Bill Text: IL HB3232 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: Amends the Community Benefits Act. Provides that the Act applies to all nonprofit and public hospitals licensed under the Hospital Licensing Act or operated under the University of Illinois Hospital Act (rather than not applying to a hospital operated by a unit of government, a hospital located outside of a metropolitan statistical area, or a hospital with 100 or fewer beds). Requires community benefits plans to describe activities the hospital is undertaking to address health equity, reduce health disparities, and improve community health. Provides that, in order to increase transparency and accessibility of charity care and financial assistance data, the Attorney General shall post on the Attorney General's website: all community benefits plans contained in reports submitted by hospitals; and a compiled report that summarizes information from completed community benefits plans. Provides that an electronic version of the compiled report shall be sent to the Governor and each member of the General Assembly. Provides a late filing fee for nonprofit hospitals for community benefits plans of $2,500 per month that the report is late (rather than $100). Makes other changes. Amends the Hospital Uninsured Patient Discount Act. Provides that a hospital, other than a rural hospital or a Critical Access Hospital, shall provide a discount from its charges to specified uninsured patients for all medically necessary health care services exceeding $150 (rather than $300) in any one inpatient admission or outpatient encounter. Provides for civil monetary penalties of $1,000 to $5,000 (rather than $500) for a violation. Requires the Attorney General to publish an annual report that outlines complaints received related to hospital uninsured discount programs and financial assistance applications. Makes other changes. Effective immediately.

Spectrum: Partisan Bill (Democrat 13-0)

Status: (Introduced - Dead) 2021-04-23 - House Floor Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee [HB3232 Detail]

Download: Illinois-2021-HB3232-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB3232 Introduced , by Rep. Camille Y. Lilly SYNOPSIS AS INTRODUCED:
See Index
Amends the Community Benefits Act. Provides that the Act applies to all nonprofit and public hospitals licensed under the Hospital Licensing Act or operated under the University of Illinois Hospital Act (rather than not applying to a hospital operated by a unit of government, a hospital located outside of a metropolitan statistical area, or a hospital with 100 or fewer beds). Requires community benefits plans to describe activities the hospital is undertaking to address health equity, reduce health disparities, and improve community health. Provides that, in order to increase transparency and accessibility of charity care and financial assistance data, the Attorney General shall post on the Attorney General's website: all community benefits plans contained in reports submitted by hospitals; and a compiled report that summarizes information from completed community benefits plans. Provides that an electronic version of the compiled report shall be sent to the Governor and each member of the General Assembly. Provides a late filing fee for nonprofit hospitals for community benefits plans of $2,500 per month that the report is late (rather than $100). Makes other changes. Amends the Hospital Uninsured Patient Discount Act. Provides that hospitals, other than a rural hospital or Critical Access Hospitals, shall provide a discount from charges to specified uninsured patients for all medically necessary health care services exceeding $150 (rather than $300) in any one inpatient admission or outpatient encounter. Provides civil monetary penalties of not$1,000 to $5,000 (rather than $500). Requires the Attorney General to publish an annual report that outlines complaints received related to hospital uninsured discount programs and financial assistance applications. Makes other changes. Effective immediately.
LRB102 15012 CPF 20367 b
A BILL FOR
HB3232 LRB102 15012 CPF 20367 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Community Benefits Act is amended by
changing Sections 5, 10, 15, 20, and 25 and by adding Section
22 as follows:
(210 ILCS 76/5)
Sec. 5. Applicability. This Act applies to all nonprofit
and public hospitals licensed under the Hospital Licensing Act
or operated under the University of Illinois Hospital Act.
This Act does not apply to a hospital operated by a unit of
government, a hospital located outside of a metropolitan
statistical area, or a hospital with 100 or fewer beds.
Hospitals that are owned or operated by or affiliated with a
health system shall be deemed to be in compliance with this Act
if the health system has met the requirements of this Act.
(Source: P.A. 93-480, eff. 8-8-03.)
(210 ILCS 76/10)
Sec. 10. Definitions. As used in this Act:
"Bad debt" means any bill submitted to a patient or
guarantor where efforts to collect are exhausted and the bill
is not paid in full.

