[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5150 Introduced in Senate (IS)]
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117th CONGRESS
2d Session
S. 5150
To amend the Public Health Service Act to provide additional
transparency and consumer protections relating to medical debt
collection practices.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 30 (legislative day, November 29), 2022
Mr. Murphy (for himself and Mr. Van Hollen) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide additional
transparency and consumer protections relating to medical debt
collection practices.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Strengthening Consumer Protections
and Medical Debt Transparency Act''.
SEC. 2. MEDICAL DEBT COLLECTIONS.
(a) In General.--Part C of title XXVII of the Public Health Service
Act (42 U.S.C. 300gg-91 et seq.) is amended by adding at the end the
following:
``SEC. 2795. MEDICAL DEBT COLLECTIONS.
``(a) Definitions.--
``(1) In general.--In this section:
``(A) Database.--The term `database' means the
medical debt collection database established under
subsection (e).
``(B) Debt collector.--The term `debt collector'
has the meaning as defined under the Fair Debt
Collection Practices Act.
``(C) Extraordinary collection action.--The term
`extraordinary collection action' is as defined for
purposes of section 501(r) of the Internal Revenue Code
of 1986 (as in effect on the date of enactment of this
section).
``(D) Health care entity.--The term `health care
entity' means an entity defined pursuant to paragraph
(2).
``(E) Medical debt.--The term `medical debt' means
debt arising from a patient's receipt of medical
services, products, or devices.
``(2) Health care entity.--For purposes of this section,
the Secretary shall develop a definition of the term `health
care entity' that shall include--
``(A) nonprofit, for-profit, critical access, and
cancer hospitals, including hospital-owned facilities;
``(B) independently licensed outpatient,
ambulatory, behavioral, optical, radiology, laboratory,
dental, emergency departments, and urgent care centers;
``(C) physician group practices, with an exemption
for small practices, as determined by the Secretary;
``(D) physician staffing firms or physician
services companies;
``(E) nursing home, skilled nursing and long-term
care facilities;
``(F) any health care agent of an entity described
in this paragraph; and
``(G) other entities as specified by the Secretary.
``(b) Requirements and Prohibitions.--
``(1) Debt collection.--A health care entity, or its debt
collector, shall not commence, or shall halt, an extraordinary
collection action with respect to a patient if the entity or
its designee is notified by any party that a health insurance
appeal is pending.
``(2) Determination of eligibility for assistance.--A
health care entity, or its debt collector, shall not commence
any extraordinary collection actions with respect to a patient
until the entity determines whether the patient qualifies for
assistance, either through enrollment in a Federal or State
program or through the entity's charity care or financial
assistance policy, with respect to such debt. The entity shall
refer such patient to any such assistance where available.
``(3) Prohibition on extraordinary collection.--With
respect to medical debt collection relating to a patient, a
health care entity, or its debt collector, shall not take any
extraordinary collection actions (including an action described
in sections 1.501(r)-6(a)(2) of title 26, Code of Federal
Regulations (as in effect on the date of enactment of this
section)) until the expiration of the 180-day period beginning
on the date on which the initial bill is sent to the patient,
or a later date if applicable.
``(4) Providing information to patients.--A health care
entity or its debt collector shall provide a patient with--
``(A) an easy-to-understand itemized statement of
the medical debt owed by the patient to the health care
entity prior to such entity, or the debt collector
acting on behalf of the entity, commencing collection
activities relating to such debt;
``(B) a copy of the detailed receipts of any
payments made to the entity or its debt collector by
the patient relating to the medical debt involved
within 30 days of such payments; and
``(C) information about the availability of
language-assistance services for individuals with
limited English proficiency (LEP).
``(5) Limitation on recovery by nonprofit entities.--A
health care entity that is a nonprofit entity, or its debt
collector, shall not collect amounts for the medical debt of a
patient who is not enrolled in health insurance coverage, that
are in excess of the amount generally billed, as described in
sections 1.501(r)-1(b)(1) and 1.501(r)-5(b) of title 26, Code
of Federal Regulations.
``(6) Requirement of health care entity or its debt
collector.--Prior to commencing any debt collection activity
with respect to a medical debt, the health care entity or its
debt collector shall make all reasonable efforts to confirm the
identity of the debtor.
