Healthcare Bills: Illinois Lawmaking Process Explained

Healthcare is a human right, and Illinois has taken steps to ensure that its residents can access this right. The state has passed several laws to improve healthcare access and equity, including the Fair Patient Billing Act, the Health Care and Human Services Reform Act, and the Healthy Illinois for All Law. These laws aim to address health inequities, improve transparency, and ensure fair billing practices. The process of how these healthcare bills and amendments become law in Illinois involves introduction and consideration by the Illinois General Assembly, approval by the Governor, and publication on the Illinois General Assembly website.

The Fair Patient Billing Act

Patient Notification

Hospitals are required to make financial assistance information available to patients. This includes posting signs in admission and registration areas with the following notice:

> "You may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For more information, contact [hospital financial assistance representative]."

The sign should be in English and in any other language that is the primary language of at least 5% of the patients served by the hospital annually. Hospitals with websites must also post this information prominently on their sites. In addition, hospitals must make information regarding financial assistance available in the form of a brochure, application, or other written materials in the hospital admission or registration area.

Bill Information and Inquiries

When billing patients, hospitals must provide the following information:

• The date(s) of health care service
• A brief description of the services provided
• The amount owed for the hospital services
• Hospital contact information for questions about bills
• A statement regarding how an uninsured patient may apply for consideration under the hospital's financial assistance policy
• Notice that a patient may obtain an itemized bill upon request

Every hospital must have a process for patients to inquire about or dispute a bill, including a telephone number to contact the hospital. Hospitals may also provide additional ways for patients to get in touch, including a toll-free number, a mailing address, a specific department or individual to contact, a website, or an email address. Hospitals must respond to calls within two business days and to written requests within 10 business days.

Bill Collection Action

Before referring a patient's bill to a collection agency, hospitals must give the patient an opportunity to:

• Assess the accuracy of the bill
• Apply for financial assistance under the hospital's financial assistance policy (hospitals must give patients 60 days from the date of discharge or receipt of outpatient care to submit an application)
• Request a reasonable payment plan. Hospitals may require patients to provide verification of their inability to pay the full amount in one payment

Bill Collection Limitations

Hospitals cannot pursue legal action for non-payment of a hospital bill against uninsured patients who have clearly demonstrated that they do not have sufficient income or assets to meet their financial obligations. To receive this protection, patients must provide the hospital with all reasonably requested financial information and documentation needed to determine their eligibility for financial assistance and payment plan options.

Notification of Out-of-Network Providers for Insured Patients

During hospital admission or as soon as is practicable, the hospital must provide insured patients with written notice that:

• They may receive separate bills for services provided by health care professionals affiliated with the hospital
• Some hospital staff members may not be participating providers in the same insurance plan and networks as the hospital
• They may have a greater financial responsibility for services provided at the hospital by providers who are not under contract with their insurance plan
• Patients should direct questions about coverage or benefit levels to their insurance plan

The Health Care and Human Services Reform Act

Healthcare bills and amendments become law in Illinois when they are signed by the Governor of Illinois. For example, the Health Care and Human Services Reform Act was signed into law by Governor JB Pritzker on April 27, 2021. This Act was established to address health inequities and obstacles, create new programs, increase oversight and training, and improve transparency.

The Act also created the Underlying Causes of Crime and Violence Study Act, which aimed to identify high-violence communities and prioritize state funding to address the underlying health issues and causes of violence in those areas. Furthermore, it reduced taxes on blood sugar testing products to 1% and amended the Employee Paid Sick Leave Act to include care for extended family members.

Lastly, the Act included provisions to improve the quality of care for all Illinois residents. It mandated that any intern, resident, or physician providing services at a hospital must have proper credentials and ongoing training certificates. Hospitals were also instructed to provide N95 masks to all physicians and nurses free of charge, and dementia training was increased with continuing annual training requirements.