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"Charity care" means care provided by a health care
provider for which the provider does not expect to receive
payment from the patient or a third party payer. "Charity
care" includes the actual cost of services provided based upon
the total cost to charge ratio derived from the nonprofit
hospital's Medicare cost report and not based upon the charges
for the services. "Charity care" does not include bad debt.
"Community benefits" means the unreimbursed cost to a
hospital or health system of providing charity care, language
assistant services, government-sponsored indigent health care,
donations, volunteer services, education,
government-sponsored program services, research, and
subsidized health services and collecting bad debts.
"Community benefits" does not include the cost of paying any
taxes or other governmental assessments.
"Cost to charge ratio" means the ratio between a
hospital's expenses and what the hospital charges, and service
costs relative to the charges assigned by the hospital, as
provided in the hospital's Medicare Cost Report.
"Financial assistance" means care given at a reduced rate
or no cost due to the inability of the patient to pay for such
care as a result of being uninsured or underinsured under the
terms and conditions the hospital offers to qualified patients
and as required by law.
"Government-sponsored Government sponsored indigent health
care" means the unreimbursed cost to a hospital or health

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system of Medicare, providing health care services to
recipients of Medicaid, and other federal, State, or local
indigent health care programs, eligibility for which is based
on financial need.
"Health system" means an entity that owns or operates at
least one hospital.
"Net patient revenue" means the amount a hospital or
health system expects to be received from a public or private
health insurance payer, or paid directly in the form of
copayments, coinsurance, or other payment, for health care
services provided by the hospital or health system.
"Nonprofit hospital" means a hospital that is organized as
a nonprofit corporation, including religious organizations, or
a charitable trust under Illinois law or the laws of any other
state or country.
"Subsidized health services" means those services provided
by a hospital in response to community needs for which the
reimbursement is less than the hospital's cost of providing
the services that must be subsidized by other hospital or
nonprofit supporting entity revenue sources. "Subsidized
health services" includes, but is not limited to, emergency
and trauma care, neonatal intensive care, community health
clinics, and collaborative efforts with local government or
private agencies to prevent illness and improve wellness, such
as immunization programs.
(Source: P.A. 93-480, eff. 8-8-03.)

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(210 ILCS 76/15)
Sec. 15. Organizational mission statement; community
benefits plan. A nonprofit hospital shall develop:
(1) an organizational mission statement that
identifies the hospital's commitment to serving the health
care needs of the community; and
(2) a community benefits plan defined as an
operational plan for serving the community's health care
needs that:
(A) sets out goals and objectives for providing
community benefits that include charity care and
government-sponsored government sponsored indigent
health care; and
(B) identifies the populations and communities
served by the hospital; and .
(C) describes activities the hospital is
undertaking to address health equity, reduce health
disparities, and improve community health. This may
include, but is not limited to:
(i) efforts to recruit and promote a racially
and culturally diverse and representative
workforce;
(ii) efforts to procure goods and services
locally and from historically underrepresented
communities;

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(iii) training that addresses cultural
competency and implicit bias; and
(iv) partnerships and investments to address
social needs such as food, housing, and community
safety.
(Source: P.A. 93-480, eff. 8-8-03.)
(210 ILCS 76/20)
Sec. 20. Annual report for community benefits plan.
(a) Each nonprofit hospital shall prepare an annual report
of the community benefits plan. The report must include, in
addition to the community benefits plan itself, all of the
following background information:
(1) The hospital's mission statement.
(2) A disclosure of the health care needs of the
community that were considered in developing the
hospital's community benefits plan.
(3) A disclosure of the amount and types of community
benefits actually provided, including charity care, and
details about financial assistance applications received
and processed by hospitals as specified in paragraph (5)
of subsection (a) of Section 22. Charity care must be
reported separate from other community benefits. In
reporting charity care, the hospital must report the
actual cost of services provided, based on the total cost
to charge ratio derived from the hospital's Medicare cost

