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Public Act 102-0581


 

Public Act 0581 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0581
 
SB1840 EnrolledLRB102 15013 CPF 20368 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Community Benefits Act is amended by
changing Sections 10, 15, and 20 and by adding Section 22 as
follows:
 
    (210 ILCS 76/10)
    Sec. 10. Definitions. As used in this Act:
    "Bad debt" means the current period charge for actual or
expected doubtful accounting resulting from the extension of
credit.
    "Charity care" means care provided by a health care
provider for which the provider does not expect to receive
payment from the patient or a third party payer. "Charity
care" includes the actual cost of services provided based upon
the total cost to charge ratio derived from a nonprofit
hospital's most recently filed Medicare cost report Worksheet
C and not based upon the charges for the services. "Charity
care" does not include bad debt.
    "Community benefits" means the unreimbursed cost to a
hospital or health system of providing charity care, language
assistant services, government-sponsored indigent health care,
donations, volunteer services, education,
government-sponsored program services, research, and
subsidized health services and collecting bad debts.
"Community benefits" does not include the cost of paying any
taxes or other governmental assessments.
    "Financial assistance" means a discount provided to a
patient under the terms and conditions the hospital offers to
qualified patients or as required by law.
    "Government-sponsored Government sponsored indigent
health care" means the unreimbursed cost to a hospital or
health system of Medicare, providing health care services to
recipients of Medicaid, and other federal, State, or local
indigent health care programs, eligibility for which is based
on financial need.
    "Health system" means an entity that owns or operates at
least one hospital.
    "Net patient revenue" means gross service revenue less
provisions for contractual adjustments with third-party
payors, courtesy and policy discounts, or other adjustments
and deductions, excluding charity care.
    "Nonprofit hospital" means a hospital that is organized as
a nonprofit corporation, including religious organizations, or
a charitable trust under Illinois law or the laws of any other
state or country.
    "Subsidized health services" means those services provided
by a hospital in response to community needs for which the
reimbursement is less than the hospital's cost of providing
the services that must be subsidized by other hospital or
nonprofit supporting entity revenue sources. "Subsidized
health services" includes, but is not limited to, emergency
and trauma care, neonatal intensive care, community health
clinics, and collaborative efforts with local government or
private agencies to prevent illness and improve wellness, such
as immunization programs.
(Source: P.A. 93-480, eff. 8-8-03.)
 
    (210 ILCS 76/15)
    Sec. 15. Organizational mission statement; community
benefits plan. A nonprofit hospital shall develop:
        (1) an organizational mission statement that
    identifies the hospital's commitment to serving the health
    care needs of the community; and
        (2) a community benefits plan defined as an
    operational plan for serving the community's health care
    needs that:
            (A) sets out goals and objectives for providing
        community benefits that include charity care and
        government-sponsored government sponsored indigent
        health care; and
            (B) identifies the populations and communities
        served by the hospital; and .
            (C) describes activities the hospital is
        undertaking to address health equity, reduce health
        disparities, and improve community health. This may
        include, but is not limited to:
                (i) efforts to recruit and promote a racially
            and culturally diverse and representative
            workforce;
                (ii) efforts to procure goods and services
            locally and from historically underrepresented
            communities;
                (iii) training that addresses cultural
            competency and implicit bias; and
                (iv) partnerships and investments to address
            social needs such as food, housing, and community
            safety.
(Source: P.A. 93-480, eff. 8-8-03.)
 
