HB4645 EngrossedLRB102 24527 CPF 33761 b

1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the Equity
5and Representation in Health Care Act.
6    Section 5. Findings; purpose.
7    (a) The General Assembly finds that:
8        (1) Every Illinois resident deserves access to high
9    quality, affordable health care regardless of his or her
10    race, ethnicity, zip code, gender identification, or
11    sexual orientation. Moreover, Illinois residents deserve
12    support from a strong, diverse health care workforce that
13    reflects, represents, and understands the patients they
14    serve.
15        (2) Establishing and building trusted relationships
16    between patients and health care providers can lead to
17    more compassionate care and improved outcomes. This is
18    particularly important for communities of color and
19    populations that experience systemic racism and other
20    barriers to obtaining equitable high quality care that
21    improves health.
22        (3) A 2004 report from Johns Hopkins University and
23    the Commonwealth Fund focused on the disparities in



HB4645 Engrossed- 2 -LRB102 24527 CPF 33761 b

1    patient experience brought on by a lack of racial and
2    ethnic diversity among health care providers. From the
3    article:
4            "In what is called 'race-discordant'
5        relationships, patients from ethnic groups frequently
6        are treated by professionals from a different ethnic
7        background. The research reviewed here documents
8        ongoing racial and ethnic disparities in health care
9        and links patient–physician race and ethnic
10        concordance with higher patient satisfaction and
11        better health care processes. Based on this research,
12        the authors issue the following recommendation: ...
13        health policy should be revised to encourage workforce
14        diversity by funding programs that support the
15        recruitment of minority students and medical
16        faculty...".
17        (4) Another 2021 study by the National Center for
18    Biotechnology Information at the National Institutes of
19    Health analyzed minority representation across 10
20    different health care provider designations and found
21    significant underrepresentation among Black, Hispanic, and
22    Native American people across all 10 designations. This
23    study makes specific mention of the disproportionate
24    impact that the COVID-19 pandemic had on minority
25    communities and how greater diversity in our health care
26    workforce could lead to increased cultural competence and



HB4645 Engrossed- 3 -LRB102 24527 CPF 33761 b

1    improved health outcomes.
2        (5) These are just 2 studies among the countless that
3    make clear the importance of diversity in our health care
4    workforce. Illinois is no exception. More must be done to
5    increase the diversity and community representation of our
6    State's health care workforce in order to better meet the
7    needs of underrepresented communities. This Act is
8    intended to support workforce development programs
9    specifically aimed at this mission.
10    (b) The purpose of this Act is to recognize and address the
11historic and systemic barriers that have prevented
12proportional representation by race, ethnicity, language,
13gender, sexual orientation, gender identity, and disability
14status in the health care provider community and address
15access to care and health disparities by prioritizing
16scholarship and loan repayment programs to individuals from
17underrepresented communities pursuing health care careers.
18    These scholarship and loan repayment programs shall
19encourage health care providers to locate and practice in
20areas of greatest need, as determined by provider shortage
21area data or health disparity data, and to support efforts for
22health care providers to better reflect the communities they
24    Section 10. Definitions.
25    "Accredited school" means a college or university in which



HB4645 Engrossed- 4 -LRB102 24527 CPF 33761 b

1a degree in allopathic medicine, osteopathic medicine,
2dentistry, physical therapy, or an equivalent credential for a
3health program is earned and for which the Council for Higher
4Education Accreditation or its affiliates has determined that
5the school meets specific standards for its programs, faculty,
6and curriculum.
7    "Advanced practice registered nurse" or "APRN" means an
8advanced practice registered nurse as defined under Section
950-10 of the Nurse Practice Act.
10    "Allopathic medicine" means the use of pharmacological
11agents or physical interventions to treat or suppress symptoms
12or processes of diseases or conditions.
13    "Applicant" means a health care professional or medical
14facility who applies for loan repayment assistance or
15scholarship funds under this Act.
16    "Approved graduate training" means training in medicine,
17dentistry, or any other health profession that leads to
18eligibility for board certification, provides evidence of
19completion, and is approved by the appropriate health care
20professional's body.
21    "Behavioral health provider" means a provider of a
22commonly recognized discipline in the behavioral health
23industry, including, but not limited to, licensed clinical
24social workers, behavioral health therapists, certified
25marriage and family counselors, licensed social workers, and
26addiction counselors.



