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Public Act 102-0942


 

Public Act 0942 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0942
 
HB4645 EnrolledLRB102 24527 CPF 33761 b

    AN ACT concerning health.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 1. Short title. This Act may be cited as the Equity
and Representation in Health Care Act.
 
    Section 5. Findings; purpose.
    (a) The General Assembly finds that:
        (1) Every Illinois resident deserves access to high
    quality, affordable health care regardless of his or her
    race, ethnicity, zip code, gender identification, or
    sexual orientation. Moreover, Illinois residents deserve
    support from a strong, diverse health care workforce that
    reflects, represents, and understands the patients they
    serve.
        (2) Establishing and building trusted relationships
    between patients and health care providers can lead to
    more compassionate care and improved outcomes. This is
    particularly important for communities of color and
    populations that experience systemic racism and other
    barriers to obtaining equitable high quality care that
    improves health.
        (3) A 2004 report from Johns Hopkins University and
    the Commonwealth Fund focused on the disparities in
    patient experience brought on by a lack of racial and
    ethnic diversity among health care providers. From the
    article:
            "In what is called 'race-discordant'
        relationships, patients from ethnic groups frequently
        are treated by professionals from a different ethnic
        background. The research reviewed here documents
        ongoing racial and ethnic disparities in health care
        and links patient–physician race and ethnic
        concordance with higher patient satisfaction and
        better health care processes. Based on this research,
        the authors issue the following recommendation: ...
        health policy should be revised to encourage workforce
        diversity by funding programs that support the
        recruitment of minority students and medical
        faculty...".
        (4) Another 2021 study by the National Center for
    Biotechnology Information at the National Institutes of
    Health analyzed minority representation across 10
    different health care provider designations and found
    significant underrepresentation among Black, Hispanic, and
    Native American people across all 10 designations. This
    study makes specific mention of the disproportionate
    impact that the COVID-19 pandemic had on minority
    communities and how greater diversity in our health care
    workforce could lead to increased cultural competence and
    improved health outcomes.
        (5) These are just 2 studies among the countless that
    make clear the importance of diversity in our health care
    workforce. Illinois is no exception. More must be done to
    increase the diversity and community representation of our
    State's health care workforce in order to better meet the
    needs of underrepresented communities. This Act is
    intended to support workforce development programs
    specifically aimed at this mission.
    (b) The purpose of this Act is to recognize and address the
historic and systemic barriers that have prevented
proportional representation by race, ethnicity, language,
gender, sexual orientation, gender identity, and disability
status in the health care provider community and address
access to care and health disparities by prioritizing
scholarship and loan repayment programs to individuals from
underrepresented communities pursuing health care careers.
    These scholarship and loan repayment programs shall
encourage health care providers to locate and practice in
areas of greatest need, as determined by provider shortage
area data or health disparity data, and to support efforts for
health care providers to better reflect the communities they
serve.
 