    (210 ILCS 76/20)
    Sec. 20. Annual report for community benefits plan.
    (a) Each nonprofit hospital shall prepare an annual report
of the community benefits plan. The report must include, in
addition to the community benefits plan itself, all of the
following background information:
        (1) The hospital's mission statement.
        (2) A disclosure of the health care needs of the
    community that were considered in developing the
    hospital's community benefits plan.
        (3) A disclosure of the amount and types of community
    benefits actually provided, including charity care, and
    details about financial assistance applications received
    and processed by the hospital as specified in paragraph
    (5) of subsection (a) of Section 22. Charity care must be
    reported separate from other community benefits. In
    reporting charity care, the hospital must report the
    actual cost of services provided, based on the total cost
    to charge ratio derived from the hospital's Medicare cost
    report (CMS 2552-96 Worksheet C, Part 1, PPS Inpatient
    Ratios), not the charges for the services. For a health
    system that includes more than one hospital, charity care
    spending and financial assistance application data must be
    reported separately for each individual hospital within
    the health system.
        (4) Audited annual financial reports for its most
    recently completed fiscal year.
    (b) Each nonprofit hospital shall annually file a report
of the community benefits plan with the Attorney General. The
report must be filed not later than the last day of the sixth
month after the close of the hospital's fiscal year, beginning
with the hospital fiscal year that ends in 2004.
    (c) Each nonprofit hospital shall prepare a statement that
notifies the public that the annual report of the community
benefits plan is:
        (1) public information;
        (2) filed with the Attorney General; and
        (3) available to the public on request from the
    Attorney General.
    This statement shall be made available to the public.
    (d) The obligations of a hospital under this Act, except
for the filing of its audited financial report, shall take
effect beginning with the hospital's fiscal year that begins
after the effective date of this Act. Within 60 days of the
effective date of this Act, a hospital shall file the audited
annual financial report that has been completed for its most
recently completed fiscal year. Thereafter, a hospital shall
include its audited annual financial report for its most
recently completed fiscal year in its annual report of its
community benefits plan.
(Source: P.A. 93-480, eff. 8-8-03.)
 
    (210 ILCS 76/22 new)
    Sec. 22. Public reports.
    (a) In order to increase transparency and accessibility of
charity care and financial assistance data, a hospital shall
make the annual hospital community benefits plan report
submitted to the Attorney General under Section 20 available
to the public by publishing the information on the hospital's
website in the same location where annual reports are posted
or on a prominent location on the homepage of the hospital's
website. A hospital is not required to post its audited
financial statements. Information made available to the public
shall include, but shall not be limited to, the following:
        (1) The reporting period.
        (2) Charity care costs consistent with the reporting
    requirements in paragraph (3) of subsection (a) of Section
    20. Charity care costs associated with services provided
    in a hospital's emergency department shall be reported as
    a subset of total charity care costs.
        (3) Total net patient revenue, reported separately by
    hospital if the reporting health system includes more than
    one hospital.
        (4) Total community benefits spending. If a hospital
    is owned or operated by a health system, total community
    benefits spending may be reported as a health system.
        (5) Data on financial assistance applications
    consistent with the reporting requirements in paragraph
    (3) of subsection (a) of Section 20, including:
            (A) the number of applications submitted to the
        hospital, both complete and incomplete;
            (B) the number of applications approved; and
            (C) the number of applications denied and the 5
        most frequent reasons for denial.
        (6) To the extent that race, ethnicity, sex, or
    preferred language is collected and available for
    financial assistance applications, the data outlined in
    paragraph (5) shall be reported by race, ethnicity, sex,
    and preferred language. If this data is not provided by
    the patient, the hospital shall indicate this in its
    reports. Public reporting of this information shall begin
    with the community benefit report filed on or after July
    1, 2022. A hospital that files a report without having a
    full year of demographic data as required by this Act may
    indicate this in its report.
    (b) The Attorney General shall provide notice on the
Attorney General's website informing the public that, upon
request, the Attorney General will provide the annual reports
filed with the Attorney General under Section 20. The notice
shall include the contact information to submit a request.
 
    Section 10. The Hospital Uninsured Patient Discount Act is
amended by changing Sections 5, 10, 15, and 25 as follows:
 
