PRIOR PRINTER'S NOS. 67, 1591
PRINTER'S NO. 1675
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
78
Session of
2023
INTRODUCED BY VENKAT, BULLOCK, KHAN, KOSIEROWSKI, PISCIOTTANO,
SCHLOSSBERG, SIEGEL, RABB, KINSEY, MADDEN, PROBST, SANCHEZ,
PARKER, HILL-EVANS, N. NELSON, DELLOSO, WARREN, ABNEY,
T. DAVIS, SMITH-WADE-EL, BIZZARRO, FLEMING, INNAMORATO,
MALAGARI, KINKEAD, McNEILL, GUENST, GREEN, HADDOCK, SOLOMON,
BOROWSKI, SHUSTERMAN, FIEDLER, FRIEL, SALISBURY, ZABEL,
MADSEN, KENYATTA, STURLA, MARKOSEK, KAZEEM, CONKLIN, STEELE,
OTTEN, TAKAC, DALEY, KUZMA, WEBSTER AND GUZMAN, MARCH 7, 2023
AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
JUNE 22, 2023
AN ACT
Establishing the Medical Debt Relief Program; establishing
requirements for hospital-based financial assistance; and
imposing duties on the Department of Health.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Medical Debt
Relief Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Bad debt expense." The cost of care for which a health care
provider expected payment from the patient or a third-party
payor, but which the health care provider or commercial debt
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collection agency subsequently determines to be uncollectible.
"Department." The Department of Health of the Commonwealth.
"Eligible patient." An individual who meets all of the
following requirements:
(1) Is a resident of this Commonwealth.
(2) Can demonstrate an inability to pay the cost of
medical care even after the application of payments for
third-party health coverage.
(3) Provides financial information and documentation
showing that their income and assets make them eligible for
hospital-based financial assistance under the policies of the
hospital and of this act.
"Eligible resident." An individual eligible for relief who
meets all of the following conditions:
(1) Is a resident of this Commonwealth.
(2) Has a household income at or below 400% of the
Federal poverty guidelines or has medical debt equal to 5% or
more of the individual's household income.
"Health care provider." Either of the following:
(1) A health care provider, as defined in section 1201
of the act of May 17, 1921 (P.L.682, No.284), known as The
Insurance Company Law of 1921.
(2) An emergency medical services agency, as defined in
35 Pa.C.S. § 8103 (relating to definitions).
"Hospital-based financial assistance." Financial assistance
provided by hospitals to patients that includes charity care or
discounted care where the cost of care ordinarily charged by a
hospital is provided free of charge or at a reduced rate or a
hospital relieves an eligible patient's medical bill in part or
in full based on eligibility criteria.
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"Medical debt." An obligation to pay money arising from the
receipt of health care services.
"Medical debt relief." The discharge of a patient's medical
debt.
"Medical debt relief coordinator." A person, company,
partnership or other entity that is able to discharge medical
debt of an eligible resident in a manner that does not result in
a taxable event for the eligible resident.
"Primary language." A language that is the preferred
language for communication during at least 5% of the annual
patient visits by patients who do not have the proficiency in
English necessary to speak, read and write about health care-
related matters.
"Program." The Medical Debt Relief Program established under
section 3.
"Public health coverage option." A program administered by
the Department of Human Services, including Medical Assistance
and the Children's Health Insurance Program, and by the
Pennsylvania Health Insurance Exchange Authority.
Section 3. Medical Debt Relief Program.
(a) Establishment and purpose.--The Medical Debt Relief
Program is established within the department for the purpose of
discharging medical debt of eligible residents by contracting
with a medical debt relief coordinator as described in
subsection (c).
(b) Use of money.--Money appropriated to the department for
the program shall be used exclusively for the program, including
contracting with a medical debt relief coordinator and providing
money to be used by the medical debt relief coordinator to
discharge medical debt of eligible residents. Money used in
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contracting with a medical debt relief coordinator may also be
used for the payment of services provided by the medical debt
relief coordinator to discharge medical debt of eligible
residents based on a budget approved by the department.
