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| Public Act 103-0492
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| SB1665 Enrolled | LRB103 27577 KTG 53953 b |
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Hospital Uninsured Patient Discount Act is |
amended by changing Sections 5, 10, and 15 as follows:
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(210 ILCS 89/5) |
Sec. 5. Definitions. As used in this Act: |
"Community health center" means a federally qualified |
health center as defined in Section 1905(l)(2)(B) of the |
federal Social Security Act or a federally qualified health |
center look-alike. |
"Cost to charge ratio" means the ratio of a hospital's |
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 |
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United States Department of Health and Human Services under |
authority of 42 U.S.C. 9902(2). |
"Financial assistance" means a discount provided to a |
patient under the terms and conditions a hospital offers to |
qualified patients or as required by law. |
"Free and charitable clinic" means a 501(c)(3) tax-exempt |
health care organization providing health services to |
low-income uninsured or underinsured individuals that is |
recognized by either the Illinois Association of Free and |
Charitable Clinics or the National Association of Free and |
Charitable Clinics. |
"Guaranteed income program" means a publicly or privately |
funded program that provides one-time or recurring |
unconditional cash transfers or payments, or gifts to |
individuals or households, for a defined number of months or |
years for the purposes of reducing poverty, promoting economic |
mobility, or increasing the financial stability of Illinois |
residents. |
"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 person who lives in Illinois |
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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.
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(Source: P.A. 102-581, eff. 1-1-22.)
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(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 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 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. |
(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. |
(5) In determining eligibility under this Act, a |
hospital subject to this Act shall exclude from |
consideration any unconditional cash transfers, payments, |
or gifts received under a guaranteed income program if: |
(A) such cash transfers, payments, or gifts are |
excluded from consideration for determining |
eligibility under public health insurance programs |
administered by the State in which the State has the |
authority to waive guaranteed income; and |
(B) the guaranteed income program is a program for |
a defined number of months or years designed to reduce |
poverty, promote social mobility, or increase |
financial stability for program participants and if |
there is an explicit plan to collect data. |
This paragraph is inoperative on and after July 1, |
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2026. |
(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 |
eligible under subsection (a) is 20% 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. The |
availability of the maximum collectible amount shall be |
included in the hospital's financial assistance |
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information provided to uninsured patients. |
(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, |
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. The hospital's financial assistance |
application shall include language that directs the uninsured |
patient to contact the hospital's financial counseling |
department with questions or concerns, along with contact |
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information for the financial counseling department, and 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.
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(Source: P.A. 102-581, eff. 1-1-22.)
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(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 |
health insurance programs, such as Medicare, Medicaid, |
AllKids, the State Children's Health Insurance Program, the |
Health Benefits for Immigrants program, or any other program, |
if there is a reasonable basis to believe that the uninsured |
patient may be eligible for such program. |
(b) Hospitals shall permit an uninsured patient to apply |
for a discount within 90 days of the date of discharge or date |
of service. |
Hospitals shall offer uninsured patients who receive |
community-based primary care provided by a community health |
center or a free and charitable clinic, are referred by such an |
entity to the hospital, and seek access to nonemergency |
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hospital-based health care services with an opportunity to be |
screened for and assistance with applying for public health |
insurance programs if there is a reasonable basis to believe |
that the uninsured patient may be eligible for a public health |
insurance program. An uninsured patient who receives |
community-based primary care provided by a community health |
center or free and charitable clinic and is referred by such an |
entity to the hospital for whom there is not a reasonable basis |
to believe that the uninsured patient may be eligible for a |
public health insurance program shall be given the opportunity |
to apply for hospital financial assistance when hospital |
services are scheduled. |
(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 |
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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 |
(4) 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 |
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presents verification of residency; |
(I) a letter from a homeless shelter, transitional |
house or other similar facility verifying that the |
uninsured patient resides at the facility; or |
(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, sex, and preferred language on the financial |
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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 impact on the outcome of the application.
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(Source: P.A. 102-581, eff. 1-1-22.)
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Section 10. The Illinois Public Aid Code is amended by |
changing Section 1-7 as follows:
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(305 ILCS 5/1-7) (from Ch. 23, par. 1-7)
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Sec. 1-7.
(a) For purposes of determining eligibility for |
assistance
under this Code, the Illinois Department, County |
Departments, and local
governmental units shall exclude from |
consideration restitution payments,
including all income and |
resources derived therefrom, made to persons of
Japanese or |
Aleutian ancestry pursuant to the federal Civil Liberties Act
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of 1988 and the Aleutian and Pribilof Island Restitution Act, |
P.L. 100-383.
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(b) For purposes of any program or form of assistance |
where a person's
income or assets are considered in |
determining eligibility or level of
assistance, whether under |
this Code or another authority, neither the State
of Illinois |
nor any entity or person administering a program wholly or
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partially financed by the State of Illinois or any of its |
political
subdivisions shall include restitution payments, |
including all income and
resources derived therefrom, made |
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pursuant to the federal Civil Liberties
Act of 1988 and the |
Aleutian and Pribilof Island Restitution Act, P.L.
100-383, in |
the calculation of income or assets for determining |
eligibility
or level of assistance.
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(c) For purposes of determining eligibility for or the |
amount of assistance
under this Code, except for the |
determination of eligibility for payments or
programs under |
the TANF employment, education, and training programs and the
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Food Stamp
Employment and Training Program, the Illinois |
Department, County Departments,
and local governmental units |
shall exclude from consideration any financial
assistance |
received under any student aid program administered by an |
agency of
this State or the federal government, by a person who |
is enrolled as a
full-time or part-time student of any public |
or private university, college, or
community college in this |
State.
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(d) For purposes of determining eligibility for or the |
amount of assistance under this Code, except for the |
determination of eligibility for payments or programs under |
the TANF employment, education, and training programs and the |
SNAP Employment and Training Program, the Illinois Department, |
County Departments, and local governmental units shall exclude |
from consideration, for a period of 36 months, any financial |
assistance, including wages, that is provided to a person who |
is enrolled in a demonstration project that is not funded with |
general revenue funds and that is intended as a bridge to |
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self-sufficiency by offering (i) intensive workforce support |
and training and (ii) support services for new and expectant |
parents that are intended to foster multi-generational healthy |
families as described in Section 12-4.51. |
(e)(1) Notwithstanding any other provision of this Code, |
and to the maximum extent permitted by federal law, for |
purposes of determining eligibility and the amount of |
assistance under this Code, the Illinois Department and local |
governmental units shall exclude from consideration, for a |
period of no more than 60 months, any financial assistance, |
including wages, cash transfers, or gifts, that is provided to |
a person through a guaranteed income program. As used in this |
subsection, "guaranteed income program" means a publicly or |
privately funded program that provides one-time or recurring |
unconditional cash transfers or payments, or gifts to |
individuals or households, for a defined number of months or |
years for the purposes of reducing poverty, promoting economic |
mobility, or increasing the financial stability of Illinois |
residents. who is enrolled in a program or research project |
that is not funded with general revenue funds and that is |
intended to investigate the impacts of policies or programs |
designed to reduce poverty, promote social mobility, or |
increase financial stability for Illinois residents if there |
is an explicit plan to collect data and evaluate the program or |
initiative that is developed prior to participants in the |
study being enrolled in the program and if a research team has |
