Bill Text: IL SB2080 | 2023-2024 | 103rd General Assembly | Introduced

---

Bill Title: Amends the Fair Patient Billing Act. Requires hospitals to screen patients for health insurance and financial assistance. Prohibits the sale of a patient's medical debt by a hospital. Prohibits hospitals from offering a payment plan to an uninsured patient without first exhausting any discount available to the uninsured patient under the Hospital Uninsured Patient Discount Act and from entering into a payment plan for a bill that is eligible to be discounted by 100% under the Hospital Uninsured Patient Discount Act. Makes other changes. Amends the Hospital Uninsured Patient Discount Act. Provides that hospital may not make the availability of a discount and maximum collectible amount contingent upon an uninsured patient's eligibility for specified programs if the patient declines to apply for a public health insurance program on the basis of concern for immigration-related consequences to the patient, which shall not be grounds for the hospital to deny financial assistance under the hospital's financial assistance policy.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced) 2023-03-10 - Rule 3-9(a) / Re-referred to Assignments [SB2080 Detail]

Download: Illinois-2023-SB2080-Introduced.html

---

103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2080 Introduced 2/9/2023, by Sen. Robert Peters SYNOPSIS AS INTRODUCED:
210 ILCS 88/5
210 ILCS 88/10
210 ILCS 88/16 new
210 ILCS 88/30
210 ILCS 89/15
Amends the Fair Patient Billing Act. Requires hospitals to screen patients for health insurance and financial assistance. Prohibits the sale of a patient's medical debt by a hospital. Prohibits hospitals from offering a payment plan to an uninsured patient without first exhausting any discount available to the uninsured patient under the Hospital Uninsured Patient Discount Act and from entering into a payment plan for a bill that is eligible to be discounted by 100% under the Hospital Uninsured Patient Discount Act. Makes other changes. Amends the Hospital Uninsured Patient Discount Act. Provides that hospital may not make the availability of a discount and maximum collectible amount contingent upon an uninsured patient's eligibility for specified programs if the patient declines to apply for a public health insurance program on the basis of concern for immigration-related consequences to the patient, which shall not be grounds for the hospital to deny financial assistance under the hospital's financial assistance policy.
LRB103 27565 CPF 53941 b
A BILL FOR
SB2080 LRB103 27565 CPF 53941 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Fair Patient Billing Act is amended by
changing Sections 5, 10, and 30 and by adding Section 16 as
follows:
(210 ILCS 88/5)
Sec. 5. Purpose; findings.
(a) The purpose of this Act is to advance the prompt and
accurate payment of health care services through fair and
reasonable billing and collection practices of hospitals.
(b) The General Assembly finds that:
(1) Medical debts are the cause of an increasing
number of bankruptcies in Illinois and are typically
associated with severe financial hardship incurred by
bankrupt persons and their families.
(2) Patients, hospitals, and government bodies alike
will benefit from clearly articulated standards regarding
fair billing and collection practices for all Illinois
hospitals.
(3) Hospitals should employ responsible standards when
collecting debt from their patients.
(4) Patients should be provided sufficient billing

SB2080 - 2 - LRB103 27565 CPF 53941 b
information from hospitals to determine the accuracy of
the bills for which they may be financially responsible.
(5) Patients should be given a fair and reasonable
opportunity to discuss and assess the accuracy of their
bill.
(6) Patients should be provided information regarding
the hospital's policies regarding financial assistance
options the hospital may offer to qualified patients.
(7) Hospitals should offer patients the opportunity to
enter into a reasonable payment plan for their hospital
care.
(8) Patients have an obligation to pay for the
hospital services they receive.
(9) Hospitals should provide patients with timely and
meaningful access to the hospital's financial assistance
options to prevent patients from incurring avoidable
medical debt. Hospitals should assist patients who need
financial assistance in accessing financial assistance in
a culturally competent manner. Patients should not be
improperly billed, steered into payment plans, or
collected upon if they are eligible for hospital financial
assistance or public health insurance coverage.
(10) Hospitals have an obligation to provide financial
assistance to uninsured patients. To promote the general
welfare, hospitals should not attempt to collect a debt
from an uninsured patient without first (i) adequately

