Full Text of SB1881 97th General Assembly
SB1881sam002 97TH GENERAL ASSEMBLY | Sen. Iris Y. Martinez Filed: 3/27/2012
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| 1 | | AMENDMENT TO SENATE BILL 1881
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1881, AS AMENDED, | 3 | | by replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 1. Short title. This Act may be cited as the | 6 | | Hospital Fair Care Act. | 7 | | Section 5. Purpose. The purpose of this Act is to improve | 8 | | access to basic, affordable health care services for all | 9 | | Illinois residents, especially poor and low-income uninsured | 10 | | residents, through the regulation of non-profit hospitals, | 11 | | which play an important role in the health care safety-net. | 12 | | Access to necessary, quality health services is vital to the | 13 | | health, safety, and welfare of all individuals living in this | 14 | | State and should not be based upon one's ability to pay. | 15 | | Section 10. Findings. The General Assembly finds the |
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| 1 | | following: | 2 | | (1) Rising health care costs have pushed private health | 3 | | insurance beyond financial
reach for many poor and low-income | 4 | | working families, thereby increasing the number of the | 5 | | uninsured. Since 1999, average health insurance premiums for | 6 | | family coverage have increased 119% according to the 2008 | 7 | | Kaiser Family Foundation's Employer Health Benefits Survey. | 8 | | (2) According to 2009 Kaiser Family Foundation State Health | 9 | | data, 1.74 million individuals living in Illinois are | 10 | | uninsured. While the majority of the uninsured are working, | 11 | | many do not earn enough to afford private health coverage. | 12 | | Fully 35% of the uninsured living in this State earn just | 13 | | $25,000 a year or less according to the 2009 Gilead report on | 14 | | Illinois' uninsured. | 15 | | (3) Minorities in particular have been disproportionately | 16 | | affected by rising health
care costs. The Gilead study reports | 17 | | that the majority of the uninsured in this State are | 18 | | minorities; 27% are Latino, 20% are African-American, 4% are | 19 | | "other or multiethnic", and 49% are white. | 20 | | (4) When the uninsured are struck by serious illness or | 21 | | injury, financial devastation
is common as medical bills mount. | 22 | | The Kaiser Family Foundation reports that nearly half (46%) of | 23 | | low-income families (those making $30,000 or less a year) | 24 | | experience problems paying medical bills. In 2007, | 25 | | overwhelming medical bills forced an estimated 20,349 Illinois | 26 | | residents to file for bankruptcy. The Hospital Uninsured |
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| 1 | | Patient Discount Act is a step toward protecting uninsured | 2 | | residents from financial devastation, but it does not go far | 3 | | enough. | 4 | | (5) The federal Patient Protection and Affordable Care Act, | 5 | | along with the federal Health Care and Education Affordability | 6 | | Reconciliation Act of 2010, reform the health care system to | 7 | | improve coverage through the expansion of Medicaid and | 8 | | regulations placed on the health insurance industry. While an | 9 | | estimated 32 million residents will gain coverage across the | 10 | | country, it is predicted that over 700,000 Illinoisans will | 11 | | remain uninsured, and many more will be underinsured, relying | 12 | | on the health safety net for care. While federal health reform | 13 | | sets forth new requirements for non-profit hospitals, | 14 | | including the development and publication of financial | 15 | | assistance policies and the regulation of billing and | 16 | | collection procedures, it does not set a standard for charity | 17 | | care provision. | 18 | | (6) Hospital behavior toward the uninsured plays a direct | 19 | | role in access to health care
and health outcomes. Many studies | 20 | | have found that exorbitant hospital charges combined with | 21 | | aggressive billing and collection practices discourage | 22 | | low-income, uninsured individuals from seeking medical care | 23 | | when it is needed. Accordingly, the uninsured often wait and | 24 | | become increasingly ill before seeking medical care, which | 25 | | results in more expensive care. | 26 | | (7) The local health care safety-net includes many |
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| 1 | | different types of health care