``(7) Limit on medical debt interest.--The interest rate
growth applied with respect to any medical debt collected under
this section shall be set forth on the initial medical bill,
but shall not exceed 5 percent annually or the annual rate set
forth under section 1961 of title 28, United States Code, for
the calendar week preceding the date of the initial medical
bill plus 2 percent, whichever is lower. This subsection shall
not be construed to limit assistance or a lower interest rate
for a patient who is otherwise eligible for financial
assistance.
``(c) Penalties.--Except as provided in this section, a health care
entity, or its debt collector, that fails to comply with any provision
of this section with respect to a patient shall be liable to such
patient for damages in an amount equal to the sum of--
``(1) any actual damages sustained by such patient as a
result of such failure to comply;
``(2) in the case of an action commenced--
``(A) by an individual, any additional damages as
the court may permit, but not to exceed $1,000 for each
failure to comply; or
``(B) by a class of patients--
``(i) such amount for each named plaintiff
as could be recovered under paragraph (1) and
subparagraph (A); and
``(ii) such amount as the court may allow
for all other class members, without regard to
a minimum individual recovery, not to exceed
the lesser of $2,000,000 or 1 percent of the
annual net income of the covered provider; and
``(3) in the case of any successful action under this
section, the costs of the action, together with a reasonable
attorney's fee as determined appropriate by the court.
``(d) Establishment of Database.--
``(1) In general.--The Secretary shall establish and
regularly update a medical debt collection public database.
``(2) Required information.--Not later than 12 months after
the date of enactment of this section, and annually thereafter,
a health care entity shall submit to the database a debt
collection report that shall include--
``(A) the name and contact information of any debt
collector owned, utilized, or retained by the entity or
to which the entity assigned or sold medical debt
during the year;
``(B) a description, or link to such description,
of the processes and policies of the entity for
assigning a medical debt to the debt collector and for
compensating such collector for services provided to
the entity;
``(C) the type and number of extraordinary
collection practices the entity, or debt collector
reported by the entity pursuant to subparagraph (A),
undertakes or seeks to undertake, such as wage
garnishment, bank account attachments, liens, arrest
warrants, reporting to a consumer reporting agency, and
lawsuits;
``(D) the breakdown, by race and ethnicity, gender,
and ZIP Code of residence, of medical debt collection
accounts referred to a debt collector;
``(E) the breakdown, by race or ethnicity, gender,
and ZIP Code of residence, against whom the health
entity, or a debt collector used by the health entity,
filed an action to collect a debt owed on a medical
bill;
``(F) the breakdown, by race or ethnicity, gender,
and ZIP Code of residence, of medical debt collection
accounts the health entity has and has not reported or
classified as bad debt;
``(G) the total dollar amount of the cost of
charges for health care services provided to patients
but not collected by the health entity for patients
covered by insurance, including the out-of-pocket costs
for patients covered by insurance, and patients without
insurance;
``(H) the recovery rate on medical debt collection
cases assigned to the debt collector, as defined by the
Secretary;
``(I) the number of bills paid using a credit card;
and
``(J) any other information determined appropriate
by the Secretary.
``(3) Availability of information.--The information
contained in the database shall be available on a public,
searchable internet website regularly updated by the Secretary.
The Secretary shall annually publish a public list on HHS.gov
of any health care entity that fails to submit such required
information.
``(4) CFPB report.--Not later than 12 months after the
expiration of two annual reporting periods under paragraph (2),
the Director of the Consumer Financial Protection Bureau shall
submit to Congress a report containing an analysis of the
reports submitted under that paragraph and an explanation of
whether the findings based on the database under this
subsection are a useful tool for the agency's Supervision of
Nondepository Covered Persons, including the Risk-Based
Supervision Program (under section 1024 of Public Law 111-203).
Such report shall include recommendations to improve the
disclosures by health care entities for the purposes of
supervising the medical debt industry, including for predictive
analytics, machine learning, or other analysis techniques used
in its Risk-Based Supervision Program.''.
(b) CFPB Report.--Not later than 12 months after the date of
enactment of this Act, and every 2 years thereafter, the Consumer
Financial Protection Bureau shall publicly report on medical debt
collections, incorporating data from the medical debt collection public
database established pursuant to section 2795(a) of the Public Health
Service Act, anonymized data from the three largest credit bureaus, the
Consumer Financial Protection Bureau database of consumer complaints,
information from the Consumer Financial Protection Bureau's Supervision
of Nondepository Covered Persons program including the Risk-Based
Supervision Program, and relevant complaints and information from other
sources as available.
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