill;
2            (D) a lease agreement;
3            (E) a vehicle registration card;
4            (F) a voter registration card;
5            (G) mail addressed to the uninsured patient at an
6        Illinois address from a government or other credible
7        source;
8            (H) a statement from a family member of the
9        uninsured patient who resides at the same address and
10        presents verification of residency; or
11            (I) a letter from a homeless shelter, transitional
12        house or other similar facility verifying that the
13        uninsured patient resides at the facility; or .
14            (J) a temporary visitor's drivers license.
15    (c) Hospital obligations toward an individual uninsured
16patient under this Act shall cease if that patient
17unreasonably fails or refuses to provide the hospital with
18information or documentation requested under subsection (b) or
19to apply for coverage under public programs when requested
20under subsection (a) within 30 days of the hospital's request.
21    (d) In order for a hospital to determine the 12 month
22maximum amount that can be collected from a patient deemed
23eligible under Section 10, an uninsured patient shall inform
24the hospital in subsequent inpatient admissions or outpatient
25encounters that the patient has previously received health
26care services from that hospital and was determined to be



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1entitled to the uninsured discount.
2    (e) Hospitals may require patients to certify that all of
3the information provided in the application is true. The
4application may state that if any of the information is
5untrue, any discount granted to the patient is forfeited and
6the patient is responsible for payment of the hospital's full
8    (f) Hospitals shall ask for an applicant's race,
9ethnicity, sex, and preferred language on the financial
10assistance application. However, the questions shall be
11clearly marked as optional responses for the patient and shall
12note that responses or nonresponses by the patient will not
13have any impact on the outcome of the application.
14(Source: P.A. 95-965, eff. 12-22-08.)
15    (210 ILCS 89/25)
16    Sec. 25. Enforcement.
17    (a) The Attorney General is responsible for administering
18and ensuring compliance with this Act, including the
19development of any rules necessary for the implementation and
20enforcement of this Act.
21    (b) The Attorney General shall develop and implement a
22process for receiving and handling complaints from individuals
23or hospitals regarding possible violations of this Act.
24    (c) The Attorney General may conduct any investigation
25deemed necessary regarding possible violations of this Act by



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1any hospital including, without limitation, the issuance of
2subpoenas to:
3        (1) require the hospital to file a statement or report
4    or answer interrogatories in writing as to all information
5    relevant to the alleged violations;
6        (2) examine under oath any person who possesses
7    knowledge or information directly related to the alleged
8    violations; and
9        (3) examine any record, book, document, account, or
10    paper necessary to investigate the alleged violation.
11    (d) If the Attorney General determines that there is a
12reason to believe that any hospital has violated this Act, the
13Attorney General may bring an action in the name of the People
14of the State against the hospital to obtain temporary,
15preliminary, or permanent injunctive relief for any act,
16policy, or practice by the hospital that violates this Act.
17Before bringing such an action, the Attorney General may
18permit the hospital to submit a Correction Plan for the
19Attorney General's approval.
20    (e) This Section applies if:
21        (1) A court orders a party to make payments to the
22    Attorney General and the payments are to be used for the
23    operations of the Office of the Attorney General; or
24        (2) A party agrees in a Correction Plan under this Act
25    to make payments to the Attorney General for the
26    operations of the Office of the Attorney General.



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1    (f) Moneys paid under any of the conditions described in
2subsection (e) shall be deposited into the Attorney General
3Court Ordered and Voluntary Compliance Payment Projects Fund.
4Moneys in the Fund shall be used, subject to appropriation,
5for the performance of any function, pertaining to the
6exercise of the duties, to the Attorney General including, but
7not limited to, enforcement of any law of this State and
8conducting public education programs; however, any moneys in
9the Fund that are required by the court to be used for a
10particular purpose shall be used for that purpose.
11    (g) The Attorney General may seek the assessment of a
12civil monetary penalty not to exceed $500 per violation in any
13action filed under this Act where a hospital, by pattern or
14practice, knowingly violates Section 10 of this Act.
15    (h) In the event a court grants a final order of relief
16against any hospital for a violation of this Act, the Attorney
17General may, after all appeal rights have been exhausted,
18refer the hospital to the Illinois Department of Public Health
19for possible adverse licensure action under the Hospital
20Licensing Act.
21    (i) Each hospital shall file Worksheet C Part I from its
22most recently filed Medicare Cost Report with the Attorney
23General within 60 days after the effective date of this Act and
24thereafter shall file each subsequent Worksheet C Part I with
25the Attorney General within 30 days of filing its Medicare
26Cost Report with the hospital's fiscal intermediary.



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1    (j) No later than September 1, 2022, the Attorney General
2shall provide data on the Attorney General's website regarding
3enforcement efforts performed under this Act from July 1, 2021
4through June 30, 2022. Thereafter, no later than September 1
5of each year through September 1, 2027, the Attorney General
6shall annually provide data on the Attorney General's website
7regarding enforcement efforts performed under this Act from
8July 1 through June 30 of each year. The data shall include the
10        (1) The total number of complaints received.
11        (2) The total number of open investigations.
12        (3) The number of complaints for which assistance in
13    resolving complaints was provided to constituents
14    throughout the State by the Attorney General without
15    resorting to investigations or actions filed.
16        (4) The total number of resolved complaints.
17        (5) The total number of actions filed.
18        (6) A list of the names of facilities found by a
19    pattern or practice to knowingly violate Section 10, along
20    with any civil penalties assessed against a listed
21    facility.
22(Source: P.A. 95-965, eff. 12-22-08.)
23    Section 99. Effective date. This Act takes effect January
241, 2022.