(c) Contracts.--
(1) The department is authorized to and shall enter into
a contract with a medical debt relief coordinator to purchase
and discharge medical debt owed by an eligible resident with
money allocated for the program.
(2) The department shall implement a competitive bidding
process to determine which medical debt relief coordinator to
use, unless the department determines that only a single
medical debt relief coordinator has the capacity and
willingness to carry out the duties specified in this act.
(3) In contracting with the department, a medical debt
relief coordinator shall adhere to the following:
(i) The medical debt relief coordinator shall review
the medical debt accounts of each commercial debt
collection agency or health care provider willing to sell
medical debt accounts in this Commonwealth.
(ii) The medical debt relief coordinator may elect
to buy the dischargeable medical debt from the commercial
debt collection agency or health care provider that
identifies the accounts described in subparagraph (i) as
a bad debt expense.
(iii) After the purchase and discharge of medical
debt from a commercial debt collection agency or health
care provider, the medical debt relief coordinator shall
notify all eligible residents whose medical debt has been
discharged under the program, in a manner approved by the
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department, that they no longer have specified medical
debt owed to the relevant health care provider or
commercial debt collection agency.
(iv) A medical debt relief coordinator shall make a
best effort to ensure parity and equity in the purchasing
and discharging of medical debt to ensure that all
eligible residents have an equal opportunity of receiving
medical debt relief regardless of their geographical
location or identities and characteristics as identified
in section 2 of the act of October 27, 1955 (P.L.744,
No.222), known as the Pennsylvania Human Relations Act.
(v) A medical debt relief coordinator shall report
to the department the summary statistics regarding
eligible residents whose medical debt has been
discharged.
(vi) A medical debt relief coordinator may not
attempt to seek payment from an eligible resident for
medical debt purchased by the medical debt relief
coordinator.
(4) A medical debt relief coordinator shall continue to
fulfill its contractual obligations to the department until
all money contracted to the medical debt relief coordinator
is exhausted, regardless of whether money allocated to the
program has been exhausted.
(d) Breach of contract.--If a medical debt relief
coordinator attempts to seek payment from an eligible resident
for medical debt purchased by the medical debt relief
coordinator or fails to carry out the responsibilities described
in its contract with the department, the medical debt relief
coordinator shall be considered in breach of contract and the
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contract provisions that apply in the case of a breach of
contract shall apply.
Section 4. Reporting on program.
(a) Requirement.--Beginning one year after the effective
date of this section and annually thereafter for as long as
medical debt relief coordinators are fulfilling their
contractual obligations under this act, the department shall
submit an annual report regarding the program in accordance with
this section.
(b) Contents.--Each report under this section shall contain
the following information for the annual period covered by the
report:
(1) The amount of medical debt purchased and discharged
under the program.
(2) The number of eligible residents who received
medical debt relief under the program.
(3) The characteristics of the eligible residents as
described in section 3(c)(3)(iv).
(4) The number of patients whose debt was discharged
that qualified for hospital-based financial assistance or a
public health coverage option.
(4) THE NUMBER AND CHARACTERISTICS OF HEALTH CARE
PROVIDERS FROM WHOM MEDICAL DEBT WAS PURCHASED AND
DISCHARGED.
(5) The number of eligible residents whose income was
calculated at 100%, 150% or 200% of the Federal poverty
level.
(6) The number of and characteristics of medical debt
relief coordinators contracted with for the purposes of
purchasing and discharging medical debt.
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(c) Submittal.--Each report under this section shall be
submitted to the following:
(1) The Governor.
(2) The President pro tempore of the Senate.
(3) The Speaker of the House of Representatives.
(4) The Majority Leader and Minority Leader of the
Senate.
(5) The Majority Leader and Minority Leader of the House
of Representatives.