SB2080 - 3 - LRB103 27565 CPF 53941 b
screening the patient for eligibility to enroll in public
health insurance programs and financial assistance and
(ii) assisting the patient in obtaining the financial
assistance for which the patient is eligible.
(Source: P.A. 94-885, eff. 1-1-07.)
(210 ILCS 88/10)
Sec. 10. Definitions. As used in this Act:
"Collection action" means any referral of a bill to a
collection agency or law firm to collect payment for services
from a patient or a patient's guarantor for hospital services.
"Culturally competent" or "cultural competency" means
providing services, support, or other assistance in a manner
that has the greatest likelihood of ensuring maximum
participation and is responsive to the beliefs, interpersonal
styles, attitudes, languages, and behaviors of individuals who
receive services.
"Health care plan" means a health insurance company,
health maintenance organization, preferred provider
arrangement, or third party administrator authorized in this
State to issue policies or subscriber contracts or administer
those policies and contracts that reimburse for inpatient and
outpatient services provided in a hospital. Health care plan,
however, does not include any government-funded program such
as Medicare or Medicaid, workers' compensation, and accident
liability insurers.

SB2080 - 4 - LRB103 27565 CPF 53941 b
"Insured patient" means a patient who is insured by a
health care plan.
"Medical debt" means a debt arising from the receipt of
health care services.
"Patient" means the individual receiving services from the
hospital and any individual who is the guarantor of the
payment for such services.
"Reasonable payment plan" means a plan to pay a hospital
bill that is offered to the patient or the patient's legal
representative and takes into account the patient's available
income and assets, the amount owed, and any prior payments.
"Reasonable payment plan" does not include a payment plan that
requires a patient to pay moneys that the hospital knows or
should know are eligible for a discount under the Hospital
Uninsured Patient Discount Act.
"Screen" or "screening" means a process whereby a hospital
engages with an uninsured patient to review whether the
patient's circumstances are conducive with eligibility
criteria for financial assistance that is offered by the
hospital or known to the hospital, public health insurance, or
discounted care. "Screen" or "screening" includes, but is not
limited to, informing the patient of the hospital's
assessment, documenting the circumstances of the screening in
the patient's file, and either assisting with the
application's completion or providing information to the
patient about how he or she can enroll or otherwise apply for

SB2080 - 5 - LRB103 27565 CPF 53941 b
the assistance.
"Uninsured patient" means a patient who is not insured by
a health care plan and is not a beneficiary under a
government-funded program, workers' compensation, or accident
liability insurance.
(Source: P.A. 94-885, eff. 1-1-07.)
(210 ILCS 88/16 new)
Sec. 16. Screening for health insurance and financial
assistance; sale of medical debt; enforcement.
(a) A hospital shall screen each uninsured patient for
eligibility in:
(1) all available public health insurance programs,
including, but not limited to:
(A) Medicare;
(B) Medicaid;
(C) the following programs offered by the
Department of Human Services:
(i) medical benefits for noncitizen victims of
trafficking, torture, or other serious crimes;
(ii) health benefits for immigrant adults; and
(iii) health benefits for immigrant seniors;
(D) the Illinois All Kids program managed by the
U.S. Department of Health and Human Services; and
(E) any other program if there is a reasonable
basis to believe that the uninsured patient may be

SB2080 - 6 - LRB103 27565 CPF 53941 b
eligible for it;
(2) any financial assistance offered by the hospital;
and
(3) any other public programs that may assist with the
patient's health care costs.
(b) All screening activities taken under this Act,
including, but not limited to, initial screenings and follow
up activities, must be culturally competent. All information
provided to an uninsured patient for a screening must be in the
uninsured patient's primary language, worded in a way that is
easy to understand, and in an accessible format. Information
from a screening that is provided to an uninsured patient
verbally may include use of a professional interpretation
service. Information from a screening that is provided to an
uninsured patient in writing shall be in the uninsured
patient's or the uninsured patient's legal representative's
primary language, if applicable.
(c) If an uninsured patient declines the screening
described in subsection (a), the hospital shall document the
uninsured patient's informed written consent to decline the
screening and the date and method by which the uninsured
patient declined it. An uninsured patient's decision to
decline a screening is a defense to a claim brought by an
uninsured patient under this Section if contemporaneous
hospital documentation shows that the decision to decline the
screening was an informed decision and presented in the

