Rep. LaToya Greenwood

Filed: 2/18/2022





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2    AMENDMENT NO. ______. Amend House Bill 4645 by replacing
3everything after the enacting clause with the following:
4    "Section 1. Short title. This Act may be cited as the
5Equity and 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



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1    more compassionate care and improved outcomes. This is
2    particularly important for communities of color and
3    populations that experience systemic racism and other
4    barriers to obtaining equitable high quality care that
5    improves health.
6        (3) A 2004 report from Johns Hopkins University and
7    the Commonwealth Fund focused on the disparities in
8    patient experience brought on by a lack of racial and
9    ethnic diversity among health care providers. From the
10    article:
11            "In what is called 'race-discordant'
12        relationships, patients from ethnic groups frequently
13        are treated by professionals from a different ethnic
14        background. The research reviewed here documents
15        ongoing racial and ethnic disparities in health care
16        and links patient–physician race and ethnic
17        concordance with higher patient satisfaction and
18        better health care processes. Based on this research,
19        the authors issue the following recommendation: ...
20        health policy should be revised to encourage workforce
21        diversity by funding programs that support the
22        recruitment of minority students and medical
23        faculty...".
24        (4) Another 2021 study by the National Center for
25    Biotechnology Information at the National Institutes of
26    Health analyzed minority representation across 10



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1    different health care provider designations and found
2    significant underrepresentation among Black, Hispanic, and
3    Native American people across all 10 designations. This
4    study makes specific mention of the disproportionate
5    impact that the COVID-19 pandemic had on minority
6    communities and how greater diversity in our health care
7    workforce could lead to increased cultural competence and
8    improved health outcomes.
9        (5) These are just 2 studies among the countless that
10    make clear the importance of diversity in our health care
11    workforce. Illinois is no exception. More must be done to
12    increase the diversity and community representation of our
13    State's health care workforce in order to better meet the
14    needs of underrepresented communities. This Act is
15    intended to support workforce development programs
16    specifically aimed at this mission.
17    (b) The purpose of this Act is to recognize and address the
18historic and systemic barriers that have prevented
19proportional representation by race, ethnicity, language,
20gender, sexual orientation, gender identity, and disability
21status in the health care provider community and address
22access to care and health disparities by prioritizing
23scholarship and loan repayment programs to individuals from
24underrepresented communities pursuing health care careers.
25    These scholarship and loan repayment programs shall
26encourage health care providers to locate and practice in



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1areas of greatest need, as determined by provider shortage
2area data or health disparity data, and to support efforts for
3health care providers to better reflect the communities they
5    Section 10. Definitions.
6    "Accredited school" means a college or university in which
7a degree in allopathic medicine, osteopathic medicine,
8dentistry, physical therapy, or an equivalent credential for a
9health program is earned and for which the Council for Higher
10Education Accreditation or its affiliates has determined that
11the school meets specific standards for its programs, faculty,
12and curriculum.
13    "Advanced practice registered nurse" or "APRN" means an
14advanced practice registered nurse as defined under Section
1550-10 of the Nurse Practice Act.
16    "Allopathic medicine" means the use of pharmacological
17agents or physical interventions to treat or suppress symptoms
18or processes of diseases or conditions.
19    "Applicant" means a health care professional or medical
20facility who applies for loan repayment assistance or
21scholarship funds under this Act.
22    "Approved graduate training" means training in medicine,
23dentistry, or any other health profession that leads to
24eligibility for board certification, provides evidence of
25completion, and is approved by the appropriate health care



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1professional's body.
2    "Behavioral health provider" means a provider of a
3commonly recognized discipline in the behavioral health
4industry, including, but not limited to, licensed clinical
5social workers, behavioral health therapists, certified
6marriage and family counselors, licensed social workers, and
7addiction counselors.
8    "Breach of service obligation" means failure for any
9reason to begin or complete a contractual service commitment.
10    "Commercial loan" means a loan made by a bank, credit
11union, savings and loan association, insurance company,
12school, or other financial institution.
13    "Community health center" means a migrant health center,
14community health center, health care program for the homeless
15or for residents of public housing supported under Section 330
16of the federal Public Health Service Act, or FQHC, including
17an FQHC Look-Alike, as designated by the U.S. Department of
18Health and Human Services, that operates at least one
19federally designated primary health care delivery site in
21    "Default" means failure to meet a legal obligation or
22condition of a loan.
23    "Department" means the Department of Public Health.
24    "Dental assistant" means a person who serves as a member
25of a dental care team, working directly with a dentist to
26perform duties that include, but are not limited to, assisting



