Bill Text: IL HB4645 | 2021-2022 | 102nd General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Creates the Equity and Representation in Health Care Act. Contains the findings of the General Assembly. Creates the Equity and Representation in Health Care Workforce Repayment Program and the Equity and Representation in Health Care Workforce Scholarship Program to be administered by the Department of Public Health. Provides that a health care professional, medical facility, or behavioral health provider may apply to the Department for loan repayment assistance under the Program. Provides that, in order to be eligible for loan repayment under the Act, the health care professional or behavioral health provider shall comply with specified requirements. Requires the Department to submit an annual report with specified requirements to the General Assembly and the Governor. Contains provisions regarding the adoption of rules by the Department. Contains other provisions.

Spectrum: Partisan Bill (Democrat 26-0)

Status: (Passed) 2022-05-27 - Public Act . . . . . . . . . 102-0942 [HB4645 Detail]

Download: Illinois-2021-HB4645-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB4645 Introduced , by Rep. LaToya Greenwood SYNOPSIS AS INTRODUCED:
New Act
Creates the Equity and Representation in Health Care Act. Contains the findings of the General Assembly. Creates the Equity and Representation in Health Care Workforce Repayment Program and the Equity and Representation in Health Care Workforce Scholarship Program to be administered by the Department of Public Health. Provides that a health care professional, medical facility, or behavioral health provider may apply to the Department for loan repayment assistance under the Program. Provides that, in order to be eligible for loan repayment under the Act, the health care professional or behavioral health provider shall comply with specified requirements. Requires the Department to submit an annual report with specified requirements to the General Assembly and the Governor. Contains provisions regarding the adoption of rules by the Department. Contains other provisions.
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A BILL FOR
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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

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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

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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

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a degree in allopathic medicine, osteopathic medicine,
dentistry, 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.

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"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

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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, behavioral
health provider, psychiatrist, psychologist, pharmacist,
dentist, 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

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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

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Services' Health Resources and Services Administration as
having too few primary care providers, high infant mortality,
high poverty, or a high elderly population.
"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.
"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

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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.

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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, or other eligible health
profession from an accredited school; have completed
an approved graduate 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

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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 for the applicable period of obligated service in an
HPSA or MUA located in Illinois.
(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.

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(a) 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.

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(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) 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 institute of higher learning, accredited
online program, Illinois-based community college, or
recognized training entity.
(2) Lab fees.
(3) Materials and test vouchers.
(4) Background checks.

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(5) Drug screenings.
(6) Professional equipment and attire, such as scrubs.
(f) Applications for loan repayments and scholarships
shall 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.
(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.
Section 25. Department powers. 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:

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(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.
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

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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.
(c) The requirement for reporting to the General Assembly
shall be satisfied by filing copies of the report as required
by Section 3.1 of the General Assembly Organization Act, and
filing such additional copies with the State Government Report
Distribution Center for the General Assembly as required under
paragraph (t) of Section 7 of the State Library Act.
Section 40. Failure to fulfill obligations.
(a) Loan repayment recipients under the Repayment Program
who fail to maintain employment at a medical facility as
defined in this Act for the amount of time determined by the
Department shall pay to the Department a sum equal to the
amount of the annual scholarship grant for each year the
recipient fails to fulfill such obligation. A scholarship
recipient who fails to fulfill the employment obligation set
forth in this Section shall have 30 days from the date on which
that failure begins in which to enter into a contract with the
Department that sets forth the manner in which that sum is
required to be paid. If the contract is not entered into within
that 30-day period or if the contract is entered into but the

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required payments are not made in the amounts and at the times
provided in the contract, the scholarship recipient also shall
be required to pay to the Department interest at the rate of 9%
per annum on the amount of that sum remaining due and unpaid.
The amounts paid to the Department under this Section shall be
deposited into the Community Health Center Care Fund and shall
be used by the Department to improve access to primary health
care services as authorized by subsection (a) of Section
2310-200 of the Department of Public Health Powers and Duties
Law of the Civil Administrative Code of Illinois.
(b) Scholarship recipients under the Scholarship Program
who fail to maintain employment at a medical facility for the
amount of time determined by the Department shall pay to the
Department a sum equal to the amount of the annual scholarship
grant for each year the recipient fails to fulfill the
employment obligation. A scholarship recipient who fails to
fulfill the employment obligation shall have 30 days from the
date on which that failure begins in which to enter into a
contract with the Department that sets forth the manner in
which that sum is required to be paid. If the contract is not
entered into within that 30-day period, or if the contract is
entered into but the required payments are not made in the
amounts and at the times provided in the contract, the
scholarship recipient shall also be required to pay to the
Department interest at the rate of 9% per annum on the amount
of that sum remaining due and unpaid. The amounts paid to the

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Department under this Section shall be deposited into the
Community Health Center Care Fund and shall be used by the
Department to improve access to primary health care services
as authorized by subsection (a) of Section 2310-200 of the
Department of Public Health Powers and Duties Law of the Civil
Administrative Code of Illinois.
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.