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report (CMS 2552-96 Worksheet C, Part 1, PPS Inpatient
Ratios), not the charges for the services. For a health
system that includes more than one hospital, charity care
spending and financial assistance application data must be
reported separately for each individual hospital within
the health system.
(4) Audited annual financial reports for its most
recently completed fiscal year.
(b) Each nonprofit hospital shall annually file a report
of the community benefits plan with the Attorney General. The
report must be filed not later than the last day of the sixth
month after the close of the hospital's fiscal year, beginning
with the hospital fiscal year that ends in 2004.
(c) Each nonprofit hospital shall prepare a statement that
notifies the public that the annual report of the community
benefits plan is:
(1) public information;
(2) filed with the Attorney General; and
(3) available to the public on request from the
Attorney General.
This statement shall be made available to the public.
(d) The obligations of a hospital under this Act, except
for the filing of its audited financial report, shall take
effect beginning with the hospital's fiscal year that begins
after the effective date of this Act. Within 60 days of the
effective date of this Act, a hospital shall file the audited

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annual financial report that has been completed for its most
recently completed fiscal year. Thereafter, a hospital shall
include its audited annual financial report for its most
recently completed fiscal year in its annual report of its
community benefits plan.
(Source: P.A. 93-480, eff. 8-8-03.)
(210 ILCS 76/22 new)
Sec. 22. Public reports.
(a) In order to increase transparency and accessibility of
charity care and financial assistance data, the Attorney
General shall post on the Attorney General's website: all
community benefits plans contained in reports submitted by
hospitals under Section 20; and a compiled report that
summarizes information from completed community benefits
plans. Past reports and disclosures shall remain publicly
available on the website for at least 15 years. Numerical data
shall be published in XML, CSV, and PDF file formats.
Hospitals shall also make this information available to the
public by publishing this information on the hospital's
website in the same location where annual reports are posted.
Information made available to the public shall include, but
not be limited to, the following:
(1) The reporting period.
(2) Charity care costs consistent with the reporting
requirements in paragraph (3) of subsection (a) of Section

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20. Charity care costs associated with services provided
as part of a hospital's obligation to comply with the
federal Emergency Medical Treatment and Labor Act shall be
reported as a subset of total charity care costs.
(3) Total net patient revenue, reported separately by
hospital if the reporting health system includes more than
one hospital.
(4) Total community benefits spending.
(5) Data on financial assistance applications
consistent with the reporting requirements in paragraph
(3) of subsection (a) Section 20, including:
(A) the number of applications submitted to the
hospital, both complete and incomplete;
(B) the number of applications approved, with
details as to whether the approval was for full or
partial financial assistance, as well as the type of
service, including inpatient, outpatient, emergency
department, or other, associated with the approved
application; and
(C) the number of applications denied, the 5 most
frequent reasons for denial, and the type of services
associated with the denied application, including
inpatient, outpatient, emergency department, or other.
(6) To the extent that race, ethnicity, or preferred
language is collected and available for financial
assistance applications, the data outlined in paragraph

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(5) shall be reported by race, ethnicity, gender,
employment status, occupation, housing status, and primary
language. If this data is not provided by the patient, the
hospital shall indicate this in its reports.
(b) An electronic version of the Attorney General report
under subsection (a) shall be sent to the Governor and each
member of the General Assembly.
(210 ILCS 76/25)
Sec. 25. Failure to file annual report. The Attorney
General may assess a late filing fee against a nonprofit
hospital that fails to make a report of the community benefits
plan as required under this Act in an amount not to exceed
$2,500 per month that the report is late $100. The Attorney
General may grant extensions for good cause. No penalty may be
assessed against a hospital under this Section until 30
business days have elapsed after written notification to the
hospital of its failure to file a report.
(Source: P.A. 93-480, eff. 8-8-03.)
Section 10. The Hospital Uninsured Patient Discount Act is
amended by changing Sections 5, 10, 15, and 25 as follows:
(210 ILCS 89/5)
Sec. 5. Definitions. As used in this Act:
"Cost to charge ratio" means the ratio of a hospital's

