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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Hospital Uninsured Patient Discount Act is | ||||||
5 | amended 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 | ||||||
9 | health center as defined in Section 1905(l)(2)(B) of the | ||||||
10 | federal Social Security Act or a federally qualified health | ||||||
11 | center look-alike. | ||||||
12 | "Cost to charge ratio" means the ratio of a hospital's | ||||||
13 | costs to its charges taken from its most recently filed | ||||||
14 | Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS | ||||||
15 | Inpatient Ratios). | ||||||
16 | "Critical Access Hospital" means a hospital that is | ||||||
17 | designated as such under the federal Medicare Rural Hospital | ||||||
18 | Flexibility Program. | ||||||
19 | "Family income" means the sum of a family's annual | ||||||
20 | earnings and cash benefits from all sources before taxes, less | ||||||
21 | payments made for child support. | ||||||
22 | "Federal poverty income guidelines" means the poverty | ||||||
23 | guidelines updated periodically in the Federal Register by the |
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1 | United States Department of Health and Human Services under | ||||||
2 | authority of 42 U.S.C. 9902(2). | ||||||
3 | "Financial assistance" means a discount provided to a | ||||||
4 | patient under the terms and conditions a hospital offers to | ||||||
5 | qualified patients or as required by law. | ||||||
6 | "Free and charitable clinic" means a 501(c)(3) tax-exempt | ||||||
7 | health care organization providing health services to | ||||||
8 | low-income uninsured or underinsured individuals that is | ||||||
9 | recognized by either the Illinois Association of Free and | ||||||
10 | Charitable Clinics or the National Association of Free and | ||||||
11 | Charitable Clinics. | ||||||
12 | "Guaranteed income program" means a publicly or privately | ||||||
13 | funded program that provides one-time or recurring | ||||||
14 | unconditional cash transfers or payments, or gifts to | ||||||
15 | individuals or households, for a defined number of months or | ||||||
16 | years for the purposes of reducing poverty, promoting economic | ||||||
17 | mobility, or increasing the financial stability of Illinois | ||||||
18 | residents. | ||||||
19 | "Health care services" means any medically necessary | ||||||
20 | inpatient or outpatient hospital service, including | ||||||
21 | pharmaceuticals or supplies provided by a hospital to a | ||||||
22 | patient. | ||||||
23 | "Hospital" means any facility or institution required to | ||||||
24 | be licensed pursuant to the Hospital Licensing Act or operated | ||||||
25 | under the University of Illinois Hospital Act. | ||||||
26 | "Illinois resident" means any person who lives in Illinois |
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1 | and who intends to remain living in Illinois indefinitely. | ||||||
2 | Relocation to Illinois for the sole purpose of receiving | ||||||
3 | health care benefits does not satisfy the residency | ||||||
4 | requirement under this Act. | ||||||
5 | "Medically necessary" means any inpatient or outpatient | ||||||
6 | hospital service, including pharmaceuticals or supplies | ||||||
7 | provided by a hospital to a patient, covered under Title XVIII | ||||||
8 | of the federal Social Security Act for beneficiaries with the | ||||||
9 | same clinical presentation as the uninsured patient. A | ||||||
10 | "medically necessary" service does not include any of the | ||||||
11 | following: | ||||||
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 | ||||||
18 | a metropolitan statistical area. | ||||||
19 | "Uninsured discount" means a hospital's charges multiplied | ||||||
20 | by the uninsured discount factor. | ||||||
21 | "Uninsured discount factor" means 1.0 less the product of | ||||||
22 | a hospital's cost to charge ratio multiplied by 1.35. | ||||||
23 | "Uninsured patient" means an Illinois resident who is a | ||||||
24 | patient of a hospital and is not covered under a policy of | ||||||
25 | health insurance and is not a beneficiary under a public or | ||||||
26 | private health insurance, health benefit, or other health |
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1 | coverage program, including high deductible health insurance | ||||||
2 | plans, workers' compensation, accident liability insurance, or | ||||||
3 | other third party liability.