HB4645 Engrossed- 5 -LRB102 24527 CPF 33761 b

1    "Breach of service obligation" means failure for any
2reason to begin or complete a contractual service commitment.
3    "Commercial loan" means a loan made by a bank, credit
4union, savings and loan association, insurance company,
5school, or other financial institution.
6    "Community health center" means a migrant health center,
7community health center, health care program for the homeless
8or for residents of public housing supported under Section 330
9of the federal Public Health Service Act, or FQHC, including
10an FQHC Look-Alike, as designated by the U.S. Department of
11Health and Human Services, that operates at least one
12federally designated primary health care delivery site in
14    "Default" means failure to meet a legal obligation or
15condition of a loan.
16    "Department" means the Department of Public Health.
17    "Dental assistant" means a person who serves as a member
18of a dental care team, working directly with a dentist to
19perform duties that include, but are not limited to, assisting
20with dental procedures, preparing patients for procedures,
21preparing examinations, and sterilizing equipment.
22    "Dentist" means a person licensed to practice dentistry
23under the Illinois Dental Practice Act.
24    "Director" means the Director of Public Health.
25    "Equity and Representation in Health Care Workforce
26Repayment Program" or "Repayment Program" means the Equity and



HB4645 Engrossed- 6 -LRB102 24527 CPF 33761 b

1Representation in Health Care Workforce Repayment Program
2created under subsection (a) of Section 15.
3    "Equity and Representation in Health Care Workforce
4Scholarship Program" or "Scholarship Program" means the Equity
5and Representation in Health Care Workforce Scholarship
6Program created under subsection (b) of Section 15.
7    "Federally Qualified Health Center" or "FQHC" means a
8health center funded under Section 330 of the federal Public
9Health Service Act.
10    "Federally Qualified Health Center Look-Alike" or "FQHC
11Look-Alike" means a health center that meets the requirements
12for receiving a grant under Section 330 of the federal Public
13Health Service Act but does not receive funding under that
15    "Government loan" means a loan made by a federal, State,
16county, or city agency authorized to make the loan.
17    "Health care professional" means a physician, physician
18assistant, advanced practice registered nurse, certified nurse
19midwife, chiropractic physician, podiatrist, physical
20therapist, physical therapist assistant, occupational
21therapist, speech therapist, behavioral health provider,
22psychiatrist, psychologist, pharmacist, dentist, medical
23assistant, dental assistant, or dental hygienist.
24    "Health professional shortage area" or "HPSA" means a
25designation from the U.S. Department of Health and Human
26Services that indicates the shortage of primary medical care



HB4645 Engrossed- 7 -LRB102 24527 CPF 33761 b

1or dental or mental health providers. The designation may be
2geographic, such as a county or service area; demographic,
3such as low-income population; or institutional, such as a
4comprehensive health center, FQHC, or other public facility.
5    "Lender" means the commercial or government entity that
6makes a qualifying loan.
7    "Loan repayment award" or "award" means the amount of
8funding awarded to a recipient based upon his or her
9reasonable educational expenses, up to a maximum established
10by the program.
11    "Loan repayment agreement" or "agreement" means the
12written instrument defining a legal relationship entered into
13between the Department and a recipient.
14    "Medical assistant" means a person who serves as a member
15of a medical care team working directly with other providers
16to perform duties that include, but are not limited to,
17gathering patient information, taking vital signs, preparing
18patients for examinations, and assisting physicians during
20    "Medical facility" means a facility in which the delivery
21of health services is provided. A medical facility must be a
22nonprofit or public facility located in Illinois and includes
23the following:
24        (1) A Federally Qualified Health Center.
25        (2) An FQHC Look-Alike.
26        (3) A hospital system operated by a county with more



HB4645 Engrossed- 8 -LRB102 24527 CPF 33761 b

1    than 3,000,000 residents.
2    "Medically underserved area" or "MUA" means an area
3designated by the U.S. Department of Health and Human
4Services' Health Resources and Services Administration as
5having too few primary care providers, high infant mortality,
6high poverty, or a high elderly population.
7    "Osteopathic medicine" means medical practice based upon
8the theory that diseases are due to loss of structural
9integrity, which can be restored by manipulation of the parts
10and supplemented by therapeutic measures.
11    "Physical therapist" means an individual licensed as a
12physical therapist under the Illinois Physical Therapy Act.
13    "Physical therapist assistant" means an individual
14licensed as a physical therapist assistant under the Illinois
15Physical Therapy Act.
16    "Physician" means a person licensed to practice medicine
17in all of its branches under the Medical Practice Act of 1987.
18    "Physician assistant" means an individual licensed under
19the Physician Assistant Practice Act of 1987.
20    "Primary care" means health care that encompasses
21prevention services, basic diagnostic and treatment services,
22and support services, including laboratory, radiology,
23transportation, and pharmacy services.
24    "Psychiatrist" means a physician licensed to practice
25medicine in Illinois under the Medical Practice Act of 1987
26who has successfully completed an accredited residency program