SB2080 - 7 - LRB103 27565 CPF 53941 b
uninsured patient's primary language.
(d) A hospital must screen an uninsured patient at the
earliest reasonable moment, which in all circumstances means
before issuing a bill to the uninsured patient. After the
screening, the hospital shall inform the uninsured patient of
the hospital's assessment of his or her circumstances.
(e) If a screening indicates that the uninsured patient
may be eligible for financial assistance, the hospital shall
assist the uninsured patient with applying for financial
assistance in accordance with Section 27.
(f) If a screening indicates that the uninsured patient
may be eligible for financial assistance, the hospital shall
provide information to the uninsured patient detailing how the
uninsured patient can enroll in the financial assistance,
including, but not limited to, referring the uninsured patient
to health care navigators who provide free and unbiased
eligibility and enrollment assistance such as Federally
Qualified Health Centers (FQHCs), programs offered by the
Department of Human Services, or any other resource that is
recognized by the State as being designed to assist uninsured
individuals in obtaining health care coverage.
(g) The date that an uninsured patient's screening takes
place, or the date on which a decision regarding the uninsured
patient's eligibility for financial assistance described under
subsection (a) is pending, whichever is applicable, is the
starting date of any deadline for the uninsured patient to

SB2080 - 8 - LRB103 27565 CPF 53941 b
file an application with the hospital for financial
assistance. If the uninsured patient's application is
approved, the hospital shall bill the entity providing the
financial assistance and shall not pursue a collection action
against the uninsured patient. If the uninsured patient's
application is denied, the hospital shall screen the uninsured
patient again, and the deadline to file an application for
financial assistance shall begin anew.
(h) If a hospital is contacted by an insured patient in
response to a bill issued by the hospital to the insured
patient, the hospital shall screen the insured patient for
discounted care at the earliest reasonable moment if (i) the
insured patient requests the screening, (ii) the insured
patient provides information suggesting his or her inability
to pay the bill, (iii) the hospital obtains information
suggesting the insured patient's inability to pay, or (iv)
circumstances suggest the insured patient's inability to pay
the bill.
(i) A hospital shall develop an operational plan for
implementing the screening requirements under this Section.
The operational plan shall describe hospital activities to
adopt and actively implement policies and training to ensure
compliance with this Section, including, but not limited to,
training on:
(1) screening requirements;
(2) interacting with uninsured patients in a

SB2080 - 9 - LRB103 27565 CPF 53941 b
culturally competent way; and
(3) addressing implicit bias when interacting with
uninsured patients.
The operational plan shall establish the parameters for
training required under this subsection, including, but not
limited to, staff required to receive the training and
ensuring compliance with this Section. Each hospital employee
shall receive the training, as applicable, required for that
employee's position at least once each year.
(j) An uninsured patient may apply for financial
assistance at any time before, during, or after a hospital has
initiated any legal process to collect the uninsured patient's
medical debt.
(k) A hospital shall not sell an obligation due to the
hospital as an uninsured patient's medical debt.
(l) A hospital may demonstrate compliance with this
Section by submitting the hospital's chief financial
officer's, or the chief financial officer's designee's, sworn
affidavit affirming that the uninsured patient does not meet
the required criteria for financial assistance and listing the
specific criteria that were not met.
(m) Notwithstanding any other provision of law:
(1) a hospital that violates this Section shall
execute and file a release, a satisfaction of judgment, or
both, as applicable, for any medical debt at issue arising
from the violation within 30 days after the violation

SB2080 - 10 - LRB103 27565 CPF 53941 b
occurs;
(2) a hospital's failure to screen an uninsured
patient in compliance with this Section is a complete
defense for an uninsured patient against any legal action
by the hospital to collect the uninsured patient's medical
debt incurred because of that failure and constitutes a
meritorious claim or defense in the uninsured patient's
petition for relief from judgment under Section 2-1401 of
the Code of Civil Procedure;
(3) a hospital that fails to comply with the
requirements of this Section is strictly liable, without
regard to fault, to an uninsured patient or any other
person aggrieved by the violation:
(A) in an amount equal to $4,000 or the uninsured
patient's or person's actual damages, whichever is
greater; and
(B) attorney's fees, costs, and expenses, and such
other relief, including an injunction, as the court
may deem appropriate;
(4) the following defenses are not available to a
hospital in any legal action brought under this Section:
(A) ignorance or mistake of law;
(B) misplaced documentation;
(C) contributory or comparative negligence; or
(D) a claim that the hospital or the hospital's
agent was unaware that the hospital (i) did not meet

