Rep. Karen May

Filed: 3/1/2006

 

 


 

 


 
09400HB4999ham003 LRB094 15918 RCE 56923 a

1
AMENDMENT TO HOUSE BILL 4999

2     AMENDMENT NO. ______. Amend House Bill 4999 by replacing
3 everything after the enacting clause with the following:
 
4     "Section 1. Short title. This Act may be cited as the Fair
5 Patient Billing Act.
 
6     Section 5. Purpose; findings.
7     (a) The purpose of this Act is to advance the prompt and
8 accurate payment of health care services through fair and
9 reasonable billing and collection practices of hospitals.
10     (b) The General Assembly finds that:
11         (1) Medical debts are the cause of an increasing number
12     of bankruptcies in Illinois and are typically associated
13     with severe financial hardship incurred by bankrupt
14     persons and their families.
15         (2) Patients, hospitals, and government bodies alike
16     will benefit from clearly articulated standards regarding
17     fair billing and collection practices for all Illinois
18     hospitals.
19         (3) Hospitals should employ responsible standards when
20     collecting debt from their patients.
21         (4) Patients should be provided sufficient billing
22     information from hospitals to determine the accuracy of the
23     bills for which they may be financially responsible.
24         (5) Patients should be given a fair and reasonable

 

 

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1     opportunity to discuss and assess the accuracy of their
2     bill.
3         (6) Patients should be provided information regarding
4     the hospital's policies regarding financial assistance
5     options the hospital may offer to qualified patients.
6         (7) Hospitals should offer patients the opportunity to
7     enter into a reasonable payment plan for their hospital
8     care.
9         (8) Patients have an obligation to pay for the hospital
10     services they receive.
 
11     Section 10. Definitions. As used in this Act:
12      "Collection action" means any referral of a bill to a
13 collection agency or law firm to collect payment for services
14 from a patient or a patient's guarantor for hospital services.
15     "Health care plan" means a health insurance company, health
16 maintenance organization, preferred provider arrangement, or
17 third party administrator authorized in this State to issue
18 policies or subscriber contracts or administer those policies
19 and contracts that reimburse for inpatient and outpatient
20 services provided in a hospital. Health care plan, however,
21 does not include any government-funded program such as Medicare
22 or Medicaid, workers' compensation, and accident liability
23 insurers.
24     "Insured patient" means a patient who is insured by a
25 health care plan.
26     "Patient" means the individual receiving services from the
27 hospital and any individual who is the guarantor of the payment
28 for such services.
29     "Reasonable payment plan" means a plan to pay a hospital
30 bill that is offered to the patient or the patient's legal
31 representative and takes into account the patient's available
32 income and assets, the amount owed, and any prior payments.
33     "Uninsured patient" means a patient who is not insured by a

 

 

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1 health care plan and is not a beneficiary under a
2 government-funded program, workers' compensation, or accident
3 liability insurance.
 
4     Section 15. Patient notification.
5     (a) Each hospital shall post a sign with the following
6 notice:
7          "You may be eligible for financial assistance under
8     the terms and conditions the hospital offers to qualified
9     patients. For more information contact [hospital financial
10     assistance representative]".
11     (b) The sign under subsection (a) shall be posted
12 conspicuously in the admission and registration areas of the
13 hospital.
14     (c) The sign shall be in English, and in any other language
15 that is the primary language of at least 5% of the patients
16 served by the hospital annually.
17     (d) Each hospital that has a website must post a notice in
18 a prominent place on its website that financial assistance is
19 available at the hospital, a description of the financial
20 assistance application process, and a copy of the financial
21 assistance application.
22     (e) Each hospital must make available information
23 regarding financial assistance from the hospital in the form of
24 either a brochure, an application for financial assistance, or
25 other written material in the hospital admission or
26 registration area.
 
27     Section 20. Bill information. If a hospital bills a patient
28 for health care services, the hospital shall provide with its
29 bill the following information:
30         (1) the date or dates that health care services were
31     provided to the patient;
32         (2) a brief description of the hospital services;

 

 

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1         (3) the amount owed for hospital services;
2         (4) hospital contact information for addressing
3     billing inquiries;
4         (5) a statement regarding how an uninsured patient may
5     apply for consideration under the hospital's financial
6     assistance policy on or with each hospital bill sent to an
7     uninsured patient; and
8         (6) notice that the patient may obtain an itemized bill
9     upon request.
10     If a hospital bills a patient, then the hospital must
11 provide an itemized statement of charges for the inpatient and
12 outpatient services rendered by the hospital upon receiving a
13 request from the patient.
 
14     Section 25. Bill inquiries.
15     (a) A hospital must implement a process for patients to
16 inquire about or dispute a bill. Such process must include a
17 telephone number for billing inquiries and disputes and may
18 include any of the following options:
19         (1) a toll-free telephone number that the patient may
20     call;
21         (2) an address to which he or she may write;
22         (3) a department or identified individual within the
23     hospital he or she may call or write, with appropriate
24     contact information; or
25         (4) a website or e-mail address.
26     (b) All hospital bills and collection notices must provide
27 a telephone number allowing the patient to inquire about or
28 dispute a bill.
29     (c) The hospital must return calls made by patients as
30 promptly as possible, but no later than 2 business days after
31 the call is made. If the hospital's billing inquiry process
32 involves correspondence from the patient, the hospital must
33 respond within 10 business days of receipt of the patient

 

 

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1 correspondence. For purposes of this Section, "business day"
2 means a day on which the hospital's billing office is open for
3 regular business.
 