    Section 10. Definitions.
    "Accredited school" means a college or university in which
a degree in allopathic medicine, osteopathic medicine,
dentistry, physical therapy, or an equivalent credential for a
health program is earned and for which the Council for Higher
Education Accreditation or its affiliates has determined that
the school meets specific standards for its programs, faculty,
and curriculum.
    "Advanced practice registered nurse" or "APRN" means an
advanced practice registered nurse as defined under Section
50-10 of the Nurse Practice Act.
    "Allopathic medicine" means the use of pharmacological
agents or physical interventions to treat or suppress symptoms
or processes of diseases or conditions.
    "Applicant" means a health care professional or medical
facility who applies for loan repayment assistance or
scholarship funds under this Act.
    "Approved graduate training" means training in medicine,
dentistry, or any other health profession that leads to
eligibility for board certification, provides evidence of
completion, and is approved by the appropriate health care
professional's body.
    "Behavioral health provider" means a provider of a
commonly recognized discipline in the behavioral health
industry, including, but not limited to, licensed clinical
social workers, behavioral health therapists, certified
marriage and family counselors, licensed social workers, and
addiction counselors.
    "Breach of service obligation" means failure for any
reason to begin or complete a contractual service commitment.
    "Commercial loan" means a loan made by a bank, credit
union, savings and loan association, insurance company,
school, or other financial institution.
    "Community health center" means a migrant health center,
community health center, health care program for the homeless
or for residents of public housing supported under Section 330
of the federal Public Health Service Act, or FQHC, including
an FQHC Look-Alike, as designated by the U.S. Department of
Health and Human Services, that operates at least one
federally designated primary health care delivery site in
Illinois.
    "Default" means failure to meet a legal obligation or
condition of a loan.
    "Department" means the Department of Public Health.
    "Dental assistant" means a person who serves as a member
of a dental care team, working directly with a dentist to
perform duties that include, but are not limited to, assisting
with dental procedures, preparing patients for procedures,
preparing examinations, and sterilizing equipment.
    "Dentist" means a person licensed to practice dentistry
under the Illinois Dental Practice Act.
    "Director" means the Director of Public Health.
    "Equity and Representation in Health Care Workforce
Repayment Program" or "Repayment Program" means the Equity and
Representation in Health Care Workforce Repayment Program
created under subsection (a) of Section 15.
    "Equity and Representation in Health Care Workforce
Scholarship Program" or "Scholarship Program" means the Equity
and Representation in Health Care Workforce Scholarship
Program created under subsection (b) of Section 15.
    "Federally Qualified Health Center" or "FQHC" means a
health center funded under Section 330 of the federal Public
Health Service Act.
    "Federally Qualified Health Center Look-Alike" or "FQHC
Look-Alike" means a health center that meets the requirements
for receiving a grant under Section 330 of the federal Public
Health Service Act but does not receive funding under that
authority.
    "Government loan" means a loan made by a federal, State,
county, or city agency authorized to make the loan.
    "Health care professional" means a physician, physician
assistant, advanced practice registered nurse, nurse,
chiropractic physician, podiatrist, physical therapist,
physical therapist assistant, occupational therapist, speech
therapist, behavioral health provider, psychiatrist,
psychologist, pharmacist, dentist, medical assistant, dental
assistant, or dental hygienist.
    "Health professional shortage area" or "HPSA" means a
designation from the U.S. Department of Health and Human
Services that indicates the shortage of primary medical care
or dental or mental health providers. The designation may be
geographic, such as a county or service area; demographic,
such as low-income population; or institutional, such as a
comprehensive health center, FQHC, or other public facility.
    "Lender" means the commercial or government entity that
makes a qualifying loan.
    "Loan repayment award" or "award" means the amount of
funding awarded to a recipient based upon his or her
reasonable educational expenses, up to a maximum established
by the program.
    "Loan repayment agreement" or "agreement" means the
written instrument defining a legal relationship entered into
between the Department and a recipient.
    "Medical assistant" means a person who serves as a member
of a medical care team working directly with other providers
to perform duties that include, but are not limited to,
gathering patient information, taking vital signs, preparing
patients for examinations, and assisting physicians during
examinations.
    "Medical facility" means a facility in which the delivery
of health services is provided. A medical facility must be a
nonprofit or public facility located in Illinois and includes
the following:
        (1) A Federally Qualified Health Center.
        (2) An FQHC Look-Alike.
        (3) A hospital system operated by a county with more
    than 3,000,000 residents.
    "Medically underserved area" or "MUA" means an area
designated by the U.S. Department of Health and Human
Services' Health Resources and Services Administration as
having too few primary care providers, high infant mortality,
high poverty, or a high elderly population.
    "Nurse" means a person who is licensed as a licensed
practical nurse or as a registered nurse under the Nurse
Practice Act.
    "Osteopathic medicine" means medical practice based upon
the theory that diseases are due to loss of structural
integrity, which can be restored by manipulation of the parts
and supplemented by therapeutic measures.
    "Physical therapist" means an individual licensed as a
physical therapist under the Illinois Physical Therapy Act.
    "Physical therapist assistant" means an individual
licensed as a physical therapist assistant under the Illinois
Physical Therapy Act.
    "Physician" means a person licensed to practice medicine
in all of its branches under the Medical Practice Act of 1987.
    "Physician assistant" means an individual licensed under
the Physician Assistant Practice Act of 1987.
    "Primary care" means health care that encompasses
prevention services, basic diagnostic and treatment services,
and support services, including laboratory, radiology,
transportation, and pharmacy services.
    "Psychiatrist" means a physician licensed to practice
medicine in Illinois under the Medical Practice Act of 1987
who has successfully completed an accredited residency program
in psychiatry.
    "Qualifying loan" means a government loan or commercial
loan used for tuition and reasonable educational and living
expenses related to undergraduate or graduate education that
was obtained by the recipient prior to his or her application
for loan repayment and that is contemporaneous with the
education received.
    "Reasonable educational expenses" means costs for
education, exclusive of tuition. These costs include, but are
not limited to, fees, books, supplies, clinical travel,
educational equipment, materials, board certification, or
licensing examinations. "Reasonable educational expenses" do
not exceed the estimated standard budget for expenses for the
degree program and for the years of enrollment.
    "Reasonable living expenses" means room and board,
transportation, and commuting costs associated with the
applicant's attendance and participation in educational and
workforce training program. "Reasonable living expenses" do
not exceed the estimated standard budget for the recipient's
degree program and for the years of enrollment.
    "Recognized training entity" means an entity approved by
the Department to provide training and education for medical
assistants and dental assistants.
    "Recipient" means a health care professional or medical
facility that may use loan repayment funds.
    "Rural" has the same meaning that is used by the federal
Health Resources and Services Administration to determine
eligibility for Rural Health Grants.
    "State" means the State of Illinois.
 