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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 | ||||||
3 | in any one inpatient admission or outpatient encounter, a | ||||||
4 | hospital shall not collect from an uninsured patient, deemed | ||||||
5 | eligible under subsection (a), more than its charges less the | ||||||
6 | amount 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 | ||||||
18 | charges to an uninsured patient shall include with it, or on | ||||||
19 | it, a prominent statement that an uninsured patient who meets | ||||||
20 | certain income requirements may qualify for an uninsured | ||||||
21 | discount and information regarding how an uninsured patient | ||||||
22 | may apply for consideration under the hospital's financial | ||||||
23 | assistance policy. The hospital's financial assistance | ||||||
24 | application shall include language that directs the uninsured | ||||||
25 | patient to contact the hospital's financial counseling | ||||||
26 | department with questions or concerns, along with contact |
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1 | information for the financial counseling department, and shall | ||||||
2 | state: "Complaints or concerns with the uninsured patient | ||||||
3 | discount application process or hospital financial assistance | ||||||
4 | process may be reported to the Health Care Bureau of the | ||||||
5 | Illinois Attorney General.". A website, phone number, or both | ||||||
6 | provided by the Attorney General shall be included with this | ||||||
7 | statement.
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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 | ||||||
12 | the maximum collectible amount under this Act contingent upon | ||||||
13 | the uninsured patient first applying for coverage under public | ||||||
14 | health insurance programs, such as Medicare, Medicaid, | ||||||
15 | AllKids, the State Children's Health Insurance Program, the | ||||||
16 | Health Benefits for Immigrants program, or any other program, | ||||||
17 | if there is a reasonable basis to believe that the uninsured | ||||||
18 | patient may be eligible for such program. | ||||||
19 | (b) Hospitals shall permit an uninsured patient to apply | ||||||
20 | for a discount within 90 days of the date of discharge or date | ||||||
21 | of service. | ||||||
22 | Hospitals shall offer uninsured patients who receive | ||||||
23 | community-based primary care provided by a community health | ||||||
24 | center or a free and charitable clinic, are referred by such an | ||||||
25 | entity to the hospital, and seek access to nonemergency |
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1 | hospital-based health care services with an opportunity to be | ||||||
2 | screened for and assistance with applying for public health | ||||||
3 | insurance programs if there is a reasonable basis to believe | ||||||
4 | that the uninsured patient may be eligible for a public health | ||||||
5 | insurance program. An uninsured patient who receives | ||||||
6 | community-based primary care provided by a community health | ||||||
7 | center or free and charitable clinic and is referred by such an | ||||||
8 | entity to the hospital for whom there is not a reasonable basis | ||||||
9 | to believe that the uninsured patient may be eligible for a | ||||||
10 | public health insurance program shall be given the opportunity | ||||||
11 | to apply for hospital financial assistance when hospital | ||||||
12 | services 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 | ||||||
7 | patient under this Act shall cease if that patient | ||||||
8 | unreasonably fails or refuses to provide the hospital with | ||||||
9 | information or documentation requested under subsection (b) or | ||||||
10 | to apply for coverage under public programs when requested | ||||||
11 | under subsection (a) within 30 days of the hospital's request. | ||||||
12 | (d) In order for a hospital to determine the 12 month | ||||||
13 | maximum amount that can be collected from a patient deemed | ||||||
14 | eligible under Section 10, an uninsured patient shall inform | ||||||
15 | the hospital in subsequent inpatient admissions or outpatient | ||||||
16 | encounters that the patient has previously received health | ||||||
17 | care services from that hospital and was determined to be | ||||||
18 | entitled to the uninsured discount. | ||||||
19 | (e) Hospitals may require patients to certify that all of | ||||||
20 | the information provided in the application is true. The | ||||||
21 | application may state that if any of the information is | ||||||
22 | untrue, any discount granted to the patient is forfeited and | ||||||
23 | the patient is responsible for payment of the hospital's full | ||||||
24 | charges. | ||||||
25 | (f) Hospitals shall ask for an applicant's race, | ||||||
26 | ethnicity, sex, and preferred language on the financial |
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1 | assistance application. However, the questions shall be | ||||||
2 | clearly marked as optional responses for the patient and shall | ||||||
3 | note that responses or nonresponses by the patient will not | ||||||
4 | have any impact on the outcome of the application.
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5 | (Source: P.A. 102-581, eff. 1-1-22 .) | ||||||
6 | Section 10. The Illinois Public Aid Code is amended by | ||||||
7 | changing Section 1-7 as follows:
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8 | (305 ILCS 5/1-7) (from Ch. 23, par. 1-7)
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9 | Sec. 1-7.