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costs to its charges taken from its most recently filed
Medicare cost report (CMS 2552-96 Worksheet C, Part I, PPS
Inpatient Ratios).
"Critical Access Hospital" means a hospital that is
designated as such under the federal Medicare Rural Hospital
Flexibility Program.
"Family income" means the sum of a family's annual
earnings and cash benefits from all sources before taxes, less
payments made for child support.
"Federal poverty income guidelines" means the poverty
guidelines updated periodically in the Federal Register by the
United States Department of Health and Human Services under
authority of 42 U.S.C. 9902(2).
"Financial assistance" means care given at a reduced rate
or no cost due to the inability of the patient to pay for such
care as a result of being uninsured or underinsured under the
terms and conditions the hospital offers to qualified patients
and as required by law.
"Health care services" means any medically necessary
inpatient or outpatient hospital service, including
pharmaceuticals or supplies provided by a hospital to a
patient.
"Hospital" means any facility or institution required to
be licensed pursuant to the Hospital Licensing Act or operated
under the University of Illinois Hospital Act.
"Illinois resident" means any a person who lives in

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Illinois and who intends to remain living in Illinois
indefinitely. Relocation to Illinois for the sole purpose of
receiving health care benefits does not satisfy the residency
requirement under this Act.
"Medically necessary" means any inpatient or outpatient
hospital service, including pharmaceuticals or supplies
provided by a hospital to a patient, covered under Title XVIII
of the federal Social Security Act for beneficiaries with the
same clinical presentation as the uninsured patient. A
"medically necessary" service does not include any of the
following:
(1) Non-medical services such as social and vocational
services.
(2) Elective cosmetic surgery, but not plastic surgery
designed to correct disfigurement caused by injury,
illness, or congenital defect or deformity.
"Rural hospital" means a hospital that is located outside
a metropolitan statistical area.
"Uninsured discount" means a hospital's charges multiplied
by the uninsured discount factor.
"Uninsured discount factor" means 1.0 less the product of
a hospital's cost to charge ratio multiplied by 1.35.
"Uninsured patient" means an Illinois resident who is a
patient of a hospital and is not covered under a policy of
health insurance and is not a beneficiary under a public or
private health insurance, health benefit, or other health

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coverage program, including high deductible health insurance
plans, workers' compensation, accident liability insurance, or
other third party liability.
(Source: P.A. 95-965, eff. 12-22-08.)
(210 ILCS 89/10)
Sec. 10. Uninsured patient discounts.
(a) Eligibility.
(1) A hospital, other than a rural hospital or
Critical Access Hospital, shall provide a discount from
its charges to any uninsured patient who applies for a
discount and has family income of not more than 600% of the
federal poverty income guidelines for all medically
necessary health care services exceeding $150 $300 in any
one inpatient admission or outpatient encounter.
(2) A hospital, other than a rural hospital or
Critical Access Hospital, shall provide a charitable
discount of 100% of its charges for all medically
necessary health care services exceeding $150 $300 in any
one inpatient admission or outpatient encounter to any
uninsured patient who applies for a discount and has
family income of not more than 200% of the federal poverty
income guidelines.
(3) A rural hospital or Critical Access Hospital shall
provide a discount from its charges to any uninsured
patient who applies for a discount and has annual family

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income of not more than 300% of the federal poverty income
guidelines for all medically necessary health care
services exceeding $300 in any one inpatient admission or
outpatient encounter.
Hospitals shall notify patients of their ability to
include health care received in the last 12 months towards
the maximum collectable amount. This information shall be
included clearly and in plain language on financial
assistance applications, hospital bills, invoices, or
summary of charges provided by the hospital.
(4) A rural hospital or Critical Access Hospital shall
provide a charitable discount of 100% of its charges for
all medically necessary health care services exceeding
$300 in any one inpatient admission or outpatient
encounter to any uninsured patient who applies for a
discount and has family income of not more than 125% of the
federal poverty income guidelines.
(b) Discount. For all health care services exceeding $300
in any one inpatient admission or outpatient encounter, a
hospital shall not collect from an uninsured patient, deemed
eligible under subsection (a), more than its charges less the
amount of the uninsured discount.
(c) Maximum Collectible Amount.
(1) The maximum amount that may be collected in a 12
month period for health care services provided by the
hospital from a patient determined by that hospital to be

