[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9129 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 9129
To amend title XVIII of the Social Security Act to establish certain
standards and requirements with respect to financial assistance and
medical debt collection for hospitals participating in the Medicare
program, and to amend title III of the Public Health Service Act to
establish a grant program for purposes of medical debt relief.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 24, 2024
Mr. Vasquez (for himself, Mr. Horsford, Mr. Ruiz, Mr. Thanedar, Ms.
Schrier, and Ms. Barragan) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish certain
standards and requirements with respect to financial assistance and
medical debt collection for hospitals participating in the Medicare
program, and to amend title III of the Public Health Service Act to
establish a grant program for purposes of medical debt relief.
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 ``Patient Debt Relief Act''.
SEC. 2. ESTABLISHING STANDARDS AND REQUIREMENTS WITH RESPECT TO
FINANCIAL ASSISTANCE AND MEDICAL DEBT COLLECTION AS
CONDITION OF PARTICIPATION IN THE MEDICARE PROGRAM.
Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is
amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the
end;
(B) in subparagraph (Y), by striking the period at
the end and inserting ``, and''; and
(C) by inserting after subparagraph (Y) the
following new subparagraph:
``(Z) in the case of a hospital, beginning January 1, 2026,
to comply with the financial assistance and debt collection
requirements described in subsection (l).'';
(2) in subsection (b), by adding at the end the following
new paragraph:
``(5)(A) A hospital that fails to comply with the
requirements of subsection (a)(1)(Z) (relating to financial
assistance and debt collection) is subject to a civil monetary
penalty under this paragraph.
``(B) The Secretary may impose a civil monetary penalty in
an amount specified by the Secretary (but not to exceed
$1,000,000) for each instance of noncompliance with the
requirements of subsection (a)(1)(Z), as determined by the
Secretary, if--
``(i) not later than 90 days after the date on
which the Secretary determines such noncompliance
exists, the Secretary submits to such hospital a
notification of such determination; and
``(ii) as of the date that is 45 days after such
notification is sent, the Secretary determines that
such hospital has not taken meaningful actions to come
into compliance with such requirements.
The provisions of section 1128A (other than subsections (a) and
(b)) shall apply to a civil monetary penalty under this
paragraph in the same manner as such provisions apply to a
penalty or proceeding under section 1128A(a).''; and
(3) by adding at the end the following new subsection:
``(l) Financial Assistance and Debt Collection Requirements.--
``(1) In general.--For purposes of subsection (a)(1)(Z),
the financial assistance and debt collection requirements are,
with respect to a hospital--
``(A) the financial assistance and charity care
requirements described in paragraph (2); and
``(B) the medical debt collection limitations
described in paragraph (3).
``(2) Financial assistance and charity care requirements.--
For purposes of paragraph (1), the requirements described in
this paragraph are, with respect to a hospital, the following:
``(A) The hospital--
``(i) has established a charity care or
financial assistance policy;
``(ii) has established minimum eligibility
requirements with respect to such charity care
or financial assistance policy, and has made
such requirements publicly available; and
``(iii) has established a process for
screening individuals furnished items or
services by the hospital to determine whether
each such individual may be eligible for
assistance with respect to payment for such
items or services pursuant to such charity care
or financial assistance policy.
``(B) With respect to items or services furnished
by the hospital to an individual who has applied for
charity care or financial assistance under the policy
described in subparagraph (A)(i), the hospital--
``(i) determines, not later than 30 days
before the date on which payment for such items
or services is due, whether such individual is
eligible for assistance with respect to such
payment pursuant to such charity care or
financial assistance policy;
``(ii) in the case that a hospital
determines pursuant to clause (i) that an
individual is ineligible for such charity care
or financial assistance policy with respect to
such payment, permits such individual to appeal
such determination; and
``(iii) does not seek to collect such
payment from such individual until the
determination under clause (i) with respect to
such individual has been made.
``(C) The hospital includes with any bill for
payment with respect to items or services furnished by
the hospital to an individual--
``(i) the minimum eligibility requirements
described in subparagraph (A)(ii) with respect
to the charity care or financial assistance
policy of the hospital;
``(ii) notice of the medical debt
collection limitations described in paragraph
(3), including the repayment program described
in subparagraph (C)(ii) of such paragraph; and
``(iii) instructions for the individual to
submit to the hospital any information that
would be necessary for the hospital to make a
determination with respect to the household
income of such individual at the time such
items or services were furnished for purposes
of carrying out subparagraph (D) of such
paragraph.