HB4645 Engrossed- 9 -LRB102 24527 CPF 33761 b

1in psychiatry.
2    "Qualifying loan" means a government loan or commercial
3loan used for tuition and reasonable educational and living
4expenses related to undergraduate or graduate education that
5was obtained by the recipient prior to his or her application
6for loan repayment and that is contemporaneous with the
7education received.
8    "Reasonable educational expenses" means costs for
9education, exclusive of tuition. These costs include, but are
10not limited to, fees, books, supplies, clinical travel,
11educational equipment, materials, board certification, or
12licensing examinations. "Reasonable educational expenses" do
13not exceed the estimated standard budget for expenses for the
14degree program and for the years of enrollment.
15    "Reasonable living expenses" means room and board,
16transportation, and commuting costs associated with the
17applicant's attendance and participation in educational and
18workforce training program. "Reasonable living expenses" do
19not exceed the estimated standard budget for the recipient's
20degree program and for the years of enrollment.
21    "Recognized training entity" means an entity approved by
22the Department to provide training and education for medical
23assistants and dental assistants.
24    "Recipient" means a health care professional or medical
25facility that may use loan repayment funds.
26    "Rural" has the same meaning that is used by the federal



HB4645 Engrossed- 10 -LRB102 24527 CPF 33761 b

1Health Resources and Services Administration to determine
2eligibility for Rural Health Grants.
3    "State" means the State of Illinois.
4    Section 15. Repayment Program; Scholarship Program;
5eligibility requirements.
6    (a) The Department shall create and administer an Equity
7and Representation in Health Care Workforce Repayment Program.
8A health care professional may apply to the Department for
9loan repayment assistance under the Repayment Program. In
10order to be eligible for loan repayment under this Act, the
11health care professional or behavioral health provider shall
12comply with the following:
13        (1) Either:
14            (A) be working at a medical facility; or
15            (B) have accepted an offer of employment at a
16        medical facility and will begin employment at that
17        medical facility within 90 calendar days after the
18        submission of the application.
19        (2) Either:
20            (A) have a degree in allopathic or osteopathic
21        medicine, nursing, dentistry, physical therapy, or
22        other eligible health profession from an accredited
23        school; have completed an approved training program;
24        and have a current, valid, and unencumbered license to
25        practice the health profession in Illinois; or



HB4645 Engrossed- 11 -LRB102 24527 CPF 33761 b

1            (B) have a degree in a relevant field of study,
2        such as behavioral health or social work.
3        (3) As necessary to his or her field of work, agree to
4    see and treat all patients at the medical facility
5    regardless of the patient's ability to pay for services.
6        (4) Submit an application to participate in the
7    Program.
8        (5) Not be in breach of a health professional service
9    obligation to the federal, State, or a local government.
10        (6) Not have any judgment liens arising from federal
11    debt.
12        (7) Not be excluded, suspended, or disqualified by a
13    federal agency.
14        (8) Sign a written agreement attesting to accepting
15    repayment of health professional educational loans and to
16    serve (i) for the applicable period of obligated service
17    in a medical facility and (ii) all patients regardless of
18    their ability to pay. The written agreement shall outline
19    details of the loan repayment service obligations,
20    including, but not limited to, the time frame required for
21    the recipient to fulfill the service obligation, the
22    amount of service required based on the award, and
23    penalties that may be levied for breach of a service
24    obligation.
25        (9) Be a current resident of Illinois or intend to
26    reside in Illinois within 90 days after receiving notice



HB4645 Engrossed- 12 -LRB102 24527 CPF 33761 b

1    of a loan repayment or scholarship award under this Act.
2    (b) The Department shall create and administer an Equity
3and Representation in Health Care Workforce Scholarship
4Program. A medical facility or an individual may apply to the
5Department to receive funds under the Scholarship Program. A
6medical facility may apply for a scholarship that covers
7expenses described under subsection (e) of Section 20. If an
8individual is the applicant, the individual shall either:
9        (1) be working at a medical facility; or
10        (2) have accepted an offer of employment at a medical
11    facility and will begin employment at that medical
12    facility within 90 calendar days after the submission of
13    the application.
14    (c) A person who earns a degree from an unaccredited
15school may not participate in the Repayment Program.
16    Section 20. Use of Repayment Program and Scholarship
17Program funds.
18    (a) Subject to appropriation, loan repayment funds under
19the Repayment Program shall be used according to the
21        (1) To repay qualifying educational loans of health
22    care professionals who agree to serve in a medical
23    facility for a specified period of time to be determined
24    by the Department.
25        (2) For educational loans that were obtained prior to