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eligible under subsection (a) is 15% 25% of the patient's
family income, and is subject to the patient's continued
eligibility under this Act.
(2) The 12 month period to which the maximum amount
applies shall begin on the first date, after the effective
date of this Act, an uninsured patient receives health
care services that are determined to be eligible for the
uninsured discount at that hospital.
(3) To be eligible to have this maximum amount applied
to subsequent charges, the uninsured patient shall inform
the hospital in subsequent inpatient admissions or
outpatient encounters that the patient has previously
received health care services from that hospital and was
determined to be entitled to the uninsured discount.
(4) Hospitals may adopt policies to exclude an
uninsured patient from the application of subdivision
(c)(1) when the patient owns assets having a value in
excess of 600% of the federal poverty level for hospitals
in a metropolitan statistical area or owns assets having a
value in excess of 300% of the federal poverty level for
Critical Access Hospitals or hospitals outside a
metropolitan statistical area, not counting the following
assets: the uninsured patient's primary residence;
personal property exempt from judgment under Section
12-1001 of the Code of Civil Procedure; or any amounts
held in a pension or retirement plan, provided, however,

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that distributions and payments from pension or retirement
plans may be included as income for the purposes of this
Act.
(d) Each hospital bill, invoice, or other summary of
charges to an uninsured patient shall include with it, or on
it, a prominent statement that an uninsured patient who meets
certain income requirements may qualify for an uninsured
discount and information regarding how an uninsured patient
may apply for consideration under the hospital's financial
assistance policy. Each hospital bill, invoice, or other
summary of charges to an uninsured patient shall state:
"Complaints or concerns with the uninsured patient discount
application process or hospital financial assistance process
may be reported to the Health Care Bureau of the Illinois
Attorney General.". A website, phone number, or both provided
by the Attorney General shall be included with this statement.
(Source: P.A. 97-690, eff. 6-14-12.)
(210 ILCS 89/15)
Sec. 15. Patient responsibility.
(a) Hospitals may make the availability of a discount and
the maximum collectible amount under this Act contingent upon
the uninsured patient first applying for coverage under public
programs, such as Medicare, Medicaid, AllKids, the State
Children's Health Insurance Program, or any other program, if
there is a reasonable basis to believe that the uninsured

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patient may be eligible for such program.
(b) Hospitals shall permit an uninsured patient to
initiate an application for financial assistance prior to the
receipt of a service apply for a discount within 60 days of the
date of discharge or date of service. Hospitals shall permit
uninsured patients with an inpatient hospital stay of 20 or
more days to initiate an application for financial assistance
within 90 days after the date of discharge.
(1) Income verification. Hospitals may require an
uninsured patient who is requesting an uninsured discount
to provide documentation of family income. Acceptable
family income documentation shall include any one of the
following:
(A) a copy of the most recent tax return;
(B) a copy of the most recent W-2 form and 1099
forms;
(C) copies of the 2 most recent pay stubs;
(D) written income verification from an employer
if paid in cash; or
(E) one other reasonable form of third party
income verification deemed acceptable to the hospital.
(2) Asset verification. Hospitals may require an
uninsured patient who is requesting an uninsured discount
to certify the existence or absence of assets owned by the
patient and to provide documentation of the value of such
assets, except for those assets referenced in paragraph

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(5) of subsection (c) of Section 10. Acceptable
documentation may include statements from financial
institutions or some other third party verification of an
asset's value. If no third party verification exists, then
the patient shall certify as to the estimated value of the
asset.
(3) Illinois resident verification. Hospitals may
require an uninsured patient who is requesting an
uninsured discount to verify Illinois residency.
Acceptable verification of Illinois residency shall
include any one of the following:
(A) any of the documents listed in paragraph (1);
(B) a valid state-issued identification card;
(C) a recent residential utility bill;
(D) a lease agreement;
(E) a vehicle registration card;
(F) a voter registration card;
(G) mail addressed to the uninsured patient at an
Illinois address from a government or other credible
source;
(H) a statement from a family member of the
uninsured patient who resides at the same address and
presents verification of residency; or
(I) a letter from a homeless shelter, transitional
house or other similar facility verifying that the
uninsured patient resides at the facility; or .