``(3) Medical debt collection limitations.--For purposes of
paragraph (1), the limitations described in this paragraph are,
with respect to a hospital and medical debt owed to the
hospital by an individual, that--
``(A) the hospital does not seek to place a lien on
or foreclose upon the home of such individual in order
to collect such medical debt;
``(B) the hospital does not seek to garnish the
wages of such individual in order to collect such
medical debt;
``(C) subject to subparagraph (D)(ii), the hospital
does not sell or assign such medical debt to a debt
collector unless--
``(i) more than 1 year has elapsed since
the date on which payment for such items or
services was due;
``(ii) the hospital makes available to the
individual a repayment program under which the
individual may make minimum monthly payments
(provided that each such payment does not
exceed 4 percent of the gross monthly income of
such individual) toward the medical debt, and
such individual fails to make 4 or more
consecutive monthly payments under such
repayment program or otherwise declines to
participate in such repayment program; and
``(iii) such debt collector agrees to abide
by the limitations described in subparagraphs
(A) and (B) for such hospital with respect to
such medical debt; and
``(D) in the case that the hospital has received
the necessary information to make the determination
described in paragraph (2)(C)(iii), if the hospital
determines that the household income of such individual
was not in excess of 250 percent of the poverty line
for the size of the family involved for the most recent
taxable year at the time the items or services that are
the subject of such medical debt were furnished, the
hospital--
``(i) does not impose an annual interest
rate with respect to such payment; and
``(ii) does not sell or assign such medical
debt to a debt collector.
``(4) Monitoring compliance.--
``(A) Audits.--Beginning January 1, 2027, and not
less frequently than annually thereafter, the Secretary
shall conduct an audit of a random sample of hospitals
to determine whether each such hospital is in
compliance with the requirements of paragraph (1).
``(B) Online portal.--Not later than January 1,
2026, the Secretary shall establish a secure internet
website portal (or other successor technology) to
permit individuals to report the noncompliance of a
hospital with the requirements of paragraph (1),
including noncompliance with the limitations described
in subparagraphs (A) and (B) of paragraph (3) of a debt
collector to which the hospital has sold or assigned
medical debt.
``(5) Definitions.--In this subsection:
``(A) Debt collector.--The term `debt collector'
has the meaning given such term in section 803(6) of
the Fair Debt Collection Practices Act (15 U.S.C.
1692a(6)).
``(B) Medical debt.--The term `medical debt' means,
with respect to items or services furnished by a
hospital to an individual, the debt (as defined in
section 803(5) of the Fair Debt Collection Practices
Act (15 U.S.C. 1692a(5))) of such individual for such
items or services.''.
SEC. 3. MEDICAL DEBT RELIEF PROGRAM.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following new
section:
``SEC. 399V-8. MEDICAL DEBT RELIEF GRANT PROGRAM.
``(a) In General.--Not later than 1 year after the date of the
enactment of this section, the Secretary shall establish a program
under which the Secretary may make grants to not more than 1 eligible
nonprofit organization to acquire and discharge the medical debt (as
defined by the Secretary) of eligible individuals in accordance with
this section.
``(b) Application.--An eligible nonprofit seeking a grant under
this section shall submit an application at such time, in such form,
and containing such information as the Secretary may require.
``(c) Use of Funds.--Amounts provided under a grant under this
section shall be used to--
``(1) identify eligible individuals; and
``(2) acquire and discharge the medical debt of such
individuals.
``(d) Notice and Reporting Requirements.--
``(1) Notice requirement.--Not later than 60 days after an
eligible nonprofit organization that has received a grant under
this section acquires and discharges the medical debt of an
eligible individual under subsection (c), such eligible
nonprofit organization shall notify such individual of such
acquisition and discharge.
``(2) Reporting requirement.--Not less frequently than once
per calendar quarter, an eligible nonprofit organization that
has received a grant under this section shall submit to the
Secretary a report containing the following information with
respect to the preceding calendar quarter:
``(A) The actions taken by the eligible nonprofit
organization to identify eligible individuals.
``(B) The number of eligible individuals whose
medical debt was acquired and discharged by the
eligible nonprofit organization, and the amount of
medical debt so acquired and discharged.
``(C) Such other information as the Secretary may
require.
``(e) Definitions.--In this section:
``(1) Eligible individual.--The term `eligible individual'
means an individual with medical debt if, for the most recent
taxable year--
``(A) such medical debt is equivalent to 5 percent
or more of the modified adjusted gross income of such
individual; or
``(B) the household income of such individual is
not in excess of 400 percent of the poverty line for
the size of the family involved.
``(2) Eligible nonprofit organization.--The term `eligible
nonprofit organization' means a nonprofit organization with the
mission of relieving individuals of their medical debt, as
determined by the Secretary.
``(3) IRC terms.--The terms `household income', `modified
adjusted gross income', and `poverty line' have the meaning
given each such term in section 36B of the Internal Revenue
Code of 1986 (26 U.S.C. 36B).
``(f) Funding.--There is authorized to be appropriated for purposes
of carrying out this section $100,000,000 for fiscal year 2025, to
remain available until expended.''.
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