    Section 15. Repayment Program; Scholarship Program;
eligibility requirements.
    (a) The Department shall create and administer an Equity
and Representation in Health Care Workforce Repayment Program.
A health care professional may apply to the Department for
loan repayment assistance under the Repayment Program. In
order to be eligible for loan repayment under this Act, the
health care professional or behavioral health provider shall
comply with the following:
        (1) Either:
            (A) be working at a medical facility; or
            (B) have accepted an offer of employment at a
        medical facility and will begin employment at that
        medical facility within 90 calendar days after the
        submission of the application.
        (2) Either:
            (A) have a degree in allopathic or osteopathic
        medicine, nursing, dentistry, physical therapy, or
        other eligible health profession from an accredited
        school; have completed an approved training program;
        and have a current, valid, and unencumbered license to
        practice the health profession in Illinois; or
            (B) have a degree in a relevant field of study,
        such as behavioral health or social work.
        (3) As necessary to his or her field of work, agree to
    see and treat all patients at the medical facility
    regardless of the patient's ability to pay for services.
        (4) Submit an application to participate in the
    Program.
        (5) Not be in breach of a health professional service
    obligation to the federal, State, or a local government.
        (6) Not have any judgment liens arising from federal
    debt.
        (7) Not be excluded, suspended, or disqualified by a
    federal agency.
        (8) Sign a written agreement attesting to accepting
    repayment of health professional educational loans and to
    serve (i) for the applicable period of obligated service
    in a medical facility and (ii) all patients regardless of
    their ability to pay. The written agreement shall outline
    details of the loan repayment service obligations,
    including, but not limited to, the time frame required for
    the recipient to fulfill the service obligation, the
    amount of service required based on the award, and
    penalties that may be levied for breach of a service
    obligation.
        (9) Be a current resident of Illinois or intend to
    reside in Illinois within 90 days after receiving notice
    of a loan repayment or scholarship award under this Act.
    (b) The Department shall create and administer an Equity
and Representation in Health Care Workforce Scholarship
Program. A medical facility or an individual may apply to the
Department to receive funds under the Scholarship Program. A
medical facility may apply for a scholarship that covers
expenses described under subsection (e) of Section 20. If an
individual is the applicant, the individual shall either:
        (1) be working at a medical facility; or
        (2) have accepted an offer of employment at a medical
    facility and will begin employment at that medical
    facility within 90 calendar days after the submission of
    the application.
    (c) A person who earns a degree from an unaccredited
school may not participate in the Repayment Program.
 