The Hospital Uninsured Patient Discount Act

Eligibility Criteria:

To be eligible for the discount, patients must meet specific criteria:

• Residency: The patient must be an Illinois resident, which can be challenging to prove for homeless individuals.
• Insurance Status: The patient must not have health insurance coverage under any health benefit plan.
• Financial Status: The patient's family income and assets must not exceed certain thresholds. For non-rural hospitals, the limit is 600% of the federal poverty level ($132,300 for a family of four). Meanwhile, rural or critical access hospitals have a limit of 300% of the federal poverty level ($66,150 for a family of four).
• Application Deadline: Patients must apply for the discount within 60 days of receiving their hospital bill or within 90 days of the date of discharge, service, or completion of screening under the Fair Patient Billing Act.

Discount Structure:

The discount offered to eligible uninsured patients is based on a sliding scale:

• A person earning six times the poverty line receives a 70% discount.
• For those earning 4.01 to 5 times the poverty line, the discount is 75%.
• If the income is 3.01 to 4 times the poverty line, the discount increases to 80%.
• Those with an income of 2.01 to 3 times the poverty line get a 90% discount.
• Individuals earning double the poverty line or less are eligible for a 100% discount.

Additional Protections:

• Annual Cap: Hospitals cannot collect more than 25% of a patient's family income in a year for medical services.
• Bill Collection Limitations: Hospitals cannot pursue legal action for non-payment against uninsured patients who lack sufficient income or assets.
• Billing Requirements: Hospitals must provide detailed billing information, including dates of service, descriptions, amounts owed, and contact information for inquiries.
• Payment Plans: Patients must be given the opportunity to request a reasonable payment plan before hospitals initiate collection efforts.

The Attorney General of Illinois is responsible for enforcing this law and addressing any complaints or disputes related to its implementation. The law aims to make healthcare more accessible and affordable for uninsured individuals in the state.

The Health and Human Services Taskforce

The creation of this taskforce is a significant step in the state's ongoing efforts to address health inequities and barriers, while also establishing new programs, bolstering oversight and training initiatives, and improving transparency. The taskforce is part of a broader legislative agenda that aims to tackle systemic racism and enhance the lives of underserved families across Illinois.

The Health and Human Services Reform Act also includes several other provisions aimed at improving healthcare access, equity, and quality for all Illinois residents. For instance, the Act establishes a Community Health Workers program, which will provide training and certification to ensure that Illinoisans can more easily access assistance from trained health workers. Additionally, the Act mandates implicit bias training for interns, residents, and physicians, better preparing them to serve all Illinois residents.

Furthermore, the Act addresses financial concerns related to healthcare. The Fair Patient Billing Act, which came into effect in 2007, ensures that hospitals employ fair billing and collection methods. This Act outlines specific requirements for hospitals, such as providing patients with detailed billing information and offering financial assistance to those in need. It is worth noting that the Fair Patient Billing Act does not apply to hospitals that offer free medical services.

In conclusion, the Health and Human Services Taskforce is a crucial component of Illinois' comprehensive approach to improving healthcare access, equity, and quality for its residents. By reviewing health and human service departments and programs, the taskforce will play a pivotal role in advancing the state's legislative agenda and ensuring that healthcare becomes a right for all Illinois residents.

The Medicaid Business Opportunity Commission

The Act includes several measures to improve healthcare access and equity, such as the creation of a Community Health Workers program, addressing implicit bias in healthcare, and improving transparency. One of the key components of the Act is the establishment of the Medicaid Business Opportunity Commission within the Illinois Department of Healthcare and Family Services (HFS).

The Commission's primary goal is to develop a program that supports and promotes the growth of businesses owned by minorities, women, and persons with disabilities. This initiative aligns with the overall objective of the legislation to reduce healthcare disparities and improve access to healthcare services for underserved communities in Illinois.

The Commission's work will likely involve creating and implementing policies that encourage and facilitate the participation of minority, women, and disability-owned businesses in the healthcare industry. This may include providing resources, training, and support to help these businesses succeed and contribute to a more diverse and inclusive healthcare sector in Illinois.

The establishment of the Medicaid Business Opportunity Commission demonstrates a commitment to addressing systemic racism and promoting economic opportunities for underrepresented groups in the healthcare industry. By supporting the growth of businesses owned by minorities, women, and persons with disabilities, the Commission aims to create a more equitable and inclusive healthcare environment in Illinois.

Frequently asked questions