HB4645 Engrossed- 13 -LRB102 24527 CPF 33761 b

1    the date the recipient submits an application for loan
2    repayment assistance.
3        (3) To retire qualifying educational loans if the
4    loans are the result of consolidated or refinanced debt.
5    To qualify, the consolidated or refinanced loans shall:
6            (A) be a government loan or a loan from a
7        commercial lender; and
8            (B) include only qualifying educational loans of
9        the health care professional.
10    (b) Loan repayment funds under the Repayment Program shall
11not be used for any of the following:
12        (1) To repay a practice obligation resulting from
13    educational loans or scholarships, whether from
14    Illinois-based institutions or governments or those in
15    other states.
16        (2) To fulfill practice obligations to the federal
17    government, the State, or any other entity under an
18    agreement with the federal government, State, or other
19    entity.
20        (3) To retire qualifying educational loans if the
21    consolidated or refinanced debt is:
22            (A) commingled with nonqualifying debt; or
23            (B) consolidated with a loan owed by another
24        person, such as a spouse or child.
25    (c) Loan repayment funds under the Repayment Program may
26not be used by the recipient to reimburse himself or herself



HB4645 Engrossed- 14 -LRB102 24527 CPF 33761 b

1for a loan that has been repaid.
2    (d) Under the provisions of the federal Treasury Offset
3Program and the State Comptroller Act, recipients shall have
4their loan repayment assistance funds offset to fulfill a
5delinquent federal or State debt. The offset of loan repayment
6assistance funds shall not reduce, waive, or suspend a
7recipient's service obligation under this Act.
8    (e) Subject to appropriation, Scholarship Program funds
9shall be used to cover the costs of training as a medical
10assistant or dental assistant, or another health care
11profession training or education program, as deemed
12appropriate by the Department. Costs shall include the
14        (1) The cost of enrollment in a training program
15    offered by an Illinois-based institution of higher
16    education, an online program accredited in Illinois, an
17    Illinois-based community college, or a recognized
18    Illinois-based training entity.
19        (2) Lab fees.
20        (3) Materials and test vouchers.
21        (4) Background checks.
22        (5) Drug screenings.
23        (6) Professional equipment and attire, such as scrubs.
24    (f) Applications for loan repayments and scholarships may
25be available twice a year, with at least 5 months between the
26closing date of the last process and application deadline for



HB4645 Engrossed- 15 -LRB102 24527 CPF 33761 b

1the next process. In order to meet the goal of this Act of
2improving diversity and community representation in the health
3care workforce, applications shall include questions that
4request demographic data from the applicant, including, but
5not limited to, race, ethnicity, disability status, gender
6identity, and sexual orientation.
7    (g) An individual who meets the eligibility requirements
8set forth in this Act may apply for loan repayment or
9scholarship funds authorized by this Act. In order to promote
10greater diversity and community representation in health care,
11the Department shall set forward criteria that prioritizes
12applicants, including, but not limited to, the following:
13        (1) Those who identify as a person from a race,
14    ethnicity, gender, sexual orientation, gender identity, or
15    disability status that is underrepresented in the health
16    care sector.
17        (2) First generation postsecondary students.
18        (3) Reservists in the U.S. Armed Forces or military
19    veterans.
20        (4) Persons working in rural medical facilities.
21    (h) An individual who is awarded a loan repayment under
22this Act shall not receive a concurrent loan repayment through
23any other Illinois or federal loan repayment program. Nothing
24in this Act prevents an individual from receiving consecutive
25loan repayment awards under this Act or any other State or
26federal program.