delivery organizations that | 2 | | deliver health care services to State residents with barriers | 3 | | to accessing health care. Such barriers include, but are not | 4 | | limited to, lack of insurance, no or low income, and ethnic and | 5 | | cultural characteristics. | 6 | | (8) This Act focuses on the role of non-profit hospitals in | 7 | | providing affordable, necessary medical care to poor and | 8 | | low-income uninsured Illinois residents because hospitals are | 9 | | typically where people go when they experience a traumatic | 10 | | injury or illness. | 11 | | (9) In March 2010, the Illinois Supreme Court ruled in | 12 | | Provena Covenant Medical Center v. Department of Revenue that | 13 | | non-profit hospitals must provide "charity care", defined as | 14 | | free or discounted care, in order to receive State property tax | 15 | | exemptions and that the "community benefits" standard is not | 16 | | the applicable test. The Court stated that the charitable | 17 | | activities of a non-profit hospital must reduce the burdens of | 18 | | local government for local property tax purposes. The Court did | 19 | | not set a standard for how much charity care a non-profit | 20 | | hospital must provide in exchange for local property tax | 21 | | exemption. Such standard is evaluated on a case-by-case basis, | 22 | | applying the 1968 Methodist Old Peoples Home v. Korzen factors. | 23 | | (10) This Act holds non-profit hospitals accountable for | 24 | | the property tax exemptions they receive by ensuring the | 25 | | provision of charity care and fairly distributing the burden of | 26 | | uninsured patient care among all non-profit hospitals in this |
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| 1 | | State. | 2 | | (11) While public hospitals are intended to play a far | 3 | | greater role than private
hospitals in caring for the | 4 | | uninsured, private hospitals are expected to play a vital role. | 5 | | However, numerous reports have concluded that many private | 6 | | hospitals do not do a good job of providing hospital care that | 7 | | is affordable to poor and low-income uninsured individuals, | 8 | | thereby effectively acting as a barrier to medical treatment | 9 | | when it is needed. | 10 | | (12) Access to affordable quality health care, hospital | 11 | | care in particular, and ensuring that all State residents, | 12 | | rather than just those with the ability to pay, get the | 13 | | appropriate medical care when it is necessary are in the public | 14 | | interest of this State. This Act seeks to provide a regulatory | 15 | | framework to protect access to care for the most vulnerable | 16 | | State residents by encouraging private non-profit general | 17 | | hospitals to provide affordable health care services to this | 18 | | population and discouraging hospital behavior that acts as an | 19 | | effective barrier to access to care. In addition, this Act will | 20 | | assist the State with its cost of caring for low-income, | 21 | | uninsured residents for whom private general hospitals either | 22 | | cannot or will not provide care.
| 23 | | Section 15. Definitions.
In this Act: | 24 | | "Bad debt" means an account receivable for services | 25 | | furnished to an individual that: (i) is regarded as |
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| 1 | | uncollectible following reasonable collection action, (ii) is | 2 | | charged as a credit loss, and (iii) is not the obligation of | 3 | | any federal, State, or local governmental unit. Bad debt does | 4 | | not constitute financial assistance, that is, charity care, as | 5 | | defined by the Illinois Supreme Court in Provena Covenant | 6 | | Medical Center v. Department of Revenue for tax purposes. | 7 | | "Charge" means the price set by a hospital for a specific | 8 | | service or supply provided by that hospital. | 9 | | "Charitable benefits" means medical services going | 10 | | directly to free or discounted services provided pursuant to a | 11 | | hospital's, hospital affiliate's, or hospitals system's | 12 | | financial assistance policy, measured at cost and subsidies | 13 | | (unreimbursed costs) attributable to the following: providing | 14 | | without charge, paying for, or subsidizing goods, activities, | 15 | | or services for the purpose of addressing the health of | 16 | | low-income individuals by providing financial support to | 17 | | community clinics or programs that serve low-income | 18 | | individuals; paying or subsidizing health care professionals | 19 | | who care for low-income individuals at free or discounted | 20 | | rates, including care provided as follow-up to emergency room | 21 | | visits; providing or subsidizing outreach services to | 22 | | low-income individuals for disease management and prevention; | 23 | | providing free or subsidized goods, supplies, or services | 24 | | needed by low-income individuals because of their diagnosed | 25 | | medical condition; and providing prenatal childbirth outreach | 26 | | to at-risk and low-income persons. |