(a) For purposes of determining eligibility for | ||||||
10 | assistance
under this Code, the Illinois Department, County | ||||||
11 | Departments, and local
governmental units shall exclude from | ||||||
12 | consideration restitution payments,
including all income and | ||||||
13 | resources derived therefrom, made to persons of
Japanese or | ||||||
14 | Aleutian ancestry pursuant to the federal Civil Liberties Act
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15 | of 1988 and the Aleutian and Pribilof Island Restitution Act, | ||||||
16 | P.L. 100-383.
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17 | (b) For purposes of any program or form of assistance | ||||||
18 | where a person's
income or assets are considered in | ||||||
19 | determining eligibility or level of
assistance, whether under | ||||||
20 | this Code or another authority, neither the State
of Illinois | ||||||
21 | nor any entity or person administering a program wholly or
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22 | partially financed by the State of Illinois or any of its | ||||||
23 | political
subdivisions shall include restitution payments, | ||||||
24 | including all income and
resources derived therefrom, made |
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1 | pursuant to the federal Civil Liberties
Act of 1988 and the | ||||||
2 | Aleutian and Pribilof Island Restitution Act, P.L.
100-383, in | ||||||
3 | the calculation of income or assets for determining | ||||||
4 | eligibility
or level of assistance.
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5 | (c) For purposes of determining eligibility for or the | ||||||
6 | amount of assistance
under this Code, except for the | ||||||
7 | determination of eligibility for payments or
programs under | ||||||
8 | the TANF employment, education, and training programs and the
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9 | Food Stamp
Employment and Training Program, the Illinois | ||||||
10 | Department, County Departments,
and local governmental units | ||||||
11 | shall exclude from consideration any financial
assistance | ||||||
12 | received under any student aid program administered by an | ||||||
13 | agency of
this State or the federal government, by a person who | ||||||
14 | is enrolled as a
full-time or part-time student of any public | ||||||
15 | or private university, college, or
community college in this | ||||||
16 | State.
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17 | (d) For purposes of determining eligibility for or the | ||||||
18 | amount of assistance under this Code, except for the | ||||||
19 | determination of eligibility for payments or programs under | ||||||
20 | the TANF employment, education, and training programs and the | ||||||
21 | SNAP Employment and Training Program, the Illinois Department, | ||||||
22 | County Departments, and local governmental units shall exclude | ||||||
23 | from consideration, for a period of 36 months, any financial | ||||||
24 | assistance, including wages, that is provided to a person who | ||||||
25 | is enrolled in a demonstration project that is not funded with | ||||||
26 | general revenue funds and that is intended as a bridge to |
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1 | self-sufficiency by offering (i) intensive workforce support | ||||||
2 | and training and (ii) support services for new and expectant | ||||||
3 | parents that are intended to foster multi-generational healthy | ||||||
4 | families as described in Section 12-4.51. | ||||||
5 | (e)(1) Notwithstanding any other provision of this Code, | ||||||
6 | and to the maximum extent permitted by federal law, for | ||||||
7 | purposes of determining eligibility and the amount of | ||||||
8 | assistance under this Code, the Illinois Department and local | ||||||
9 | governmental units shall exclude from consideration , for a | ||||||
10 | period of no more than 60 months, any financial assistance, | ||||||
11 | including wages, cash transfers , or gifts, that is provided to | ||||||
12 | a person through a guaranteed income program. As used in this | ||||||
13 | subsection, "guaranteed income program" means a publicly or | ||||||
14 | privately funded program that provides one-time or recurring | ||||||
15 | unconditional cash transfers or payments, or gifts to | ||||||
16 | individuals or households, for a defined number of months or | ||||||
17 | years for the purposes of reducing poverty, promoting economic | ||||||
18 | mobility, or increasing the financial stability of Illinois | ||||||
19 | residents. who is enrolled in a program or research project | ||||||
20 | that is not funded with general revenue funds and that is | ||||||
21 | intended to investigate the impacts of policies or programs | ||||||
22 | designed to reduce poverty, promote social mobility, or | ||||||
23 | increase financial stability for Illinois residents if there | ||||||
24 | is an explicit plan to collect data and evaluate the program or | ||||||
25 | initiative that is developed prior to participants in the | ||||||
26 | study being enrolled in the program and if a research team has |
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1 | been identified to oversee the evaluation. | ||||||
2 | (2) The Department shall choose State options and seek all | ||||||
3 | necessary federal approvals or waivers to implement this | ||||||
4 | subsection. | ||||||
5 | (Source: P.A. 100-806, eff. 1-1-19; 101-415, eff. 8-16-19.)
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6 | Section 99. Effective date. This Act takes effect January | ||||||
7 | 1, 2024.
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