4     Section 30. Pursuing collection action.
5     (a) Hospitals and their agents may pursue collection action
6 against an uninsured patient only if the following conditions
7 are met:
8         (1) The hospital has given the uninsured patient the
9     opportunity to:
10             (A) assess the accuracy of the bill;
11             (B) apply for financial assistance under the
12         hospital's financial assistance policy; and
13             (C) avail themselves of a reasonable payment plan.
14         (2) If the uninsured patient has indicated an inability
15     to pay the full amount of the debt in one payment, the
16     hospital has offered the patient a reasonable payment plan.
17     The hospital may require the uninsured patient to provide
18     reasonable verification of his or her inability to pay the
19     full amount of the debt in one payment.
20         (3) To the extent the hospital provides financial
21     assistance and the circumstances of the uninsured patient
22     suggest the potential for eligibility for charity care, the
23     uninsured patient has been given at least 60 days following
24     the date of discharge or receipt of outpatient care to
25     submit an application for financial assistance.
26         (4) If the uninsured patient has agreed to a reasonable
27     payment plan with the hospital, and the patient has failed
28     to make payments in accordance with that reasonable payment
29     plan.
30         (5) If the uninsured patient informs the hospital that
31     he or she has applied for health care coverage under
32     Medicaid, Kidcare, or other government-sponsored health
33     care program (and there is a reasonable basis to believe

 

 

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1     that the patient will qualify for such program) but the
2     patient's application is denied.
3     (b) A hospital may not refer a bill, or portion thereof, to
4 a collection agency or attorney for collection action against
5 the insured patient, without first offering the patient the
6 opportunity to request a reasonable payment plan for the amount
7 personally owed by the patient. Such an opportunity shall be
8 made available for the 30 days following the date of the
9 initial bill. If the insured patient requests a reasonable
10 payment plan, but fails to agree to a plan within 30 days of
11 the request, the hospital may proceed with collection action
12 against the patient.
13     (c) No collection agency, law firm, or individual may
14 initiate legal action for non-payment of a hospital bill
15 against a patient without the written approval of an authorized
16 hospital employee who reasonably believes that the conditions
17 for pursuing collection action under this Section have been
18 met.
19     (d) Nothing in this Section prohibits a hospital from
20 engaging an outside third party agency, firm, or individual to
21 manage the process of implementing the hospital's financial
22 assistance and reasonable payment plan programs and policies so
23 long as such agency, firm, or individual is contractually bound
24 to comply with the terms of this Act.
 
25     Section 35. Collection limitations. The hospital shall not
26 pursue legal action for non-payment of a hospital bill against
27 uninsured patients who have clearly demonstrated that they have
28 neither sufficient income nor assets to meet their financial
29 obligations provided the patient has complied with Section 45
30 of this Act.
 
31     Section 40. Hospital agents. The hospital must ensure that
32 any external collection agency, law firm, or individual engaged

 

 

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1 by the hospital to obtain payment of outstanding bills for
2 hospital services agrees in writing to comply with the
3 collections provisions of this Act.
 
4     Section 45. Patient responsibilities.
5     (a) To receive the protection and benefits of this Act, a
6 patient responsible for paying a hospital bill must act
7 reasonably and cooperate in good faith with the hospital by
8 providing the hospital with all of the reasonably requested
9 financial and other relevant information and documentation
10 needed to determine the patient's eligibility under the
11 hospital's financial assistance policy and reasonable payment
12 plan options to qualified patients within 30 days of a request
13 for such information.
14     (b) To receive the protection and benefits of this Act, a
15 patient responsible for paying a hospital bill shall
16 communicate to the hospital any material change in the
17 patient's financial situation that may affect the patient's
18 ability to abide by the provisions of an agreed upon reasonable
19 payment plan or qualification for financial assistance within
20 30 days of the change.
 
21     Section 50. Notification concerning out-of-network
22 providers. During the admission or as soon as practicable
23 thereafter, the hospital must provide an insured patient with
24 written notice that:
25         (1) the patient may receive separate bills for services
26     provided by health care professionals affiliated with the
27     hospital;
28         (2) if applicable, some hospital staff members may not
29     be participating providers in the same insurance plans and
30     networks as the hospital;
31         (3) if applicable, the patient may have a greater
32     financial responsibility for services provided by health

 

 

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1     care professionals at the hospital who are not under
2     contract with the patient's health care plan; and
3         (4) questions about coverage or benefit levels should
4     be directed to the patient's health care plan and the
5     patient's certificate of coverage.
 