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| 1 | | "Collection action" means any activity by which a hospital, | 2 | | a designated agent, or an assignee of a hospital or a purchaser | 3 | | of a patient account receivable requests payment for services | 4 | | from a patient or a patient's family. "Collection action" | 5 | | include, without limitation, pre-admission or pre-treatment | 6 | | deposits, billing statements, letters, electronic mail, | 7 | | telephone, and personal contacts related to hospital bills, | 8 | | court summonses and complaints, and any other activity related | 9 | | to collecting a hospital bill. | 10 | | "Cost" means the actual expense a hospital incurs to | 11 | | provide each service or supply. | 12 | | "Effective date of eligibility" means the later of the date | 13 | | on which medical services are rendered or the date of discharge | 14 | | from a hospital. | 15 | | "Eligible individual" means an individual (i) who does not | 16 | | have public or private health insurance and whose family income | 17 | | is at or below 400% of the federal poverty guidelines or (ii) | 18 | | who has an insurance plan but the total out-of-pocket hospital | 19 | | charges exceed 10% of the patient's family income in a 12-month | 20 | | period. | 21 | | "Family" means, for an individual 18 years of age and | 22 | | older, the individual's spouse or domestic partner and | 23 | | dependent children under age 21, whether living at home or not. | 24 | | For an individual under 18 years of age, "family" means parents | 25 | | or caretaker relatives. | 26 | | "Federal poverty guidelines" means the poverty guidelines |
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| 1 | | updated periodically in the Federal Register by the United | 2 | | States Department of Health and Human Services under authority | 3 | | of 42 U.S.C. 9902(2). | 4 | | "Financial assistance" includes "charity care", as defined | 5 | | by the Illinois Supreme Court's decision in Provena Covenant | 6 | | Medical Center v. Illinois Department of Revenue and means | 7 | | inpatient or outpatient medical services provided | 8 | | free-of-charge or at reduced charges to an eligible individual, | 9 | | and must be rendered with no expectation of payment from the | 10 | | patient or such patient's family. Financial assistance shall be | 11 | | measured at the cost of the medical services provided based on | 12 | | the total cost-to-charge ratio derived from the hospital's | 13 | | Medicare Cost Report (CMS 2552-96 Worksheet C, Part 1 PPS | 14 | | Inpatient Ratios). Financial assistance shall not be recorded | 15 | | as revenue, an account receivable or bad debt. Financial | 16 | | assistance shall include only full financial assistance and | 17 | | partial financial assistance as defined in this Act. | 18 | | "General hospital" means any institution required to be | 19 | | licensed by this State pursuant to the Hospital Licensing Act | 20 | | or the University of Illinois Licensing Act and holds a General | 21 | | license pursuant to Title 77, paragraph (1) subsection (g) of | 22 | | Section 250.120 of the Illinois Administrative Code. "General | 23 | | hospital" does not include hospitals that hold a specialized | 24 | | license. | 25 | | "Non-profit hospital" means any general hospital that | 26 | | receives a State income, sales, and property tax exemption |
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| 1 | | through the Illinois Department of Revenue for being | 2 | | charitable. | 3 | | "Income" means a family's annual gross earnings and cash | 4 | | benefits from all sources before taxes, less payments for child | 5 | | support. | 6 | | "Medical services" means services, whether inpatient or | 7 | | outpatient services, or supplies that are reasonably expected | 8 | | to prevent, diagnose, prevent the worsening of, alleviate, | 9 | | correct, or cure a condition that endangers life, causes | 10 | | suffering or pain, causes physical deformity or malfunction, | 11 | | threatens to cause or aggravate a handicap, or results in | 12 | | illness or infirmity. "Medical services" includes any | 13 | | inpatient or outpatient hospital services mandated under Title | 14 | | XIX of the federal Social Security Act and emergency care | 15 | | mandates. "Medical services" also includes plastic surgery | 16 | | designed to correct disfigurement caused by injury, illness, or | 17 | | congenital defect or deformity. "Medical services" includes | 18 | | only services deemed medically necessary. | 19 | | "Non-safety-net hospital" means any freestanding general | 20 | | hospital that did not qualify for Medicaid Disproportionate | 21 | | Share Hospital (DSH) payment adjustments, pursuant to Title 89, | 22 | | Section 148.120(a) of the Illinois Administrative Code, for the | 23 | | most recent year that such payments were made. | 24 | | "Operating margin" means the ratio of operating income to | 25 | | operating revenues as each are reported in a hospital's audited | 26 | | financial statements. The operating margin shall be measured on |