(6) The chairperson and minority chairperson of the
Health and Human Services Committee of the Senate.
(7) The chairperson and minority chairperson of the
Health Committee of the House of Representatives.
Section 5. Hospital-based financial assistance forms and
policies.
(a) Forms.--The department shall develop the following forms
and make them available to hospitals and the general public:
(1) A uniform application for financial assistance that
shall be used in every hospital in this Commonwealth to
determine if an individual is an eligible patient.
(2) A uniform one-page template all hospitals shall use
to summarize eligibility information for financial
assistance. At a minimum, the summary shall include:
(i) Income eligibility guidelines for hospital-based
financial assistance expressed as both a percent of the
Federal Poverty Income Guidelines and a dollar amount
based on common household sizes.
(ii) Information about the limits on amounts and
type of assets.
(iii) Information on income eligibility guidelines
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for a public health coverage option expressed as both a
percent of the Federal Poverty Income Guidelines and a
dollar amount based on common household sizes and how to
apply for those coverage options.
(iv) Contact information for how to apply for
hospital-based financial assistance and how to get help
applying for hospital-based financial assistance.
(3) A brief uniform statement of the availability of
hospital-based financial assistance and of the application
for hospital-based financial assistance to be stated
prominently on hospital materials.
(b) Development of form.--The department shall include input
from hospitals and the general public in developing the forms
described in subsection (a)(1).
(c) Accessibility of forms.--Each form outlined in
subsection (a) shall be:
(1) Written in plain language at a sixth grade reading
level.
(2) Translated by the department into all primary
languages identified by a hospital.
(3) Made accessible by the hospital to individuals with
visual impairments upon request.
(4) Posted by hospitals online in a publicly accessible
format. A full copy of the hospital's financial assistance
policies shall also be published along with the summary in
subsection (a)(2).
(d) Disclosure to patients.--
(1) A hospital shall provide the form discussed in
subsection (a)(2) to all patients upon intake and discharge.
Additionally, a hospital shall place the uniform statement
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provided for in subsection (a)(3) on all bills, billing
statements, good faith estimates, admittance forms and
discharge paperwork.
(2) A hospital shall provide a full copy of its
financial assistance policies upon request.
(3) A hospital shall provide assistance understanding
and completing a financial assistance application upon
request.
(e) Alignment with public health coverage options.--
(1) Hospitals shall use the income counting rules and
household composition rules consistent with 42 CFR 435.603
(relating to application of modified adjusted gross income
(MAGI)) and shall adjust their policies according to rules
within 180 days after the effective date of this paragraph.
(2) The Department of Human Services shall explore a
process for connecting the uniform application for financial
assistance with the department's electronic eligibility
system in order to evaluate an applicant's eligibility for a
public health coverage option.
(3) A patient seeking financial assistance may provide
the following financial information and documentation in
support of their application:
(i) paychecks or pay stubs;
(ii) unemployment documentation;
(iii) Social Security income;
(iv) rent receipts;
(v) a letter from the patient's employer attesting
to the patient's gross income;
(vi) copies of recent tax returns; or
(vii) if none of the aforementioned information and
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documentation are available, a written self-attestation
of the patient's income.
(4) Hospitals may provide hospital-based financial
assistance to any patient who is already enrolled in the
Supplemental Nutrition Assistance Program (SNAP), Special
Supplemental Nutrition Program for Women, Infants and
Children (WIC) or Low-Income Home Energy Assistance Program
(LIHEAP), based on presumptive eligibility through use of
electronic verification data.
(5) Upon submission of a completed application form, the
patient is not liable for any bills until the hospital has
rendered a decision on the application.
Section 6. Tax applicability.
The amount of interest and principal balance of medical debt
discharged under the program shall not be included in the
classes of income identified in section 303 of the act of March
4, 1971 (P.L.6, No.2), known as the Tax Reform Code of 1971.
Section 7. Effective date.
This act shall take effect immediately.
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