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(J) a temporary visitor's drivers license.
(c) Hospital obligations toward an individual uninsured
patient under this Act shall cease if that patient
unreasonably fails or refuses to provide the hospital with
information or documentation requested under subsection (b) or
to apply for coverage under public programs when requested
under subsection (a) within 30 days of the hospital's request.
(d) In order for a hospital to determine the 12 month
maximum amount that can be collected from a patient deemed
eligible under Section 10, an uninsured patient shall inform
the hospital in subsequent inpatient admissions or outpatient
encounters that the patient has previously received health
care services from that hospital and was determined to be
entitled to the uninsured discount.
(e) Hospitals may require patients to certify that all of
the information provided in the application is true. The
application may state that if any of the information is
untrue, any discount granted to the patient is forfeited and
the patient is responsible for payment of the hospital's full
charges.
(f) Hospitals shall ask for an applicant's race,
ethnicity, gender, employment status, occupation, housing
status, and preferred language on the financial assistance
application. However, the questions shall be clearly marked as
optional responses for the patient and shall note that
responses or nonresponses by the patient will not have any

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impact on the outcome of the application.
(Source: P.A. 95-965, eff. 12-22-08.)
(210 ILCS 89/25)
Sec. 25. Enforcement.
(a) The Attorney General is responsible for administering
and ensuring compliance with this Act, including the
development of any rules necessary for the implementation and
enforcement of this Act.
(b) The Attorney General shall develop and implement a
process for receiving and handling complaints from individuals
or hospitals regarding possible violations of this Act.
(c) The Attorney General may conduct any investigation
deemed necessary regarding possible violations of this Act by
any hospital including, without limitation, the issuance of
subpoenas to:
(1) require the hospital to file a statement or report
or answer interrogatories in writing as to all information
relevant to the alleged violations;
(2) examine under oath any person who possesses
knowledge or information directly related to the alleged
violations; and
(3) examine any record, book, document, account, or
paper necessary to investigate the alleged violation.
(d) If the Attorney General determines that there is a
reason to believe that any hospital has violated this Act, the

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Attorney General may bring an action in the name of the People
of the State against the hospital to obtain temporary,
preliminary, or permanent injunctive relief for any act,
policy, or practice by the hospital that violates this Act.
Before bringing such an action, the Attorney General may
permit the hospital to submit a Correction Plan for the
Attorney General's approval.
(e) This Section applies if:
(1) A court orders a party to make payments to the
Attorney General and the payments are to be used for the
operations of the Office of the Attorney General; or
(2) A party agrees in a Correction Plan under this Act
to make payments to the Attorney General for the
operations of the Office of the Attorney General.
(f) Moneys paid under any of the conditions described in
subsection (e) shall be deposited into the Attorney General
Court Ordered and Voluntary Compliance Payment Projects Fund.
Moneys in the Fund shall be used, subject to appropriation,
for the performance of any function, pertaining to the
exercise of the duties, to the Attorney General including, but
not limited to, enforcement of any law of this State and
conducting public education programs; however, any moneys in
the Fund that are required by the court to be used for a
particular purpose shall be used for that purpose.
(g) The Attorney General may seek the assessment of a
civil monetary penalty of not less than $1,000 but not to

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exceed $5,000 for a $500 per violation in any action filed
under this Act where a hospital, by pattern or practice,
knowingly violates Section 10 of this Act.
(h) In the event a court grants a final order of relief
against any hospital for a violation of this Act, the Attorney
General may, after all appeal rights have been exhausted,
refer the hospital to the Illinois Department of Public Health
for possible adverse licensure action under the Hospital
Licensing Act.
(i) Each hospital shall file Worksheet C Part I from its
most recently filed Medicare Cost Report with the Attorney
General within 60 days after the effective date of this Act and
thereafter shall file each subsequent Worksheet C Part I with
the Attorney General within 30 days of filing its Medicare
Cost Report with the hospital's fiscal intermediary.
(j) On and after January 1, 2022, the Attorney General
shall publish an annual report that outlines complaints
received related to hospital uninsured discount programs and
financial assistance applications. The initial report shall
include the following:
(1) The number of complaints received, listed by
hospital.
(2) The status of each of the complaints.
(3) The number of violations found by the Attorney
General, and any actions, including monetary penalties
issued by the Attorney General, since January 1, 2012.

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Numerical data shall be published in XML, CSV, and PDF
file formats. Subsequent annual reports may be limited to
only reflect the most recent completed calendar year.
(Source: P.A. 95-965, eff. 12-22-08.)
Section 99. Effective date. This Act takes effect upon
becoming law.
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INDEX
Statutes amended in order of appearance