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| 1 | | a separate hospital basis rather than a system-wide or hospital | 2 | | network basis. | 3 | | "Safety-net hospital" means a freestanding general | 4 | | hospital that qualified for Medicaid Disproportionate Share | 5 | | Hospital (DSH) payment adjustments, pursuant to Title 89, | 6 | | Section 148.120(a) of the Illinois Administrative Code, for the | 7 | | most recent year that such payments were made. | 8 | | "Subsidies" means unreimbursed costs attributable to the | 9 | | following: providing without charge, paying for, or | 10 | | subsidizing goods, activities, or services for the purpose of | 11 | | addressing the health of low-income individuals by providing | 12 | | financial support to community clinics or programs that serve | 13 | | low-income individuals; paying or subsidizing health care | 14 | | professionals who care for low-income individuals at free or | 15 | | discounted rates, including care provided as follow-up to | 16 | | emergency room visits; providing or subsidizing outreach | 17 | | services to low-income individuals for disease management and | 18 | | prevention; providing free or subsidized goods, supplies, or | 19 | | services needed by low-income individuals because of their | 20 | | diagnosed medical condition; and providing prenatal childbirth | 21 | | outreach to at-risk and low-income persons. | 22 | | Section 20. Financial assistance requirements. | 23 | | (a)
Each general hospital operating in this State must | 24 | | provide financial assistance in accordance with Section 25 to | 25 | | eligible individuals on a yearly basis in a total amount at |
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| 1 | | least equal to the thresholds set in this Act. | 2 | | (b) Financial assistance and eligibility are defined as | 3 | | follows: | 4 | | (1) For the purpose of this Section, "full financial | 5 | | assistance" means the provision of medical services
| 6 | | provided to an eligible individual free-of-charge to the | 7 | | individual. At a
minimum, a general hospital must provide | 8 | | full financial assistance to an eligible individual who | 9 | | applies for financial assistance and whose annual income is | 10 | | equal to or less than 200% of the federal poverty | 11 | | guidelines. A general hospital must not take
any collection | 12 | | action, including but not limited to, the issuance of a | 13 | | bill or invoice, against any individual or such | 14 | | individual's family who has applied, and qualifies for full | 15 | | financial assistance under this Act with respect to the | 16 | | medical services for which the individual receives | 17 | | financial assistance. | 18 | | (2) for the purpose of this Section, "partial financial | 19 | | assistance" means the provision of medical services
| 20 | | provided to an eligible individual at partially discounted | 21 | | charges, which shall not exceed 25% of the individual's | 22 | | income. A general hospital must limit any bill or invoice | 23 | | sent to an eligible individual or the individual's family | 24 | | who applies and qualifies for financial assistance to the | 25 | | following amounts: | 26 | | (A) At a
minimum, for an eligible individual whose |
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| 1 | | annual income is more than 200% of the federal poverty | 2 | | guidelines but equal to or less than 300% of the | 3 | | federal poverty guidelines, the amount billed to such | 4 | | individual or such individual's family shall not | 5 | | exceed the lesser of 20% of the general hospital's cost | 6 | | of providing the medical services or 25% of the | 7 | | individual's income. At a minimum, for an eligible | 8 | | individual whose annual income is more than 300% of the | 9 | | federal poverty guidelines but equal to or less than | 10 | | 400% of the federal poverty guidelines, the amount | 11 | | billed to such individual or such individual's family | 12 | | shall not exceed the lesser of 30% of the general | 13 | | hospital's cost of providing the medical services or | 14 | | 25% of the individual's income. | 15 | | (B) If an individual applies and qualifies for | 16 | | partial
financial assistance but indicates an | 17 | | inability to pay the full amount of a bill or invoice | 18 | | for such financial assistance in one payment, a general | 19 | | hospital must offer such individual or his or her | 20 | | family a reasonable payment plan without interest. The | 21 | | hospital may require such individual or his or her | 22 | | family to provide reasonable verification of his or her | 23 | | inability to pay the full amount of the bill or invoice | 24 | | in one payment. | 25 | | (3) This Section is not intended to interfere or | 26 | | conflict with any duty established by the Hospital |