HB4645 Engrossed- 16 -LRB102 24527 CPF 33761 b

1    Section 25. Department powers and duties.
2    (a) The Department may exercise the following powers:
3        (1) To make loan repayment and scholarship awards
4    under the Repayment Program or Scholarship Program with
5    the following priorities:
6            (A) To increase the number of health care
7        providers in MUAs.
8            (B) To increase the number of behavioral health
9        providers in MUAs.
10            (C) To increase the number of accredited, eligible
11        health care provider residencies within the State.
12            (D) To increase the percentage of eligible health
13        care providers establishing practice within the State
14        upon completion of residency.
15            (E) To promote greater diversity and community
16        representation in Illinois' health care workforce.
17        (2) To adopt rules necessary for the establishment and
18    maintenance of the Repayment Program and Scholarship
19    Program required under this Act.
20    (b) The Department shall share information about the
21application process for a scholarship or loan repayment under
22this Act prominently on the Department's website, as well as
23with Illinois-based health care training programs and
24institutions of higher education that offer associate,
25undergraduate, and graduate degree programs in health care.



HB4645 Engrossed- 17 -LRB102 24527 CPF 33761 b

1    Section 30. Administrative procedure. The Illinois
2Administrative Procedure Act is hereby expressly adopted and
3incorporated herein as if all of the provisions of the Act were
4included in this Act.
5    Section 35. Annual report.
6    (a) The Department shall annually report the results and
7progress of the Repayment Program and Scholarship Program on
8or before March 15 of each year to the General Assembly and the
10    (b) The annual report to the General Assembly and the
11Governor shall include the impact of the Repayment Program and
12Scholarship Program on the ability of MUAs to attract and
13retain eligible health care providers, as well as increase
14diversity and community representation in Illinois' health
15care workforce. The report shall include recommendations to
16improve that ability.
17    Section 40. Failure to fulfill obligations.
18    (a) Loan repayment recipients under the Repayment Program
19who fail to meet the obligations set forth in this Act and
20outlined in the signed agreement with the Department shall pay
21to the Department a sum of no less than 1.5 times the amount of
22the annual loan repayment for each year the recipient fails to
23fulfill the obligation, plus interest at the rate of 7%



HB4645 Engrossed- 18 -LRB102 24527 CPF 33761 b

1annually. Repayment to the Department shall be made as a lump
2sum payment or over a period of no more than 6 years with
3interest compounded over that period. An individual who
4fulfills a portion of his or her obligation may have his or her
5repayment amount adjusted accordingly by the Department.
6    (b) Scholarship recipients under the Scholarship Program
7who fail to meet the obligations set forth in this Act and
8outlined in the signed agreement with the Department shall pay
9to the Department a sum of no less than 1.5 times the amount of
10the annual scholarship grant for each year the recipient fails
11to fulfill the employment obligation, plus interest at the
12rate of 7% annually. Repayment to the Department shall occur
13as a lump sum payment or over a period of no more than 6 years
14with interest compounded over that period. An individual who
15fulfills a portion of his or her obligation may have his or her
16repayment amount adjusted accordingly by the Department.
17    (c) Moneys paid to the Department under this Section shall
18be used by the Department to support awards, scholarships, and
19Department operations related to the awards and scholarships
20authorized under this Act.
21    (d) A waiver or deferment request of a recipient's
22obligation under this Act may be submitted to the Department
23for consideration. The request must be submitted in writing
24and shall be consistent with criteria that are in place for
25waiver or deferment from obligations in other State health
26care loan repayment programs.



HB4645 Engrossed- 19 -LRB102 24527 CPF 33761 b

1    (e) The Department may allow an individual who completes a
2different course of study or pursues a different health care
3profession to meet his or her obligations under his or her
4original application if he or she submits the request in
5writing along with any other information requested by the
6Department and continues to meet his or her obligations under
7this Act.
8    Section 45. Transfer of moneys; use of funds.
9    (a) The Department may transfer to the Illinois Finance
10Authority, into an account outside the State treasury, moneys
11in the Community Health Center Care Fund as needed, but not to
12exceed an amount established, by rule, by the Department to
13establish a reserve or credit enhancement escrow account to
14support a financing program or a loan or equipment leasing
15program to provide moneys to support the purposes of
16subsection (a) of Section 2310-200 of the Department of Public
17Health Powers and Duties Law of the Civil Administrative Code
18of Illinois. The disposition of moneys at the conclusion of
19any financing program under this Section shall be determined
20by an interagency agreement.
21    (b) The Department may use a reasonable portion of funds
22appropriated for this Act to increase Department resources as
23is necessary in order to effectively administer the Repayment
24Program and Scholarship Program.
25    Section 99. Effective date. This Act takes effect January



HB4645 Engrossed- 20 -LRB102 24527 CPF 33761 b

11, 2023.