HB4701 104TH GENERAL ASSEMBLY

LRB104 17497 BAB 30923 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4701

Introduced , by Rep. Tracy Katz Muhl

SYNOPSIS AS INTRODUCED:

New Act
210 ILCS 88/12
815 ILCS 505/2MMMM new

Creates the Limitations on Facility Fees Act. Provides that no health care provider shall charge, bill, or collect a facility fee, except for: (i) services provided on a hospital's campus; (ii) services provided at a facility that includes a licensed hospital emergency department; or (iii) emergency services provided at a freestanding emergency center. Provides that, except as specified, no health care provider shall charge, bill, or collect a facility fee for: (i) outpatient evaluation and management services; or (ii) any other outpatient, diagnostic, or imaging services identified by the Department of Public Health. Requires the Department to annually identify services subject to the limitations on specified facility fees that may reliably be provided safely and effectively in settings other than hospitals. Sets forth provisions concerning reporting, rulemaking, and enforcement of the Act. Amends the Fair Patient Billing Act to make a conforming change. Amends the Consumer Fraud and Deceptive Business Practices Act. Provides that any person who violates the Limitations on Facility Fees Act commits an unlawful practice.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Limitations on Facility Fees Act.

Section 5. Definitions. As used in this Act:

"Campus" means: (i) a hospital's main buildings; (ii) the physical area immediately adjacent to a hospital's main buildings and other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings; or (iii) any other area that has been determined on an individual case basis by the Centers for Medicare and Medicaid Services to be part of a hospital's campus.

"Department" means the Department of Public Health.

"Facility fee" means any fee charged or billed by a health care provider for outpatient services provided in a hospital-based facility or freestanding emergency center that is: (i) intended to compensate the health care provider for the operational expenses of the health care provider; (ii) separate and distinct from a professional fee; and (iii) regardless of the modality through which the health care services were provided.

"Freestanding emergency center" means a freestanding emergency center licensed under Section 32.5 of the Emergency Medical Services (EMS) Systems Act. "Freestanding emergency center" does not include an urgent care clinic.

"Health care provider" means an individual, entity, corporation, person, or organization, whether for profit or nonprofit, that furnishes, bills, or is paid for health care service delivery in the normal course of business, and includes, without limitation, health systems, hospitals, hospital-based facilities, freestanding emergency centers, and urgent care clinics.

"Health system" means: (i) a parent corporation of one or more hospitals and any entity affiliated with the parent corporation through ownership, governance, membership, or other means, or (ii) a hospital and any entity affiliated with the hospital through ownership, governance, membership, or other means.

"Hospital" means a hospital licensed under the Hospital Licensing Act.

"Hospital-based facility" means a facility that is owned or operated, in whole or in part, by a hospital where hospital or professional medical services are provided.

"Professional fee" means any fee charged or billed by a provider for professional medical services provided in a hospital-based facility.

Section 10. Limits on facility fees.

(a) Site-specific limits. No health care provider shall charge, bill, or collect a facility fee, except for: (i) services provided on a hospital's campus; (ii) services provided at a facility that includes a licensed hospital emergency department; or (iii) emergency services provided at a freestanding emergency center.

(b) Service-specific limits. Notwithstanding subsection (a) and whether or not the services are provided on a hospital's campus, no health care provider shall charge, bill, or collect a facility fee for: (i) outpatient evaluation and management services; or (ii) any other outpatient, diagnostic, or imaging services identified by the Department pursuant to subsection (c).

(c) Identification of services. The Department shall annually identify services subject to the limitations on facility fees provided in subsection (b) that may reliably be provided safely and effectively in settings other than hospitals.

Section 15. Reporting.

(a) Each hospital, health system, and freestanding emergency center shall submit a report annually to the Department concerning facility fees charged or billed during the preceding calendar year. The Department shall publish the information reported on a publicly accessible website designated by the Department.

(b) The report shall include, without limitation, the following information:

(1) the name and full address of each facility owned or operated by the hospital, health system, or freestanding emergency center that provides services for which a facility fee is charged or billed;

(2) the number of patient visits at each hospital-based facility or freestanding emergency center for which a facility fee was charged or billed;

(3) the number, total amount, and range of allowable facility fees paid at each facility by Medicare, Medicaid, and private insurance;

(4) for each hospital-based facility, and for the hospital or health system as a whole or freestanding emergency center, the total amount billed and the total revenue received from facility fees;

(5) the top 10 procedures or services, identified by current procedural terminology (CPT) category I codes, provided by the hospital, health system, or freestanding emergency center overall that generated the greatest amount of facility fee gross revenue, the volume each of these 10 procedures or services and gross and net revenue totals, for each of the procedures or services, and, for each of the procedures or services, the total net amount of revenue received by the hospital, health system, or freestanding emergency center derived from facility fees;

(6) the top 10 procedures or services, identified by current procedural terminology (CPT) category I codes, based on patient volume, provided by the hospital, health system, or freestanding emergency center overall for which facility fees are billed or charged based on patient volume, including the gross and net revenue totals received for each such procedure or service; and

(7) any other information related to facility fees that the Department may require.

(c) Until the expiration of 4 years after the furnishing of any services for which a facility fee was charged, billed, or collected, each health care provider shall make available, upon written request by the Department or its designee, copies of any books, documents, records, or data that are necessary for the purposes of completing the audit.

Section 20. Rulemaking. The Department may adopt rules necessary to implement the provisions of this Act, specify the format and content of reports, and impose penalties for noncompliance consistent with the Department's authority to regulate health care providers.

Section 25. Enforcement.

(a) Any violation of this Act shall be considered an unlawful practice within the meaning of the Consumer Fraud and Deceptive Business Practices Act.

(b) A health care provider that violates this Act or the rules adopted pursuant to this Act shall be subject to an administrative penalty of not more than $1,000 per occurrence.

(c) The Department or its designee may audit any health care provider for compliance with the requirements of this Act.

Section 30. The Fair Patient Billing Act is amended by changing Section 12 as follows:

(210 ILCS 88/12)

Sec. 12. Facility fee disclosure. Notwithstanding the provisions set forth in the Limitations on Facility Fees Act, if If a hospital charges a facility fee for outpatient services separate and distinct from a professional fee, then the hospital shall develop a policy to inform patients as soon as reasonably practicable that they may be subject to a facility fee. The policy shall include, but not be limited to, the method the facility will use to inform patients that they may be charged a facility fee; the services and operating expenses generally covered by facility fees; the reason for charging a facility fee on the patient or patient's health plan; and contact information to allow the patient to request more information.

(Source: P.A. 104-181, eff. 1-1-26.)

Section 35. The Consumer Fraud and Deceptive Business Practices Act is amended by adding Section 2MMMM as follows:

(815 ILCS 505/2MMMM new)

Sec. 2MMMM. Violations of the Limitations on Facility Fees Act. Any person who violates the Limitations on Facility Fees Act commits an unlawful practice within the meaning of this Act.