Full Text of HB4645 102nd General Assembly
HB4645enr 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning health.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. Short title. This Act may be cited as the Equity | 5 | | 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 | 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 | 11 | | historic and systemic barriers that have prevented | 12 | | proportional representation by race, ethnicity, language, | 13 | | gender, sexual orientation, gender identity, and disability | 14 | | status in the health care provider community and address | 15 | | access to care and health disparities by prioritizing | 16 | | scholarship and loan repayment programs to individuals from | 17 | | underrepresented communities pursuing health care careers. | 18 | | These scholarship and loan repayment programs shall | 19 | | encourage health care providers to locate and practice in | 20 | | areas of greatest need, as determined by provider shortage | 21 | | area data or health disparity data, and to support efforts for | 22 | | health care providers to better reflect the communities they | 23 | | serve. | 24 | | Section 10. Definitions. | 25 | | "Accredited school" means a college or university in which |
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| 1 | | a degree in allopathic medicine, osteopathic medicine, | 2 | | dentistry, physical therapy, or an equivalent credential for a | 3 | | health program is earned and for which the Council for Higher | 4 | | Education Accreditation or its affiliates has determined that | 5 | | the school meets specific standards for its programs, faculty, | 6 | | and curriculum. | 7 | | "Advanced practice registered nurse" or "APRN" means an | 8 | | advanced practice registered nurse as defined under Section | 9 | | 50-10 of the Nurse Practice Act. | 10 | | "Allopathic medicine" means the use of pharmacological | 11 | | agents or physical interventions to treat or suppress symptoms | 12 | | or processes of diseases or conditions. | 13 | | "Applicant" means a health care professional or medical | 14 | | facility who applies for loan repayment assistance or | 15 | | scholarship funds under this Act. | 16 | | "Approved graduate training" means training in medicine, | 17 | | dentistry, or any other health profession that leads to | 18 | | eligibility for board certification, provides evidence of | 19 | | completion, and is approved by the appropriate health care | 20 | | professional's body. | 21 | | "Behavioral health provider" means a provider of a | 22 | | commonly recognized discipline in the behavioral health | 23 | | industry, including, but not limited to, licensed clinical | 24 | | social workers, behavioral health therapists, certified | 25 | | marriage and family counselors, licensed social workers, and | 26 | | addiction counselors. |
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| 1 | | "Breach of service obligation" means failure for any | 2 | | reason to begin or complete a contractual service commitment. | 3 | | "Commercial loan" means a loan made by a bank, credit | 4 | | union, savings and loan association, insurance company, | 5 | | school, or other financial institution. | 6 | | "Community health center" means a migrant health center, | 7 | | community health center, health care program for the homeless | 8 | | or for residents of public housing supported under Section 330 | 9 | | of the federal Public Health Service Act, or FQHC, including | 10 | | an FQHC Look-Alike, as designated by the U.S. Department of | 11 | | Health and Human Services, that operates at least one | 12 | | federally designated primary health care delivery site in | 13 | | Illinois. | 14 | | "Default" means failure to meet a legal obligation or | 15 | | condition of a loan. | 16 | | "Department" means the Department of Public Health. | 17 | | "Dental assistant" means a person who serves as a member | 18 | | of a dental care team, working directly with a dentist to | 19 | | perform duties that include, but are not limited to, assisting | 20 | | with dental procedures, preparing patients for procedures, | 21 | | preparing examinations, and sterilizing equipment. | 22 | | "Dentist" means a person licensed to practice dentistry | 23 | | under the Illinois Dental Practice Act. | 24 | | "Director" means the Director of Public Health. | 25 | | "Equity and Representation in Health Care Workforce | 26 | | Repayment Program" or "Repayment Program" means the Equity and |