    Section 20. Use of Repayment Program and Scholarship
Program funds.
    (a) Subject to appropriation, loan repayment funds under
the Repayment Program shall be used according to the
following:
        (1) To repay qualifying educational loans of health
    care professionals who agree to serve in a medical
    facility for a specified period of time to be determined
    by the Department.
        (2) For educational loans that were obtained prior to
    the date the recipient submits an application for loan
    repayment assistance.
        (3) To retire qualifying educational loans if the
    loans are the result of consolidated or refinanced debt.
    To qualify, the consolidated or refinanced loans shall:
            (A) be a government loan or a loan from a
        commercial lender; and
            (B) include only qualifying educational loans of
        the health care professional.
    (b) Loan repayment funds under the Repayment Program shall
not be used for any of the following:
        (1) To repay a practice obligation resulting from
    educational loans or scholarships, whether from
    Illinois-based institutions or governments or those in
    other states.
        (2) To fulfill practice obligations to the federal
    government, the State, or any other entity under an
    agreement with the federal government, State, or other
    entity.
        (3) To retire qualifying educational loans if the
    consolidated or refinanced debt is:
            (A) commingled with nonqualifying debt; or
            (B) consolidated with a loan owed by another
        person, such as a spouse or child.
    (c) Loan repayment funds under the Repayment Program may
not be used by the recipient to reimburse himself or herself
for a loan that has been repaid.
    (d) Under the provisions of the federal Treasury Offset
Program and the State Comptroller Act, recipients shall have
their loan repayment assistance funds offset to fulfill a
delinquent federal or State debt. The offset of loan repayment
assistance funds shall not reduce, waive, or suspend a
recipient's service obligation under this Act.
    (e) Subject to appropriation, Scholarship Program funds
shall be used to cover the costs of training as a medical
assistant or dental assistant, or another health care
profession training or education program, as deemed
appropriate by the Department. Costs shall include the
following:
        (1) The cost of enrollment in a training program
    offered by an Illinois-based institution of higher
    education, an online program accredited in Illinois, an
    Illinois-based community college, or a recognized
    Illinois-based training entity.
        (2) Lab fees.
        (3) Materials and test vouchers.
        (4) Background checks.
        (5) Drug screenings.
        (6) Professional equipment and attire, such as scrubs.
    (f) Applications for loan repayments and scholarships may
be available twice a year, with at least 5 months between the
closing date of the last process and application deadline for
the next process. In order to meet the goal of this Act of
improving diversity and community representation in the health
care workforce, applications shall include questions that
request demographic data from the applicant, including, but
not limited to, race, ethnicity, disability status, gender
identity, and sexual orientation.
    (g) An individual who meets the eligibility requirements
set forth in this Act may apply for loan repayment or
scholarship funds authorized by this Act. In order to promote
greater diversity and community representation in health care,
the Department shall set forward criteria that prioritizes
applicants, including, but not limited to, the following:
        (1) Those who identify as a person from a race,
    ethnicity, gender, sexual orientation, gender identity, or
    disability status that is underrepresented in the health
    care sector.
        (2) First generation postsecondary students.
        (3) Reservists in the U.S. Armed Forces or military
    veterans.
        (4) Persons working in rural medical facilities.
    (h) An individual who is awarded a loan repayment under
this Act shall not receive a concurrent loan repayment through
any other Illinois or federal loan repayment program. Nothing
in this Act prevents an individual from receiving consecutive
loan repayment awards under this Act or any other State or
federal program.
 
