Rep. LaToya Greenwood

Filed: 3/1/2022





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2    AMENDMENT NO. ______. Amend House Bill 4645, AS AMENDED,
3by replacing everything after the enacting clause with the
5    "Section 1. Short title. This Act may be cited as the
6Equity and Representation in Health Care Act.
7    Section 5. Findings; purpose.
8    (a) The General Assembly finds that:
9        (1) Every Illinois resident deserves access to high
10    quality, affordable health care regardless of his or her
11    race, ethnicity, zip code, gender identification, or
12    sexual orientation. Moreover, Illinois residents deserve
13    support from a strong, diverse health care workforce that
14    reflects, represents, and understands the patients they
15    serve.
16        (2) Establishing and building trusted relationships



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



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



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1encourage health care providers to locate and practice in
2areas of greatest need, as determined by provider shortage
3area data or health disparity data, and to support efforts for
4health care providers to better reflect the communities they
6    Section 10. Definitions.
7    "Accredited school" means a college or university in which
8a degree in allopathic medicine, osteopathic medicine,
9dentistry, physical therapy, or an equivalent credential for a
10health program is earned and for which the Council for Higher
11Education Accreditation or its affiliates has determined that
12the school meets specific standards for its programs, faculty,
13and curriculum.
14    "Advanced practice registered nurse" or "APRN" means an
15advanced practice registered nurse as defined under Section
1650-10 of the Nurse Practice Act.
17    "Allopathic medicine" means the use of pharmacological
18agents or physical interventions to treat or suppress symptoms
19or processes of diseases or conditions.
20    "Applicant" means a health care professional or medical
21facility who applies for loan repayment assistance or
22scholarship funds under this Act.
23    "Approved graduate training" means training in medicine,
24dentistry, or any other health profession that leads to
25eligibility for board certification, provides evidence of



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1completion, and is approved by the appropriate health care
2professional's body.
3    "Behavioral health provider" means a provider of a
4commonly recognized discipline in the behavioral health
5industry, including, but not limited to, licensed clinical
6social workers, behavioral health therapists, certified
7marriage and family counselors, licensed social workers, and
8addiction counselors.
9    "Breach of service obligation" means failure for any
10reason to begin or complete a contractual service commitment.
11    "Commercial loan" means a loan made by a bank, credit
12union, savings and loan association, insurance company,
13school, or other financial institution.
14    "Community health center" means a migrant health center,
15community health center, health care program for the homeless
16or for residents of public housing supported under Section 330
17of the federal Public Health Service Act, or FQHC, including
18an FQHC Look-Alike, as designated by the U.S. Department of
19Health and Human Services, that operates at least one
20federally designated primary health care delivery site in
22    "Default" means failure to meet a legal obligation or
23condition of a loan.
24    "Department" means the Department of Public Health.
25    "Dental assistant" means a person who serves as a member
26of a dental care team, working directly with a dentist to



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1perform duties that include, but are not limited to, assisting
2with dental procedures, preparing patients for procedures,
3preparing examinations, and sterilizing equipment.
4    "Dentist" means a person licensed to practice dentistry
5under the Illinois Dental Practice Act.
6    "Director" means the Director of Public Health.
7    "Equity and Representation in Health Care Workforce
8Repayment Program" or "Repayment Program" means the Equity and
9Representation in Health Care Workforce Repayment Program
10created under subsection (a) of Section 15.
11    "Equity and Representation in Health Care Workforce
12Scholarship Program" or "Scholarship Program" means the Equity
13and Representation in Health Care Workforce Scholarship
14Program created under subsection (b) of Section 15.
15    "Federally Qualified Health Center" or "FQHC" means a
16health center funded under Section 330 of the federal Public
17Health Service Act.
18    "Federally Qualified Health Center Look-Alike" or "FQHC
19Look-Alike" means a health center that meets the requirements
20for receiving a grant under Section 330 of the federal Public
21Health Service Act but does not receive funding under that
23    "Government loan" means a loan made by a federal, State,
24county, or city agency authorized to make the loan.
25    "Health care professional" means a physician, physician
26assistant, advanced practice registered nurse, certified nurse