    (210 ILCS 89/5)
    Sec. 5. Definitions. As used in this Act:
    "Community health center" means a federally qualified
health center as defined in Section 1905(l)(2)(B) of the
federal Social Security Act or a federally qualified health
center look-alike.
    "Cost to charge ratio" means the ratio of a hospital's
costs to its charges taken from its most recently filed
Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
Inpatient Ratios).
    "Critical Access Hospital" means a hospital that is
designated as such under the federal Medicare Rural Hospital
Flexibility Program.
    "Family income" means the sum of a family's annual
earnings and cash benefits from all sources before taxes, less
payments made for child support.
    "Federal poverty income guidelines" means the poverty
guidelines updated periodically in the Federal Register by the
United States Department of Health and Human Services under
authority of 42 U.S.C. 9902(2).
    "Financial assistance" means a discount provided to a
patient under the terms and conditions a hospital offers to
qualified patients or as required by law.
    "Free and charitable clinic" means a 501(c)(3) tax-exempt
health care organization providing health services to
low-income uninsured or underinsured individuals that is
recognized by either the Illinois Association of Free and
Charitable Clinics or the National Association of Free and
Charitable Clinics.
    "Health care services" means any medically necessary
inpatient or outpatient hospital service, including
pharmaceuticals or supplies provided by a hospital to a
patient.
    "Hospital" means any facility or institution required to
be licensed pursuant to the Hospital Licensing Act or operated
under the University of Illinois Hospital Act.
    "Illinois resident" means any a person who lives in
Illinois and who intends to remain living in Illinois
indefinitely. Relocation to Illinois for the sole purpose of
receiving health care benefits does not satisfy the residency
requirement under this Act.
    "Medically necessary" means any inpatient or outpatient
hospital service, including pharmaceuticals or supplies
provided by a hospital to a patient, covered under Title XVIII
of the federal Social Security Act for beneficiaries with the
same clinical presentation as the uninsured patient. A
"medically necessary" service does not include any of the
following:
        (1) Non-medical services such as social and vocational
    services.
        (2) Elective cosmetic surgery, but not plastic surgery
    designed to correct disfigurement caused by injury,
    illness, or congenital defect or deformity.
    "Rural hospital" means a hospital that is located outside
a metropolitan statistical area.
    "Uninsured discount" means a hospital's charges multiplied
by the uninsured discount factor.
    "Uninsured discount factor" means 1.0 less the product of
a hospital's cost to charge ratio multiplied by 1.35.
    "Uninsured patient" means an Illinois resident who is a
patient of a hospital and is not covered under a policy of
health insurance and is not a beneficiary under a public or
private health insurance, health benefit, or other health
coverage program, including high deductible health insurance
plans, workers' compensation, accident liability insurance, or
other third party liability.
(Source: P.A. 95-965, eff. 12-22-08.)
 