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| 1 | | Uninsured Patient Discount Act upon hospitals to provide | 2 | | discounts to uninsured patients. | 3 | | (c) Non-profit general hospitals must provide charitable | 4 | | benefits, as defined in Section 15 of this Act,
for hospital | 5 | | fiscal year
2012 and beyond at a threshold level equal to at | 6 | | least 6% of
the hospital's total revenue. At least 5% must go | 7 | | to medical services as defined in Section 15 of this Act and 1% | 8 | | may go to subsidies as defined in Section 15 of this Act. | 9 | | Working with representatives of hospitals and of patients | 10 | | in need of charitable benefits, the Department of Revenue shall | 11 | | develop a standard application for free or discounted medical | 12 | | services and a system of presumptive eligibility for use by all | 13 | | non-profit hospitals. The Department of Revenue shall adopt the | 14 | | standard application and system of presumptive eligibility by | 15 | | rule issued no later than 120 days after the effective date of | 16 | | this Act. | 17 | | (d) Application procedures for financial assistance are as | 18 | | follows: | 19 | | (1) Screening requirements are as follows: | 20 | | (A) General hospitals must
screen each individual, | 21 | | on or prior to the effective date of eligibility, to | 22 | | determine whether such individual is uninsured. If an | 23 | | individual is determined to be uninsured, he or she, or | 24 | | the individual's representative, shall be provided an | 25 | | application for financial assistance no later than the | 26 | | effective date of eligibility. |
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| 1 | | (B) Individuals who believe they are underinsured | 2 | | will be expected to self-identify to the financial | 3 | | assistance staff at the hospitals to determine | 4 | | eligibility for charity care. | 5 | | (C) General hospitals must refrain from issuing | 6 | | any bill or
invoice to an individual who is uninsured, | 7 | | or his or her family, until at least 90 days after the | 8 | | effective date of eligibility and, if the individual | 9 | | files a financial assistance application before the | 10 | | end of the 90-day period, must further refrain from | 11 | | issuing any bill or invoice until the hospital | 12 | | determines the individual's eligibility for financial | 13 | | assistance pursuant to this Act. | 14 | | (2) An individual or individual's representative
may | 15 | | submit a financial assistance application to a general | 16 | | hospital within 90 days after the effective date of | 17 | | eligibility. | 18 | | (3) Each general hospital
must deliver written notice | 19 | | of a financial assistance determination to an individual or | 20 | | such individual's representative who has applied for | 21 | | financial assistance within 14 days after receipt of a | 22 | | completed financial assistance application. A general | 23 | | hospital must not deny or delay an individual's medical | 24 | | care while his or her application for financial assistance | 25 | | is pending. | 26 | | (4) Until a standard application and presumptive |
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| 1 | | eligibility system are adopted by rule by the Department of | 2 | | Revenue, general hospitals may use their own financial
| 3 | | assistance application forms to determine eligibility for | 4 | | financial assistance in compliance with this Act. The | 5 | | application form must state eligibility criteria for full | 6 | | and partial financial assistance as set forth in this | 7 | | Section. The application form must be easy to understand | 8 | | and must request only information that is reasonably | 9 | | necessary to determine eligibility. | 10 | | (5) Each general hospital must translate and
| 11 | | distribute its financial assistance application form in | 12 | | accordance with the Language Assistance Services Act and | 13 | | must also translate the application form into the | 14 | | non-English languages most frequently used in the service | 15 | | area of the hospital and make those translations of the | 16 | | form readily available. | 17 | | (e) General hospitals must provide
notification of the | 18 | | availability of financial assistance as follows: | 19 | | (1) Each general hospital must post signs in the | 20 | | inpatient, outpatient,
emergency, admissions, and | 21 | | registration areas of the facility and in the business | 22 | | office areas that are customarily used by patients that | 23 | | conspicuously inform patients of the availability of full | 24 | | and partial financial assistance, as defined in this Act, | 25 | | and the location within the hospital at which to apply for | 26 | | financial assistance. Signs must be in English and in the |