6     Section 55. Enforcement.
7     (a) The Attorney General is responsible for administering
8 and ensuring compliance with this Act, including the
9 development of any rules necessary for the implementation and
10 enforcement of this Act.
11     (b) The Attorney General shall develop and implement a
12 process for receiving and handling complaints from individuals
13 or hospitals regarding possible violations of this Act.
14     (c) The Attorney General may conduct any investigation
15 deemed necessary regarding possible violations of this Act by
16 any hospital including, without limitation, the issuance of
17 subpoenas to: (i) require the hospital to file a statement or
18 report or answer interrogatories in writing as to all
19 information relevant to the alleged violations; (ii) examine
20 under oath any person who possesses knowledge or information
21 directly related to the alleged violations; and (iii) examine
22 any record, book, document, account, or paper necessary to
23 investigate the alleged violation.
24     (d) If the Attorney General determines that there is a
25 reason to believe that any hospital has violated the Act, the
26 Attorney General may bring an action in the name of the People
27 of the State against the hospital to obtain temporary,
28 preliminary, or permanent injunctive relief for any act,
29 policy, or practice by the hospital that violates this Act.
30 Before bringing such an action, the Attorney General may permit
31 the hospital to submit a Correction Plan for the Attorney
32 General's approval.
33     (e) This Section applies if:

 

 

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1         (i) a court orders a party to make payments to the
2     Attorney General and the payments are to be used for the
3     operations of the Office of the Attorney General; or
4         (ii) a party agrees in a Correction Plan under this
5     Act, to make payments to the Attorney General for the
6     operations of the Office of the Attorney General.
7     (f) Moneys paid under any of the conditions described in
8 (e) shall be deposited into the Attorney General court ordered
9 and Voluntary Compliance Payment Projects Fund. Moneys in the
10 Fund shall be used, subject to appropriation, for the
11 performance of any function pertaining to the exercise of the
12 duties to the Attorney General including, but not limited to,
13 enforcement of any law of this State and conducting public
14 education programs; however, any moneys in the Fund that are
15 required by the court to be used for a particular purpose shall
16 be used for that purpose.
17     (g) The Attorney General may seek the assessment of one or
18 more of the following civil monetary penalties in any action
19 filed under this Act where the hospital knowingly violates the
20 Act:
21         (1) For violations, involving a pattern or practice, of
22     not providing the information to patients under Sections
23     15, 20, 25, and 50, the civil monetary penalty shall not
24     exceed $500 per violation.
25         (2) For violations involving the failure to engage in
26     or refrain from certain activities under Sections 30, 35
27     and 40, the civil monetary penalty shall not exceed $1000
28     per violation.
29     (h) In the event a court grants a final order of relief
30 against any hospital for a violation of this Act, the Attorney
31 General may, after all appeal rights have been exhausted, refer
32 the hospital to the Illinois Department of Public Health for
33 possible adverse licensure action under the Hospital Licensing
34 Act.
 

 

 

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1     Section 60. Limitations. Nothing in this Act shall be used
2 by any private or public payer as a basis for reducing the
3 third-party payer's rates, policies, or usual and customary
4 charges for any health care service. Nothing in this Act shall
5 be construed as imposing an obligation on a hospital to provide
6 any particular service or treatment to an uninsured patient.
7 Nothing in this Act shall be construed as imposing an
8 obligation on a hospital to file a lawsuit to collect payment
9 on a patient's bill. This Act establishes new and additional
10 legal obligations for all hospitals in the State of Illinois.
11 Nothing in this Act shall be construed as relieving or reducing
12 any hospital of any other obligation under the Illinois
13 Constitution or under any other statute or the common law
14 including, without limitation, obligations of hospitals to
15 furnish financial assistance or community benefits. No
16 provision of this Act shall derogate from the common law or
17 statutory authority of the Attorney General, nor shall any
18 provision be construed as a limitation on the common law or
19 statutory authority of the Attorney General to investigate
20 hospitals or initiate enforcement actions against them
21 including, without limitation, the authority to investigate at
22 any time charitable trusts for the purpose of determining and
23 ascertaining whether they are being administered in accordance
24 with Illinois law and with the terms purposes thereof.
 
25     Section 70. Application.
26     (a) This Act applies to all hospitals licensed under the
27 Hospital Licensing Act or the University of Illinois Hospital
28 Act. This Act does not apply to a hospital that does not charge
29 for its services.
30     (b) The obligations of hospitals under this Act shall take
31 effect for services provided on or after the first day of the
32 month that begins 180 days after the effective date of this

 

 

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1 Act.
 
2     Section 75. Home rule. A home rule unit may not regulate
3 hospitals in a manner inconsistent with the provisions of this
4 Act. This Section is a limitation under subsection (i) of
5 Section 6 of the Article VII of the Illinois Constitution on
6 the concurrent exercise by home rule units of powers and
7 functions exercised by the State.
 
8     Section 80. Administrative Procedure Act. The Illinois
9 Administrative Procedure Act applies to all rules promulgated
10 by the Attorney General under the Act.
 
11     Section 999. Effective date. This Act takes effect January
12 1, 2007.".