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1with dental procedures, preparing patients for procedures,
2preparing examinations, and sterilizing equipment.
3    "Dentist" means a person licensed to practice dentistry
4under the Illinois Dental Practice Act.
5    "Director" means the Director of Public Health.
6    "Equity and Representation in Health Care Workforce
7Repayment Program" or "Repayment Program" means the Equity and
8Representation in Health Care Workforce Repayment Program
9created under subsection (a) of Section 15.
10    "Equity and Representation in Health Care Workforce
11Scholarship Program" or "Scholarship Program" means the Equity
12and Representation in Health Care Workforce Scholarship
13Program created under subsection (b) of Section 15.
14    "Federally Qualified Health Center" or "FQHC" means a
15health center funded under Section 330 of the federal Public
16Health Service Act.
17    "Federally Qualified Health Center Look-Alike" or "FQHC
18Look-Alike" means a health center that meets the requirements
19for receiving a grant under Section 330 of the federal Public
20Health Service Act but does not receive funding under that
22    "Government loan" means a loan made by a federal, State,
23county, or city agency authorized to make the loan.
24    "Health care professional" means a physician, physician
25assistant, advanced practice registered nurse, physical
26therapist, physical therapist assistant, behavioral health



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1provider, psychiatrist, psychologist, pharmacist, dentist, or
2dental hygienist.
3    "Health professional shortage area" or "HPSA" means a
4designation from the U.S. Department of Health and Human
5Services that indicates the shortage of primary medical care
6or dental or mental health providers. The designation may be
7geographic, such as a county or service area; demographic,
8such as low-income population; or institutional, such as a
9comprehensive health center, FQHC, or other public facility.
10    "Lender" means the commercial or government entity that
11makes a qualifying loan.
12    "Loan repayment award" or "award" means the amount of
13funding awarded to a recipient based upon his or her
14reasonable educational expenses, up to a maximum established
15by the program.
16    "Loan repayment agreement" or "agreement" means the
17written instrument defining a legal relationship entered into
18between the Department and a recipient.
19    "Medical assistant" means a person who serves as a member
20of a medical care team working directly with other providers
21to perform duties that include, but are not limited to,
22gathering patient information, taking vital signs, preparing
23patients for examinations, and assisting physicians during
25    "Medical facility" means a facility in which the delivery
26of health services is provided. A medical facility must be a



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1nonprofit or public facility located in Illinois and includes
2the following:
3        (1) A Federally Qualified Health Center.
4        (2) An FQHC Look-Alike.
5        (3) A hospital system operated by a county with more
6    than 3,000,000 residents.
7    "Medically underserved area" or "MUA" means an area
8designated by the U.S. Department of Health and Human
9Services' Health Resources and Services Administration as
10having too few primary care providers, high infant mortality,
11high poverty, or a high elderly population.
12    "Osteopathic medicine" means medical practice based upon
13the theory that diseases are due to loss of structural
14integrity, which can be restored by manipulation of the parts
15and supplemented by therapeutic measures.
16    "Physical therapist" means an individual licensed as a
17physical therapist under the Illinois Physical Therapy Act.
18    "Physical therapist assistant" means an individual
19licensed as a physical therapist assistant under the Illinois
20Physical Therapy Act.
21    "Physician" means a person licensed to practice medicine
22in all of its branches under the Medical Practice Act of 1987.
23    "Physician assistant" means an individual licensed under
24the Physician Assistant Practice Act of 1987.
25    "Primary care" means health care that encompasses
26prevention services, basic diagnostic and treatment services,



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



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



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1        medicine, nursing, dentistry, physical therapy, or
2        other eligible health profession from an accredited
3        school; have completed an approved graduate training
4        program; and have a current, valid, and unencumbered
5        license to practice the health profession in Illinois;
6        or
7            (B) have a degree in a relevant field of study,
8        such as behavioral health or social work.
9        (3) As necessary to his or her field of work, agree to
10    see and treat all patients at the medical facility
11    regardless of the patient's ability to pay for services.
12        (4) Submit an application to participate in the
13    Program.
14        (5) Not be in breach of a health professional service
15    obligation to the federal, State, or a local government.
16        (6) Not have any judgment liens arising from federal
17    debt.
18        (7) Not be excluded, suspended, or disqualified by a
19    federal agency.
20        (8) Sign a written agreement attesting to accepting
21    repayment of health professional educational loans and to
22    serve for the applicable period of obligated service in an
23    HPSA or MUA located in Illinois.
24    (b) The Department shall create and administer an Equity
25and Representation in Health Care Workforce Scholarship
26Program. A medical facility or an individual may apply to the



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



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



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1assistance funds shall not reduce, waive, or suspend a
2recipient's service obligation under this Act.
3    (e) Scholarship Program funds shall be used to cover the
4costs of training as a medical assistant or dental assistant,
5or another health care profession training or education
6program, as deemed appropriate by the Department. Costs shall
7include the following:
8        (1) The cost of enrollment in a training program
9    offered by an institute of higher learning, accredited
10    online program, Illinois-based community college, or
11    recognized training entity.
12        (2) Lab fees.
13        (3) Materials and test vouchers.
14        (4) Background checks.
15        (5) Drug screenings.
16        (6) Professional equipment and attire, such as scrubs.
17    (f) Applications for loan repayments and scholarships
18shall be available twice a year, with at least 5 months between
19the closing date of the last process and application deadline
20for the next process.
21    (g) An individual who meets the eligibility requirements
22set forth in this Act may apply for loan repayment or
23scholarship funds authorized by this Act. In order to promote
24greater diversity and community representation in health care,
25the Department shall set forward criteria that prioritizes
26applicants, including, but not limited to, the following:



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1        (1) Those who identify as a person from a race,
2    ethnicity, gender, sexual orientation, gender identity, or
3    disability status that is underrepresented in the health
4    care sector.
5        (2) First generation postsecondary students.
6        (3) Reservists in the U.S. Armed Forces or military
7    veterans.
8        (4) Persons working in rural medical facilities.
9    Section 25. Department powers. The Department may exercise
10the following powers:
11        (1) To make loan repayment and scholarship awards
12    under the Repayment Program or Scholarship Program with
13    the following priorities:
14            (A) To increase the number of health care
15        providers in MUAs.
16            (B) To increase the number of behavioral health
17        providers in MUAs.
18            (C) To increase the number of accredited, eligible
19        health care provider residencies within the State.
20            (D) To increase the percentage of eligible health
21        care providers establishing practice within the State
22        upon completion of residency.
23            (E) To promote greater diversity and community
24        representation in Illinois' health care workforce.
25        (2) To adopt rules necessary for the establishment and



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1    maintenance of the Repayment Program and Scholarship
2    Program required under this Act.
3    Section 30. Administrative procedure. The Illinois
4Administrative Procedure Act is hereby expressly adopted and
5incorporated herein as if all of the provisions of the Act were
6included in this Act.
7    Section 35. Annual report.
8    (a) The Department shall annually report the results and
9progress of the Repayment Program and Scholarship Program on
10or before March 15 of each year to the General Assembly and the
12    (b) The annual report to the General Assembly and the
13Governor shall include the impact of the Repayment Program and
14Scholarship Program on the ability of MUAs to attract and
15retain eligible health care providers, as well as increase
16diversity and community representation in Illinois' health
17care workforce. The report shall include recommendations to
18improve that ability.
19    Section 40. Failure to fulfill obligations.
20    (a) Loan repayment recipients under the Repayment Program
21who fail to maintain employment at a medical facility as
22defined in this Act for the amount of time determined by the
23Department shall pay to the Department a sum equal to the



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1amount of the annual scholarship grant for each year the
2recipient fails to fulfill such obligation. A scholarship
3recipient who fails to fulfill the employment obligation set
4forth in this Section shall have 30 days from the date on which
5that failure begins in which to enter into a contract with the
6Department that sets forth the manner in which that sum is
7required to be paid. If the contract is not entered into within
8that 30-day period or if the contract is entered into but the
9required payments are not made in the amounts and at the times
10provided in the contract, the scholarship recipient also shall
11be required to pay to the Department interest at the rate of 9%
12per annum on the amount of that sum remaining due and unpaid.
13The amounts paid to the Department under this Section shall be
14deposited into the Community Health Center Care Fund and shall
15be used by the Department to improve access to primary health
16care services as authorized by subsection (a) of Section
172310-200 of the Department of Public Health Powers and Duties
18Law of the Civil Administrative Code of Illinois.
19    (b) Scholarship recipients under the Scholarship Program
20who fail to maintain employment at a medical facility for the
21amount of time determined by the Department shall pay to the
22Department a sum equal to the amount of the annual scholarship
23grant for each year the recipient fails to fulfill the
24employment obligation. A scholarship recipient who fails to
25fulfill the employment obligation shall have 30 days from the
26date on which that failure begins in which to enter into a



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1contract with the Department that sets forth the manner in
2which that sum is required to be paid. If the contract is not
3entered into within that 30-day period, or if the contract is
4entered into but the required payments are not made in the
5amounts and at the times provided in the contract, the
6scholarship recipient shall also be required to pay to the
7Department interest at the rate of 9% per annum on the amount
8of that sum remaining due and unpaid. The amounts paid to the
9Department under this Section shall be deposited into the
10Community Health Center Care Fund and shall be used by the
11Department to improve access to primary health care services
12as authorized by subsection (a) of Section 2310-200 of the
13Department of Public Health Powers and Duties Law of the Civil
14Administrative Code of Illinois.
15    Section 45. Transfer of moneys; use of funds.
16    (a) The Department may transfer to the Illinois Finance
17Authority, into an account outside the State treasury, moneys
18in the Community Health Center Care Fund as needed, but not to
19exceed an amount established, by rule, by the Department to
20establish a reserve or credit enhancement escrow account to
21support a financing program or a loan or equipment leasing
22program to provide moneys to support the purposes of
23subsection (a) of Section 2310-200 of the Department of Public
24Health Powers and Duties Law of the Civil Administrative Code
25of Illinois. The disposition of moneys at the conclusion of



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1any financing program under this Section shall be determined
2by an interagency agreement.
3    (b) The Department may use a reasonable portion of funds
4appropriated for this Act to increase Department resources as
5is necessary in order to effectively administer the Repayment
6Program and Scholarship Program.".