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| 1 | | languages other than English that are most frequently | 2 | | spoken in the hospital's service area as well as in the | 3 | | languages required under the Language Assistance Services | 4 | | Act. | 5 | | (2) Each general hospital must post a notice in a | 6 | | prominent place
on its website that financial assistance is | 7 | | available at the facility. The notice must include a brief | 8 | | description of the financial assistance application | 9 | | process, qualifications for financial assistance, and a | 10 | | copy of the application form. The notice must be in the | 11 | | same language as the signs that are required pursuant to | 12 | | this Section. | 13 | | (3) Each general hospital must provide individual | 14 | | notice,
in the appropriate language, of the availability of | 15 | | full or partial financial assistance, as defined in this | 16 | | Act, to any patient who is identified as uninsured. | 17 | | (4) Each general hospital must provide notice, or
| 18 | | ensure that notice is provided, of the availability of full | 19 | | or partial financial assistance in any patient bill, | 20 | | invoice, or collection action issued by the hospital or by | 21 | | a collection agent, assignee, or account purchaser the | 22 | | hospital retains or with which the hospital has contracted. | 23 | | (5) Each general hospital must, on a quarterly basis,
| 24 | | publish notice in a newspaper of general circulation in the | 25 | | hospital's service area indicating that financial | 26 | | assistance is available at the facility. The notice must |
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| 1 | | include a brief description of the financial assistance | 2 | | application process. Each general hospital must provide a | 3 | | similar notice to all community medical centers located in | 4 | | its service area. These notices must be provided in the | 5 | | same languages as the signs that are required in this | 6 | | Section. | 7 | | (f) Patient rights and responsibilities are as follows: | 8 | | (1) General hospitals must distribute to every | 9 | | patient, on or
before the effective date of eligibility, a | 10 | | written statement regarding financial assistance. This | 11 | | statement must include the following: | 12 | | (A) the availability of full or partial financial | 13 | | assistance as provided
in this Section; | 14 | | (B) a patient's right to apply for financial | 15 | | assistance within 90 days
after the effective date of | 16 | | eligibility; | 17 | | (C) a determination of eligibility for full or | 18 | | partial financial
assistance must be made, in writing, | 19 | | within 14 days after a completed application is made; | 20 | | and | 21 | | (D) a patient has the right to enter into a payment | 22 | | plan pursuant to
this Section if he or she is | 23 | | determined eligible for partial financial assistance. | 24 | | (2) If a patient qualifies for financial
assistance | 25 | | pursuant to this Act, then the general hospital shall | 26 | | provide the patient assistance in filling out the |
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| 1 | | application and determining what types of documentation | 2 | | are necessary. | 3 | | (3) Individuals applying for or receiving financial
| 4 | | assistance from any general hospital must do all of the | 5 | | following: | 6 | | (A) Cooperate with the hospital to provide the | 7 | | information and
documentation necessary to apply for | 8 | | other public or private existing programs or resources | 9 | | that may be available to pay for health care, | 10 | | including, without limitation, Medicare, Medicaid, or | 11 | | the Children's Health Insurance Program. | 12 | | (B) Promptly provide the hospital with accurate | 13 | | and complete
documentation and information. | 14 | | (C) Promptly notify the hospital of any | 15 | | significant change in
financial status that is likely | 16 | | to adversely affect eligibility for financial | 17 | | assistance. | 18 | | (D) Upon qualifying for partial financial | 19 | | assistance, cooperate with the hospital to establish a | 20 | | reasonable payment plan that takes into account | 21 | | available income and assets, the amount of the | 22 | | discounted bill or bills, and any prior payments and | 23 | | must make a good faith effort to comply with this | 24 | | payment plan. The patient is responsible for promptly | 25 | | communicating to the hospital any change in financial | 26 | | situation that may impact his or her ability to pay the |
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| 1 | | discounted hospital bills or to honor the provisions of | 2 | | the payment plan.