    (210 ILCS 89/10)
    Sec. 10. Uninsured patient discounts.
    (a) Eligibility.
        (1) A hospital, other than a rural hospital or
    Critical Access Hospital, shall provide a discount from
    its charges to any uninsured patient who applies for a
    discount and has family income of not more than 600% of the
    federal poverty income guidelines for all medically
    necessary health care services exceeding $150 $300 in any
    one inpatient admission or outpatient encounter.
        (2) A hospital, other than a rural hospital or
    Critical Access Hospital, shall provide a charitable
    discount of 100% of its charges for all medically
    necessary health care services exceeding $150 $300 in any
    one inpatient admission or outpatient encounter to any
    uninsured patient who applies for a discount and has
    family income of not more than 200% of the federal poverty
    income guidelines.
        (3) A rural hospital or Critical Access Hospital shall
    provide a discount from its charges to any uninsured
    patient who applies for a discount and has annual family
    income of not more than 300% of the federal poverty income
    guidelines for all medically necessary health care
    services exceeding $300 in any one inpatient admission or
    outpatient encounter.
        (4) A rural hospital or Critical Access Hospital shall
    provide a charitable discount of 100% of its charges for
    all medically necessary health care services exceeding
    $300 in any one inpatient admission or outpatient
    encounter to any uninsured patient who applies for a
    discount and has family income of not more than 125% of the
    federal poverty income guidelines.
    (b) Discount. For all health care services exceeding $300
in any one inpatient admission or outpatient encounter, a
hospital shall not collect from an uninsured patient, deemed
eligible under subsection (a), more than its charges less the
amount of the uninsured discount.
    (c) Maximum Collectible Amount.
        (1) The maximum amount that may be collected in a
    12-month 12 month period for health care services provided
    by the hospital from a patient determined by that hospital
    to be eligible under subsection (a) is 20% 25% of the
    patient's family income, and is subject to the patient's
    continued eligibility under this Act.
        (2) The 12-month 12 month period to which the maximum
    amount applies shall begin on the first date, after the
    effective date of this Act, an uninsured patient receives
    health care services that are determined to be eligible
    for the uninsured discount at that hospital.
        (3) To be eligible to have this maximum amount applied
    to subsequent charges, the uninsured patient shall inform
    the hospital in subsequent inpatient admissions or
    outpatient encounters that the patient has previously
    received health care services from that hospital and was
    determined to be entitled to the uninsured discount. The
    availability of the maximum collectible amount shall be
    included in the hospital's financial assistance
    information provided to uninsured patients.
        (4) Hospitals may adopt policies to exclude an
    uninsured patient from the application of subdivision
    (c)(1) when the patient owns assets having a value in
    excess of 600% of the federal poverty level for hospitals
    in a metropolitan statistical area or owns assets having a
    value in excess of 300% of the federal poverty level for
    Critical Access Hospitals or hospitals outside a
    metropolitan statistical area, not counting the following
    assets: the uninsured patient's primary residence;
    personal property exempt from judgment under Section
    12-1001 of the Code of Civil Procedure; or any amounts
    held in a pension or retirement plan, provided, however,
    that distributions and payments from pension or retirement
    plans may be included as income for the purposes of this
    Act.
    (d) Each hospital bill, invoice, or other summary of
charges to an uninsured patient shall include with it, or on
it, a prominent statement that an uninsured patient who meets
certain income requirements may qualify for an uninsured
discount and information regarding how an uninsured patient
may apply for consideration under the hospital's financial
assistance policy. The hospital's financial assistance
application shall include language that directs the uninsured
patient to contact the hospital's financial counseling
department with questions or concerns, along with contact
information for the financial counseling department, and shall
state: "Complaints or concerns with the uninsured patient
discount application process or hospital financial assistance
process may be reported to the Health Care Bureau of the
Illinois Attorney General.". A website, phone number, or both
provided by the Attorney General shall be included with this
statement.
(Source: P.A. 97-690, eff. 6-14-12.)
 