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1midwife, chiropractic physician, podiatrist, physical
2therapist, physical therapist assistant, occupational
3therapist, speech therapist, behavioral health provider,
4psychiatrist, psychologist, pharmacist, dentist, medical
5assistant, dental assistant, or dental hygienist.
6    "Health professional shortage area" or "HPSA" means a
7designation from the U.S. Department of Health and Human
8Services that indicates the shortage of primary medical care
9or dental or mental health providers. The designation may be
10geographic, such as a county or service area; demographic,
11such as low-income population; or institutional, such as a
12comprehensive health center, FQHC, or other public facility.
13    "Lender" means the commercial or government entity that
14makes a qualifying loan.
15    "Loan repayment award" or "award" means the amount of
16funding awarded to a recipient based upon his or her
17reasonable educational expenses, up to a maximum established
18by the program.
19    "Loan repayment agreement" or "agreement" means the
20written instrument defining a legal relationship entered into
21between the Department and a recipient.
22    "Medical assistant" means a person who serves as a member
23of a medical care team working directly with other providers
24to perform duties that include, but are not limited to,
25gathering patient information, taking vital signs, preparing
26patients for examinations, and assisting physicians during



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



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



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1not exceed the estimated standard budget for the recipient's
2degree program and for the years of enrollment.
3    "Recognized training entity" means an entity approved by
4the Department to provide training and education for medical
5assistants and dental assistants.
6    "Recipient" means a health care professional or medical
7facility that may use loan repayment funds.
8    "Rural" has the same meaning that is used by the federal
9Health Resources and Services Administration to determine
10eligibility for Rural Health Grants.
11    "State" means the State of Illinois.
12    Section 15. Repayment Program; Scholarship Program;
13eligibility requirements.
14    (a) The Department shall create and administer an Equity
15and Representation in Health Care Workforce Repayment Program.
16A health care professional may apply to the Department for
17loan repayment assistance under the Repayment Program. In
18order to be eligible for loan repayment under this Act, the
19health care professional or behavioral health provider shall
20comply with the following:
21        (1) Either:
22            (A) be working at a medical facility; or
23            (B) have accepted an offer of employment at a
24        medical facility and will begin employment at that
25        medical facility within 90 calendar days after the



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



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1    details of the loan repayment service obligations,
2    including, but not limited to, the time frame required for
3    the recipient to fulfill the service obligation, the
4    amount of service required based on the award, and
5    penalties that may be levied for breach of a service
6    obligation.
7        (9) Be a current resident of Illinois or intend to
8    reside in Illinois within 90 days after receiving notice
9    of a loan repayment or scholarship award under this Act.
10    (b) The Department shall create and administer an Equity
11and Representation in Health Care Workforce Scholarship
12Program. A medical facility or an individual may apply to the
13Department to receive funds under the Scholarship Program. A
14medical facility may apply for a scholarship that covers
15expenses described under subsection (e) of Section 20. If an
16individual is the applicant, the individual shall either:
17        (1) be working at a medical facility; or
18        (2) have accepted an offer of employment at a medical
19    facility and will begin employment at that medical
20    facility within 90 calendar days after the submission of
21    the application.
22    (c) A person who earns a degree from an unaccredited
23school may not participate in the Repayment Program.
24    Section 20. Use of Repayment Program and Scholarship
25Program funds.



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



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1    entity.
2        (3) To retire qualifying educational loans if the
3    consolidated or refinanced debt is:
4            (A) commingled with nonqualifying debt; or
5            (B) consolidated with a loan owed by another
6        person, such as a spouse or child.
7    (c) Loan repayment funds under the Repayment Program may
8not be used by the recipient to reimburse himself or herself
9for a loan that has been repaid.
10    (d) Under the provisions of the federal Treasury Offset
11Program and the State Comptroller Act, recipients shall have
12their loan repayment assistance funds offset to fulfill a
13delinquent federal or State debt. The offset of loan repayment
14assistance funds shall not reduce, waive, or suspend a
15recipient's service obligation under this Act.
16    (e) Subject to appropriation, Scholarship Program funds
17shall be used to cover the costs of training as a medical
18assistant or dental assistant, or another health care
19profession training or education program, as deemed
20appropriate by the Department. Costs shall include the
22        (1) The cost of enrollment in a training program
23    offered by an Illinois-based institution of higher
24    education, an online program accredited in Illinois, an
25    Illinois-based community college, or a recognized
26    Illinois-based training entity.