SB2080 - 11 - LRB103 27565 CPF 53941 b
the requirements under this Section or (ii) was
otherwise engaged in the hospital's conduct described
in the legal action;
(5) any person aggrieved by a violation of this
Section shall have a right of action in any court of
competent jurisdiction and shall recover damages equal to
the sum of $4,000 or actual damages; and
(6) any waiver of an uninsured patient's or aggrieved
person's right to sue, defend, or countersue under this
Section is against public policy, is void, and shall not
be enforceable in any court.
(210 ILCS 88/30)
Sec. 30. Pursuing collection action.
(a) Hospitals and their agents may pursue collection
action against an uninsured patient only if the following
conditions are met:
(1) The hospital has given the uninsured patient the
opportunity to:
(A) assess the accuracy of the bill;
(B) apply for financial assistance under the
hospital's financial assistance policy; and
(C) avail themselves of a reasonable payment plan.
(2) If the uninsured patient has indicated an
inability to pay the full amount of the debt in one payment
during the screening required under Section 16, the

SB2080 - 12 - LRB103 27565 CPF 53941 b
hospital has offered the patient a reasonable payment
plan. A payment plan is not reasonable if it requires
payment of moneys required to be written off or discounted
under the Hospital Uninsured Patient Discount Act. The
hospital and its agents, including, but not limited to,
third-party entities acting as hospital agents, shall not
offer a payment plan to an uninsured patient without first
exhausting any discount available to the uninsured patient
under the Hospital Uninsured Patient Discount Act and
shall not at any point enter into a payment plan for a bill
that is eligible to be discounted by 100% under the
Hospital Uninsured Patient Discount Act. The hospital may
require the uninsured patient to provide reasonable
verification of his or her inability to pay the full
amount of the debt in one payment.
(3) To the extent the hospital provides financial
assistance and the circumstances of the uninsured patient
suggest the potential for eligibility for charity care,
the uninsured patient has been given at least 90 60 days
following the date of discharge or receipt of outpatient
care to submit an application for financial assistance and
has been assisted in completing the application in
accordance with Sections 16 and 27.
(4) If the uninsured patient has agreed to a
reasonable payment plan with the hospital, and the patient
has failed to make payments in accordance with that

SB2080 - 13 - LRB103 27565 CPF 53941 b
reasonable payment plan.
(5) If the uninsured patient informs the hospital that
he or she has applied for health care coverage under
Medicaid, Kidcare, or other government-sponsored health
care program (and there is a reasonable basis to believe
that the patient will qualify for such program) but the
patient's application is denied.
(6) The hospital has offered to provide the uninsured
patient with all financial assistance available to the
uninsured patient under the Hospital Uninsured Patient
Discount Act.
(7) The hospital has screened the uninsured patient
under Section 16 and is in full compliance with that
Section.
(a-5) A hospital shall proactively offer information on
charity care options available to uninsured patients,
regardless of their immigration status or residency.
(b) A hospital may not refer a bill, or portion thereof, to
a collection agency or attorney for collection action against
the insured patient, without first offering the patient the
opportunity to request a reasonable payment plan for the
amount personally owed by the patient. Such an opportunity
shall be made available for the 30 days following the date of
the initial bill. If the insured patient requests a reasonable
payment plan, but fails to agree to a plan within 30 days of
the request, the hospital may proceed with collection action

SB2080 - 14 - LRB103 27565 CPF 53941 b
against the patient.
(c) No collection agency, law firm, or individual may
initiate legal action for non-payment of a hospital bill
against a patient without the written approval of an
authorized hospital employee who reasonably believes that the
conditions for pursuing collection action under this Section
have been met.
(d) Nothing in this Section prohibits a hospital from
engaging an outside third party agency, firm, or individual to
manage the process of implementing the hospital's financial
assistance and reasonable payment plan programs and policies
so long as such agency, firm, or individual is contractually
bound to comply with the terms of this Act.
(Source: P.A. 102-504, eff. 12-1-21.)
Section 10. The Hospital Uninsured Patient Discount Act is
amended by changing Section 15 as follows:
(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, or any
other program, if there is a reasonable basis to believe that

SB2080 - 15 - LRB103 27565 CPF 53941 b
the uninsured patient may be eligible for such program, unless
the patient declines to apply for a public health insurance
program on the basis of concern for immigration-related
consequences to the patient, which shall not be grounds for
the hospital to deny financial assistance under the hospital's
financial assistance policy.
(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
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

SB2080 - 16 - LRB103 27565 CPF 53941 b
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
(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.

SB2080 - 17 - LRB103 27565 CPF 53941 b
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;
(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

SB2080 - 18 - LRB103 27565 CPF 53941 b
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
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.
(Source: P.A. 102-581, eff. 1-1-22.)