| 3 | | Section 25. Fair Care fee. To ensure that low-income, | 4 | | uninsured individuals living in the State have access to basic, | 5 | | affordable health care and to fairly distribute the cost of | 6 | | caring for uninsured patients that other hospitals either | 7 | | cannot or will not care for, each hospital that does not meet | 8 | | the applicable threshold level of financial assistance set | 9 | | forth in Section 20 of this Act shall pay a fee to the State | 10 | | Fair Care Trust equal to the difference between the cost of the | 11 | | charitable benefits provided for the year and the applicable | 12 | | threshold for the year. The fee shall be calculated annually on | 13 | | a stand-alone hospital basis as follows: | 14 | | (1) For purposes of calculating the fee, the amount of | 15 | | a general hospital's total revenue shall be determined by | 16 | | the hospital's most recent audited financial statements. | 17 | | If a hospital is part of an affiliated or consolidated | 18 | | group that files audited financial statements on a group | 19 | | basis rather than individually, then the total expenses for | 20 | | the stand-alone hospital shall be determined from the | 21 | | consolidating statements in the affiliated or consolidated | 22 | | audited financial statements. | 23 | | (2) If the financial assistance provided by a hospital | 24 | | for the year in accordance with Section 20 of this Act as | 25 | | reported in the financial assistance statement required in |
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| 1 | | Section 20 is less than the threshold set forth in Section | 2 | | 20, a fee shall be paid to the State in an amount equal to | 3 | | the difference between the cost of the financial assistance | 4 | | provided and applicable threshold. Any fee due under this | 5 | | Act shall be paid to the State Treasurer within 90 days | 6 | | after receipt of notice of any fee due. | 7 | | (3) Non-profit general hospitals that cannot meet the | 8 | | threshold as defined in Section 20 due to financial | 9 | | hardship may apply for a hardship waiver from the | 10 | | Department of Revenue to determine an exemption from this | 11 | | requirement for a one-year period.
| 12 | | Section 30. Date of determination of any Fair Care fee. The | 13 | | Fair Care fee for a general hospital shall be calculated by the | 14 | | Department of Revenue no later than October 1st of each year, | 15 | | using the most recent audited financial statements of each | 16 | | hospital and the most recently filed hospital financial | 17 | | assistance statement, both of which are required to be filed | 18 | | with the State pursuant to Section 35 of this Act. The Fair | 19 | | Care fee shall be calculated annually for each non-profit | 20 | | general hospital located within the State. | 21 | | Section 35. Fair Care Trust Fund. | 22 | | (a) There is hereby created the Fair Care Trust Fund as a | 23 | | special fund in the State Treasury. All Fair Care Fees and | 24 | | penalties paid under this Act shall be deposited into the Fair |
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| 1 | | Care Trust Fund. Subject to appropriation, money in the Fair | 2 | | Care Trust Fund shall be expended exclusively for uncompensated | 3 | | indigent care to those non-profit general hospitals that exceed | 4 | | the required threshold as set forth in Section 20 of this Act. | 5 | | No Fair Care fees or penalties paid pursuant to this Act may be | 6 | | transferred to the General Revenue Fund. | 7 | | (b) Fair Care Trust Fund funds shall be distributed | 8 | | annually to the Illinois non-profit and public hospitals that | 9 | | exceed the 6% standard for charitable benefits, with the funds | 10 | | divided among such hospitals in proportion to the dollar amount | 11 | | of excess charitable benefits each hospital provided. | 12 | | Section 40. Charitable benefits reporting. Not later than | 13 | | March 31st of each calendar year, each general non-profit | 14 | | hospital operating in this State must submit the following to | 15 | | the State Attorney General: | 16 | | (1) Charitable benefits statement. A statement that | 17 | | identifies the dollar amount of charitable benefits, | 18 | | showing an aggregate amount for medical services and an | 19 | | aggregate amount for subsidies, as defined in Section 15 of | 20 | | this Act, furnished by the hospital in its most recently | 21 | | completed fiscal year for which the data is available, in | 22 | | accordance with this Act, to be reported at the actual cost | 23 | | of the services provided based on the total cost-to-charge | 24 | | ratio derived from the hospital's most recently settled | 25 | | Medicare Cost Report. If a hospital is required to file |
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| 1 | | Form AG-CBP-1, Annual Non Profit Hospital Community | 2 | | Benefits Plan Report with the Attorney General, then a copy | 3 | | of this form shall be sufficient as long as the financial | 4 | | assistance reported was provided in accordance with | 5 | | Section 20 of this Act. Alternatively, a hospital may also | 6 | | submit a copy of its profile compiled by the Department of | 7 | | Public Health based on that Department's Annual Hospital | 8 | | Questionnaire for purposes of reporting the amount of | 9 | | financial assistance provided for the most recent fiscal | 10 | | year as long as the assistance was provided in accordance | 11 | | with Section 20 of this Act.