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1        (2) Lab fees.
2        (3) Materials and test vouchers.
3        (4) Background checks.
4        (5) Drug screenings.
5        (6) Professional equipment and attire, such as scrubs.
6    (f) Applications for loan repayments and scholarships may
7be available twice a year, with at least 5 months between the
8closing date of the last process and application deadline for
9the next process. In order to meet the goal of this Act of
10improving diversity and community representation in the health
11care workforce, applications shall include questions that
12request demographic data from the applicant, including, but
13not limited to, race, ethnicity, disability status, gender
14identity, and sexual orientation.
15    (g) An individual who meets the eligibility requirements
16set forth in this Act may apply for loan repayment or
17scholarship funds authorized by this Act. In order to promote
18greater diversity and community representation in health care,
19the Department shall set forward criteria that prioritizes
20applicants, including, but not limited to, the following:
21        (1) Those who identify as a person from a race,
22    ethnicity, gender, sexual orientation, gender identity, or
23    disability status that is underrepresented in the health
24    care sector.
25        (2) First generation postsecondary students.
26        (3) Reservists in the U.S. Armed Forces or military



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1    veterans.
2        (4) Persons working in rural medical facilities.
3    (h) An individual who is awarded a loan repayment under
4this Act shall not receive a concurrent loan repayment through
5any other Illinois or federal loan repayment program. Nothing
6in this Act prevents an individual from receiving consecutive
7loan repayment awards under this Act or any other State or
8federal program.
9    Section 25. Department powers and duties.
10    (a) The Department may exercise the 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    (b) The Department shall share information about the
4application process for a scholarship or loan repayment under
5this Act prominently on the Department's website, as well as
6with Illinois-based health care training programs and
7institutions of higher education that offer associate,
8undergraduate, and graduate degree programs in health care.
9    Section 30. Administrative procedure. The Illinois
10Administrative Procedure Act is hereby expressly adopted and
11incorporated herein as if all of the provisions of the Act were
12included in this Act.
13    Section 35. Annual report.
14    (a) The Department shall annually report the results and
15progress of the Repayment Program and Scholarship Program on
16or before March 15 of each year to the General Assembly and the
18    (b) The annual report to the General Assembly and the
19Governor shall include the impact of the Repayment Program and
20Scholarship Program on the ability of MUAs to attract and
21retain eligible health care providers, as well as increase
22diversity and community representation in Illinois' health
23care workforce. The report shall include recommendations to
24improve that ability.



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1    Section 40. Failure to fulfill obligations.
2    (a) Loan repayment recipients under the Repayment Program
3who fail to meet the obligations set forth in this Act and
4outlined in the signed agreement with the Department shall pay
5to the Department a sum of no less than 1.5 times the amount of
6the annual loan repayment for each year the recipient fails to
7fulfill the obligation, plus interest at the rate of 7%
8annually. Repayment to the Department shall be made as a lump
9sum payment or over a period of no more than 6 years with
10interest compounded over that period. An individual who
11fulfills a portion of his or her obligation may have his or her
12repayment amount adjusted accordingly by the Department.
13    (b) Scholarship recipients under the Scholarship Program
14who fail to meet the obligations set forth in this Act and
15outlined in the signed agreement with the Department shall pay
16to the Department a sum of no less than 1.5 times the amount of
17the annual scholarship grant for each year the recipient fails
18to fulfill the employment obligation, plus interest at the
19rate of 7% annually. Repayment to the Department shall occur
20as a lump sum payment or over a period of no more than 6 years
21with interest compounded over that period. An individual who
22fulfills a portion of his or her obligation may have his or her
23repayment amount adjusted accordingly by the Department.
24    (c) Moneys paid to the Department under this Section shall
25be used by the Department to support awards, scholarships, and



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



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1of Illinois. The disposition of moneys at the conclusion of
2any financing program under this Section shall be determined
3by an interagency agreement.
4    (b) The Department may use a reasonable portion of funds
5appropriated for this Act to increase Department resources as
6is necessary in order to effectively administer the Repayment
7Program and Scholarship Program.
8    Section 99. Effective date. This Act takes effect January
91, 2023.".