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| 1 | | Representation in Health Care Workforce Repayment Program | 2 | | created under subsection (a) of Section 15. | 3 | | "Equity and Representation in Health Care Workforce | 4 | | Scholarship Program" or "Scholarship Program" means the Equity | 5 | | and Representation in Health Care Workforce Scholarship | 6 | | Program created under subsection (b) of Section 15. | 7 | | "Federally Qualified Health Center" or "FQHC" means a | 8 | | health center funded under Section 330 of the federal Public | 9 | | Health Service Act. | 10 | | "Federally Qualified Health Center Look-Alike" or "FQHC | 11 | | Look-Alike" means a health center that meets the requirements | 12 | | for receiving a grant under Section 330 of the federal Public | 13 | | Health Service Act but does not receive funding under that | 14 | | authority. | 15 | | "Government loan" means a loan made by a federal, State, | 16 | | county, or city agency authorized to make the loan. | 17 | | "Health care professional" means a physician, physician | 18 | | assistant, advanced practice registered nurse, nurse, | 19 | | chiropractic physician, podiatrist, physical therapist, | 20 | | physical therapist assistant, occupational therapist, speech | 21 | | therapist, behavioral health provider, psychiatrist, | 22 | | psychologist, pharmacist, dentist, medical assistant, dental | 23 | | assistant, or dental hygienist. | 24 | | "Health professional shortage area" or "HPSA" means a | 25 | | designation from the U.S. Department of Health and Human | 26 | | Services that indicates the shortage of primary medical care |
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| 1 | | or dental or mental health providers. The designation may be | 2 | | geographic, such as a county or service area; demographic, | 3 | | such as low-income population; or institutional, such as a | 4 | | comprehensive health center, FQHC, or other public facility. | 5 | | "Lender" means the commercial or government entity that | 6 | | makes a qualifying loan. | 7 | | "Loan repayment award" or "award" means the amount of | 8 | | funding awarded to a recipient based upon his or her | 9 | | reasonable educational expenses, up to a maximum established | 10 | | by the program. | 11 | | "Loan repayment agreement" or "agreement" means the | 12 | | written instrument defining a legal relationship entered into | 13 | | between the Department and a recipient. | 14 | | "Medical assistant" means a person who serves as a member | 15 | | of a medical care team working directly with other providers | 16 | | to perform duties that include, but are not limited to, | 17 | | gathering patient information, taking vital signs, preparing | 18 | | patients for examinations, and assisting physicians during | 19 | | examinations. | 20 | | "Medical facility" means a facility in which the delivery | 21 | | of health services is provided. A medical facility must be a | 22 | | nonprofit or public facility located in Illinois and includes | 23 | | the 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 | 3 | | designated by the U.S. Department of Health and Human | 4 | | Services' Health Resources and Services Administration as | 5 | | having too few primary care providers, high infant mortality, | 6 | | high poverty, or a high elderly population. | 7 | | "Nurse" means a person who is licensed as a licensed | 8 | | practical nurse or as a registered nurse under the Nurse | 9 | | Practice Act. | 10 | | "Osteopathic medicine" means medical practice based upon | 11 | | the theory that diseases are due to loss of structural | 12 | | integrity, which can be restored by manipulation of the parts | 13 | | and supplemented by therapeutic measures. | 14 | | "Physical therapist" means an individual licensed as a | 15 | | physical therapist under the Illinois Physical Therapy Act. | 16 | | "Physical therapist assistant" means an individual | 17 | | licensed as a physical therapist assistant under the Illinois | 18 | | Physical Therapy Act.