| 12 | | (2) Most recent annual audited financial statements. | 13 | | The hospital's most recent
annual audited financial | 14 | | statements, including consolidating statements if the | 15 | | hospital is part of a group or network that files | 16 | | consolidated or affiliated financial statements. | 17 | | (3) Medicaid Disproportionate Share Hospital | 18 | | Statement. A statement identifying
whether the hospital | 19 | | received Medicaid Disproportionate Share Hospital Payments | 20 | | in the most recent year that such payments were made by the | 21 | | State. | 22 | | (4) Other necessary information. Hospitals must report | 23 | | any other information the
Attorney General deems necessary | 24 | | to ensure compliance with the provisions of this Act.
| 25 | | Section 45. Implementation and enforcement.
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| 1 | | (a) The Department of Revenue shall be responsible for | 2 | | calculating each general non-profit hospital's Fair Care fee | 3 | | due pursuant to Section 25 of this Act. The Department of | 4 | | Revenue has the authority to issue any rules necessary to carry | 5 | | out this Act.
| 6 | | (b) The Director of Revenue shall appoint a Fair Care | 7 | | Officer within the Department of Revenue. The Officer shall be | 8 | | responsible for ensuring that each general non-profit hospital | 9 | | in the State is in compliance with Section 20 of this Act. If | 10 | | the Officer determines a general non-profit hospital is not in | 11 | | compliance with any of the provisions of this Act, then the | 12 | | Officer shall notify the hospital of the assessment of the | 13 | | appropriate penalty or penalties provided for in Section 45 of | 14 | | this Act. The Fair Care Officer has the authority to adopt any | 15 | | rules necessary to carry out this Act. | 16 | | (c) Enforcement of the provisions of this Act shall occur | 17 | | as follows: | 18 | | (1) A general non-profit hospital that fails to post | 19 | | any notice or provide any notification required under this | 20 | | Act is subject to a civil penalty of $1,000 per day for | 21 | | each day the required notice is not posted or notification | 22 | | is not provided. | 23 | | (2) A general non-profit hospital that fails to provide | 24 | | information to the public as required under this Act is | 25 | | subject to a civil penalty of $1,000 per violation. | 26 | | (3) A general hospital that violates any provision of |
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| 1 | | this Act other
than the provisions of subsection (b) of | 2 | | Section 20 and Section 25 is subject to a civil penalty of | 3 | | $1,000 per violation. | 4 | | (4) All fees and penalties provided for in this Act | 5 | | shall constitute a
debt to the State. The State's Attorney | 6 | | is authorized to institute a civil suit in the name of the | 7 | | State to recover the amount of any such unpaid fee or | 8 | | penalty. | 9 | | (5) If a general non-profit hospital fails to provide | 10 | | the 6% in charitable benefits and fails to pay a Fair Care | 11 | | fee as required in Section 20, the State Department of | 12 | | Revenue shall revoke that hospital's tax-exempt status, | 13 | | including the State property, sales, and income tax | 14 | | exemptions.
| 15 | | Section 55. Renewal. This Act shall be reviewed and revised | 16 | | by July 1, 2019 after the full implementation of the Affordable | 17 | | Care Act.
| 18 | | Section 90. The State Finance Act is amended by adding | 19 | | Section 5.811 as follows: | 20 | | (30 ILCS 105/5.811 new) | 21 | | Sec. 5.811. The Fair Care Trust Fund. | 22 | | Section 99. Effective date. This Act takes effect January
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| 1 | | 1, 2013.".
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