    (210 ILCS 89/15)
    Sec. 15. Patient responsibility.
    (a) Hospitals may make the availability of a discount and
the maximum collectible amount under this Act contingent upon
the uninsured patient first applying for coverage under public
health insurance programs, such as Medicare, Medicaid,
AllKids, the State Children's Health Insurance Program, or any
other program, if there is a reasonable basis to believe that
the uninsured patient may be eligible for such program.
    (b) Hospitals shall permit an uninsured patient to apply
for a discount within 90 60 days of the date of discharge or
date of service.
    Hospitals shall offer uninsured patients who receive
community-based primary care provided by a community health
center or a free and charitable clinic, are referred by such an
entity to the hospital, and seek access to nonemergency
hospital-based health care services with an opportunity to be
screened for and assistance with applying for public health
insurance programs if there is a reasonable basis to believe
that the uninsured patient may be eligible for a public health
insurance program. An uninsured patient who receives
community-based primary care provided by a community health
center or free and charitable clinic and is referred by such an
entity to the hospital for whom there is not a reasonable basis
to believe that the uninsured patient may be eligible for a
public health insurance program shall be given the opportunity
to apply for hospital financial assistance when hospital
services are scheduled.
        (1) Income verification. Hospitals may require an
    uninsured patient who is requesting an uninsured discount
    to provide documentation of family income. Acceptable
    family income documentation shall include any one of the
    following:
            (A) a copy of the most recent tax return;
            (B) a copy of the most recent W-2 form and 1099
        forms;
            (C) copies of the 2 most recent pay stubs;
            (D) written income verification from an employer
        if paid in cash; or
            (E) one other reasonable form of third party
        income verification deemed acceptable to the hospital.
        (2) Asset verification. Hospitals may require an
    uninsured patient who is requesting an uninsured discount
    to certify the existence or absence of assets owned by the
    patient and to provide documentation of the value of such
    assets, except for those assets referenced in paragraph
    (4) of subsection (c) of Section 10. Acceptable
    documentation may include statements from financial
    institutions or some other third party verification of an
    asset's value. If no third party verification exists, then
    the patient shall certify as to the estimated value of the
    asset.
        (3) Illinois resident verification. Hospitals may
    require an uninsured patient who is requesting an
    uninsured discount to verify Illinois residency.
    Acceptable verification of Illinois residency shall
    include any one of the following:
            (A) any of the documents listed in paragraph (1);
            (B) a valid state-issued identification card;
            (C) a recent residential utility bill;
            (D) a lease agreement;
            (E) a vehicle registration card;
            (F) a voter registration card;
            (G) mail addressed to the uninsured patient at an
        Illinois address from a government or other credible
        source;
            (H) a statement from a family member of the
        uninsured patient who resides at the same address and
        presents verification of residency; or
            (I) a letter from a homeless shelter, transitional
        house or other similar facility verifying that the
        uninsured patient resides at the facility; or .
            (J) a temporary visitor's drivers license.
    (c) Hospital obligations toward an individual uninsured
patient under this Act shall cease if that patient
unreasonably fails or refuses to provide the hospital with
information or documentation requested under subsection (b) or
to apply for coverage under public programs when requested
under subsection (a) within 30 days of the hospital's request.
    (d) In order for a hospital to determine the 12 month
maximum amount that can be collected from a patient deemed
eligible under Section 10, an uninsured patient shall inform
the hospital in subsequent inpatient admissions or outpatient
encounters that the patient has previously received health
care services from that hospital and was determined to be
entitled to the uninsured discount.
    (e) Hospitals may require patients to certify that all of
the information provided in the application is true. The
application may state that if any of the information is
untrue, any discount granted to the patient is forfeited and
the patient is responsible for payment of the hospital's full
charges.
    (f) Hospitals shall ask for an applicant's race,
ethnicity, sex, and preferred language on the financial
assistance application. However, the questions shall be
clearly marked as optional responses for the patient and shall
note that responses or nonresponses by the patient will not
have any impact on the outcome of the application.
(Source: P.A. 95-965, eff. 12-22-08.)
 
    (210 ILCS 89/25)
    Sec. 25. 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:
        (1) require the hospital to file a statement or report
    or answer interrogatories in writing as to all information
    relevant to the alleged violations;
        (2) examine under oath any person who possesses
    knowledge or information directly related to the alleged
    violations; and
        (3) 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 this 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:
        (1) 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
        (2) 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
subsection (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 a
civil monetary penalty not to exceed $500 per violation in any
action filed under this Act where a hospital, by pattern or
practice, knowingly violates Section 10 of this Act.
    (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.
    (i) Each hospital shall file Worksheet C Part I from its
most recently filed Medicare Cost Report with the Attorney
General within 60 days after the effective date of this Act and
thereafter shall file each subsequent Worksheet C Part I with
the Attorney General within 30 days of filing its Medicare
Cost Report with the hospital's fiscal intermediary.
    (j) No later than September 1, 2022, the Attorney General
shall provide data on the Attorney General's website regarding
enforcement efforts performed under this Act from July 1, 2021
through June 30, 2022. Thereafter, no later than September 1
of each year through September 1, 2027, the Attorney General
shall annually provide data on the Attorney General's website
regarding enforcement efforts performed under this Act from
July 1 through June 30 of each year. The data shall include the
following:
        (1) The total number of complaints received.
        (2) The total number of open investigations.
        (3) The number of complaints for which assistance in
    resolving complaints was provided to constituents
    throughout the State by the Attorney General without
    resorting to investigations or actions filed.
        (4) The total number of resolved complaints.
        (5) The total number of actions filed.
        (6) A list of the names of facilities found by a
    pattern or practice to knowingly violate Section 10, along
    with any civil penalties assessed against a listed
    facility.
(Source: P.A. 95-965, eff. 12-22-08.)
 
    Section 99. Effective date. This Act takes effect January
1, 2022.

Effective Date: 1/1/2022