| 19 | | "Physician" means a person licensed to practice medicine | 20 | | in all of its branches under the Medical Practice Act of 1987. | 21 | | "Physician assistant" means an individual licensed under | 22 | | the Physician Assistant Practice Act of 1987. | 23 | | "Primary care" means health care that encompasses | 24 | | prevention services, basic diagnostic and treatment services, | 25 | | and support services, including laboratory, radiology, | 26 | | transportation, and pharmacy services. |
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| 1 | | "Psychiatrist" means a physician licensed to practice | 2 | | medicine in Illinois under the Medical Practice Act of 1987 | 3 | | who has successfully completed an accredited residency program | 4 | | in psychiatry. | 5 | | "Qualifying loan" means a government loan or commercial | 6 | | loan used for tuition and reasonable educational and living | 7 | | expenses related to undergraduate or graduate education that | 8 | | was obtained by the recipient prior to his or her application | 9 | | for loan repayment and that is contemporaneous with the | 10 | | education received. | 11 | | "Reasonable educational expenses" means costs for | 12 | | education, exclusive of tuition. These costs include, but are | 13 | | not limited to, fees, books, supplies, clinical travel, | 14 | | educational equipment, materials, board certification, or | 15 | | licensing examinations. "Reasonable educational expenses" do | 16 | | not exceed the estimated standard budget for expenses for the | 17 | | degree program and for the years of enrollment. | 18 | | "Reasonable living expenses" means room and board, | 19 | | transportation, and commuting costs associated with the | 20 | | applicant's attendance and participation in educational and | 21 | | workforce training program. "Reasonable living expenses" do | 22 | | not exceed the estimated standard budget for the recipient's | 23 | | degree program and for the years of enrollment. | 24 | | "Recognized training entity" means an entity approved by | 25 | | the Department to provide training and education for medical | 26 | | assistants and dental assistants. |
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| 1 | | "Recipient" means a health care professional or medical | 2 | | facility that may use loan repayment funds. | 3 | | "Rural" has the same meaning that is used by the federal | 4 | | Health Resources and Services Administration to determine | 5 | | eligibility for Rural Health Grants. | 6 | | "State" means the State of Illinois. | 7 | | Section 15. Repayment Program; Scholarship Program; | 8 | | eligibility requirements. | 9 | | (a) The Department shall create and administer an Equity | 10 | | and Representation in Health Care Workforce Repayment Program. | 11 | | A health care professional may apply to the Department for | 12 | | loan repayment assistance under the Repayment Program. In | 13 | | order to be eligible for loan repayment under this Act, the | 14 | | health care professional or behavioral health provider shall | 15 | | comply 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 | 6 | | and Representation in Health Care Workforce Scholarship | 7 | | Program. A medical facility or an individual may apply to the | 8 | | Department to receive funds under the Scholarship Program. A | 9 | | medical facility may apply for a scholarship that covers | 10 | | expenses described under subsection (e) of Section 20. If an | 11 | | individual 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 | 18 | | school may not participate in the Repayment Program. | 19 | | Section 20. Use of Repayment Program and Scholarship | 20 | | Program funds. | 21 | | (a) Subject to appropriation, loan repayment funds under | 22 | | the Repayment Program shall be used according to the | 23 | | following: | 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 | 14 | | not 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 | 3 | | not be used by the recipient to reimburse himself or herself | 4 | | for a loan that has been repaid. | 5 | | (d) Under the provisions of the federal Treasury Offset | 6 | | Program and the State Comptroller Act, recipients shall have | 7 | | their loan repayment assistance funds offset to fulfill a | 8 | | delinquent federal or State debt. The offset of loan repayment | 9 | | assistance funds shall not reduce, waive, or suspend a | 10 | | recipient's service obligation under this Act. | 11 | | (e) Subject to appropriation, Scholarship Program funds | 12 | | shall be used to cover the costs of training as a medical | 13 | | assistant or dental assistant, or another health care | 14 | | profession training or education program, as deemed | 15 | | appropriate by the Department. Costs shall include the | 16 | | following: | 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 | 2 | | be available twice a year, with at least 5 months between the | 3 | | closing date of the last process and application deadline for | 4 | | the next process. In order to meet the goal of this Act of | 5 | | improving diversity and community representation in the health | 6 | | care workforce, applications shall include questions that
| 7 | | request demographic data from the applicant, including, but | 8 | | not limited to, race, ethnicity, disability status, gender | 9 | | identity, and sexual orientation. | 10 | | (g) An individual who meets the eligibility requirements | 11 | | set forth in this Act may apply for loan repayment or | 12 | | scholarship funds authorized by this Act. In order to promote | 13 | | greater diversity and community representation in health care, | 14 | | the Department shall set forward criteria that prioritizes | 15 | | applicants, 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 | 25 | | this Act shall not receive
a concurrent loan repayment through | 26 | | any other Illinois or federal loan repayment program. Nothing |
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| 1 | | in this
Act prevents an individual from receiving consecutive | 2 | | loan repayment awards under this Act or any other State
or | 3 | | federal 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 | 24 | | application process for a scholarship or loan repayment under | 25 | | this Act prominently on the Department's website,
as well as |
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| 1 | | with Illinois-based health care training programs and | 2 | | institutions of higher education that
offer associate, | 3 | | undergraduate, and graduate degree programs in health care.
