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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



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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



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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



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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.



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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



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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, nurse,
19chiropractic physician, podiatrist, physical therapist,
20physical therapist assistant, occupational therapist, speech
21therapist, behavioral health provider, psychiatrist,
22psychologist, pharmacist, dentist, medical assistant, dental
23assistant, 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



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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



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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    "Nurse" means a person who is licensed as a licensed
8practical nurse or as a registered nurse under the Nurse
9Practice Act.
10    "Osteopathic medicine" means medical practice based upon
11the theory that diseases are due to loss of structural
12integrity, which can be restored by manipulation of the parts
13and supplemented by therapeutic measures.
14    "Physical therapist" means an individual licensed as a
15physical therapist under the Illinois Physical Therapy Act.
16    "Physical therapist assistant" means an individual
17licensed as a physical therapist assistant under the Illinois
18Physical Therapy Act.
19    "Physician" means a person licensed to practice medicine
20in all of its branches under the Medical Practice Act of 1987.
21    "Physician assistant" means an individual licensed under
22the Physician Assistant Practice Act of 1987.
23    "Primary care" means health care that encompasses
24prevention services, basic diagnostic and treatment services,
25and support services, including laboratory, radiology,
26transportation, and pharmacy services.



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1    "Psychiatrist" means a physician licensed to practice
2medicine in Illinois under the Medical Practice Act of 1987
3who has successfully completed an accredited residency program
4in psychiatry.
5    "Qualifying loan" means a government loan or commercial
6loan used for tuition and reasonable educational and living
7expenses related to undergraduate or graduate education that
8was obtained by the recipient prior to his or her application
9for loan repayment and that is contemporaneous with the
10education received.
11    "Reasonable educational expenses" means costs for
12education, exclusive of tuition. These costs include, but are
13not limited to, fees, books, supplies, clinical travel,
14educational equipment, materials, board certification, or
15licensing examinations. "Reasonable educational expenses" do
16not exceed the estimated standard budget for expenses for the
17degree program and for the years of enrollment.
18    "Reasonable living expenses" means room and board,
19transportation, and commuting costs associated with the
20applicant's attendance and participation in educational and
21workforce training program. "Reasonable living expenses" do
22not exceed the estimated standard budget for the recipient's
23degree program and for the years of enrollment.
24    "Recognized training entity" means an entity approved by
25the Department to provide training and education for medical
26assistants and dental assistants.



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



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



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



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



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1        person, such as a spouse or child.
2    (c) Loan repayment funds under the Repayment Program may
3not be used by the recipient to reimburse himself or herself
4for a loan that has been repaid.
5    (d) Under the provisions of the federal Treasury Offset
6Program and the State Comptroller Act, recipients shall have
7their loan repayment assistance funds offset to fulfill a
8delinquent federal or State debt. The offset of loan repayment
9assistance funds shall not reduce, waive, or suspend a
10recipient's service obligation under this Act.
11    (e) Subject to appropriation, Scholarship Program funds
12shall be used to cover the costs of training as a medical
13assistant or dental assistant, or another health care
14profession training or education program, as deemed
15appropriate by the Department. Costs shall include the
17        (1) The cost of enrollment in a training program
18    offered by an Illinois-based institution of higher
19    education, an online program accredited in Illinois, an
20    Illinois-based community college, or a recognized
21    Illinois-based training entity.
22        (2) Lab fees.
23        (3) Materials and test vouchers.
24        (4) Background checks.
25        (5) Drug screenings.
26        (6) Professional equipment and attire, such as scrubs.



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



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



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1with Illinois-based health care training programs and
2institutions of higher education that offer associate,
3undergraduate, and graduate degree programs in health care.
4    Section 30. Administrative procedure. The Illinois
5Administrative Procedure Act is hereby expressly adopted and
6incorporated herein as if all of the provisions of the Act were
7included in this Act.
8    Section 35. Annual report.
9    (a) The Department shall annually report the results and
10progress of the Repayment Program and Scholarship Program on
11or before March 15 of each year to the General Assembly and the
13    (b) The annual report to the General Assembly and the
14Governor shall include the impact of the Repayment Program and
15Scholarship Program on the ability of MUAs to attract and
16retain eligible health care providers, as well as increase
17diversity and community representation in Illinois' health
18care workforce. The report shall include recommendations to
19improve that ability.
20    Section 40. Failure to fulfill obligations.
21    (a) Loan repayment recipients under the Repayment Program
22who fail to meet the obligations set forth in this Act and
23outlined in the signed agreement with the Department shall pay



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



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



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1is necessary in order to effectively administer the Repayment
2Program and Scholarship Program.
3    Section 99. Effective date. This Act takes effect January
41, 2023.