    Section 25. Department powers and duties.
    (a) The Department may exercise the following powers:
        (1) To make loan repayment and scholarship awards
    under the Repayment Program or Scholarship Program with
    the following priorities:
            (A) To increase the number of health care
        providers in MUAs.
            (B) To increase the number of behavioral health
        providers in MUAs.
            (C) To increase the number of accredited, eligible
        health care provider residencies within the State.
            (D) To increase the percentage of eligible health
        care providers establishing practice within the State
        upon completion of residency.
            (E) To promote greater diversity and community
        representation in Illinois' health care workforce.
        (2) To adopt rules necessary for the establishment and
    maintenance of the Repayment Program and Scholarship
    Program required under this Act.
    (b) The Department shall share information about the
application process for a scholarship or loan repayment under
this Act prominently on the Department's website, as well as
with Illinois-based health care training programs and
institutions of higher education that offer associate,
undergraduate, and graduate degree programs in health care.
 
    Section 30. Administrative procedure. The Illinois
Administrative Procedure Act is hereby expressly adopted and
incorporated herein as if all of the provisions of the Act were
included in this Act.
 
    Section 35. Annual report.
    (a) The Department shall annually report the results and
progress of the Repayment Program and Scholarship Program on
or before March 15 of each year to the General Assembly and the
Governor.
    (b) The annual report to the General Assembly and the
Governor shall include the impact of the Repayment Program and
Scholarship Program on the ability of MUAs to attract and
retain eligible health care providers, as well as increase
diversity and community representation in Illinois' health
care workforce. The report shall include recommendations to
improve that ability.
 
    Section 40. Failure to fulfill obligations.
    (a) Loan repayment recipients under the Repayment Program
who fail to meet the obligations set forth in this Act and
outlined in the signed agreement with the Department shall pay
to the Department a sum of no less than 1.5 times the amount of
the annual loan repayment for each year the recipient fails to
fulfill the obligation, plus interest at the rate of 7%
annually. Repayment to the Department shall be made as a lump
sum payment or over a period of no more than 6 years with
interest compounded over that period. An individual who
fulfills a portion of his or her obligation may have his or her
repayment amount adjusted accordingly by the Department.
    (b) Scholarship recipients under the Scholarship Program
who fail to meet the obligations set forth in this Act and
outlined in the signed agreement with the Department shall pay
to the Department a sum of no less than 1.5 times the amount of
the annual scholarship grant for each year the recipient fails
to fulfill the employment obligation, plus interest at the
rate of 7% annually. Repayment to the Department shall occur
as a lump sum payment or over a period of no more than 6 years
with interest compounded over that period. An individual who
fulfills a portion of his or her obligation may have his or her
repayment amount adjusted accordingly by the Department.
    (c) Moneys paid to the Department under this Section shall
be used by the Department to support awards, scholarships, and
Department operations related to the awards and scholarships
authorized under this Act.
    (d) A waiver or deferment request of a recipient's
obligation under this Act may be submitted to the Department
for consideration. The request must be submitted in writing
and shall be consistent with criteria that are in place for
waiver or deferment from obligations in other State health
care loan repayment programs.
    (e) The Department may allow an individual who completes a
different course of study or pursues a different health care
profession to meet his or her obligations under his or her
original application if he or she submits the request in
writing along with any other information requested by the
Department and continues to meet his or her obligations under
this Act.
 
    Section 45. Transfer of moneys; use of funds.
    (a) The Department may transfer to the Illinois Finance
Authority, into an account outside the State treasury, moneys
in the Community Health Center Care Fund as needed, but not to
exceed an amount established, by rule, by the Department to
establish a reserve or credit enhancement escrow account to
support a financing program or a loan or equipment leasing
program to provide moneys to support the purposes of
subsection (a) of Section 2310-200 of the Department of Public
Health Powers and Duties Law of the Civil Administrative Code
of Illinois. The disposition of moneys at the conclusion of
any financing program under this Section shall be determined
by an interagency agreement.
    (b) The Department may use a reasonable portion of funds
appropriated for this Act to increase Department resources as
is necessary in order to effectively administer the Repayment
Program and Scholarship Program.
 
    Section 99. Effective date. This Act takes effect January
1, 2023.

Effective Date: 1/1/2023