| 4 | | Section 30. Administrative procedure. The Illinois | 5 | | Administrative Procedure Act is hereby expressly adopted and | 6 | | incorporated herein as if all of the provisions of the Act were | 7 | | included in this Act. | 8 | | Section 35. Annual report. | 9 | | (a) The Department shall annually report the results and | 10 | | progress of the Repayment Program and Scholarship Program on | 11 | | or before March 15 of each year to the General Assembly and the | 12 | | Governor. | 13 | | (b) The annual report to the General Assembly and the | 14 | | Governor shall include the impact of the Repayment Program and | 15 | | Scholarship Program on the ability of MUAs to attract and | 16 | | retain eligible health care providers, as well as increase | 17 | | diversity and community representation in Illinois' health | 18 | | care workforce. The report shall include recommendations to | 19 | | improve that ability. | 20 | | Section 40. Failure to fulfill obligations. | 21 | | (a) Loan repayment recipients under the Repayment Program | 22 | | who fail to meet the obligations set forth
in this Act and | 23 | | outlined in the signed agreement with the Department shall pay |
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| 1 | | to the Department a sum of no less than 1.5 times the amount of | 2 | | the annual loan repayment for each year the recipient fails to | 3 | | fulfill the obligation, plus interest at the rate of 7% | 4 | | annually. Repayment to the Department shall be made as a lump | 5 | | sum payment or over a period of no more than 6 years with | 6 | | interest compounded over that period. An individual who | 7 | | fulfills a portion of his or her obligation may have his or her | 8 | | repayment amount adjusted accordingly by the Department. | 9 | | (b) Scholarship recipients under the Scholarship Program | 10 | | who fail to meet the obligations set forth in
this Act and | 11 | | outlined in the signed agreement with the Department shall pay | 12 | | to the Department a sum of no less than 1.5 times the amount of | 13 | | the annual scholarship grant for each year the recipient fails | 14 | | to fulfill the employment obligation, plus interest at the | 15 | | rate of 7% annually. Repayment to the Department shall occur | 16 | | as a lump sum payment or over a period of no more than 6 years | 17 | | with interest compounded over that period. An individual who | 18 | | fulfills a portion of his or her obligation may have his or her | 19 | | repayment amount adjusted accordingly by the Department. | 20 | | (c) Moneys paid to the Department under this Section shall | 21 | | be used by the
Department to support awards, scholarships, and | 22 | | Department operations related to the awards and
scholarships | 23 | | authorized under this Act. | 24 | | (d) A waiver or deferment request of a recipient's | 25 | | obligation under this Act may be submitted to the Department | 26 | | for consideration. The request must be submitted in writing |
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| 1 | | and shall be consistent with criteria that are in place for | 2 | | waiver or deferment from obligations in other State health | 3 | | care loan repayment programs. | 4 | | (e) The Department may allow an individual who completes a | 5 | | different course of study or pursues a different health care | 6 | | profession to meet his or her obligations under his or her | 7 | | original application if he or she submits the request in | 8 | | writing along with any other information requested by the | 9 | | Department and continues to meet his or her obligations under | 10 | | this Act. | 11 | | Section 45. Transfer of moneys; use of funds. | 12 | | (a) The Department may transfer to the Illinois Finance | 13 | | Authority, into an account outside the State treasury, moneys | 14 | | in the Community Health Center Care Fund as needed, but not to | 15 | | exceed an amount established, by rule, by the Department to | 16 | | establish a reserve or credit enhancement escrow account to | 17 | | support a financing program or a loan or equipment leasing | 18 | | program to provide moneys to support the purposes of | 19 | | subsection (a) of Section 2310-200 of the Department of Public | 20 | | Health Powers and Duties Law of the Civil Administrative Code | 21 | | of Illinois. The disposition of moneys at the conclusion of | 22 | | any financing program under this Section shall be determined | 23 | | by an interagency agreement. | 24 | | (b) The Department may use a reasonable portion of funds | 25 | | appropriated for this Act to increase Department resources as |
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| 1 | | is necessary in order to effectively administer the Repayment | 2 | | Program and Scholarship Program.
| 3 | | Section 99. Effective date. This Act takes effect January | 4 | | 1, 2023. |
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