,,ii  #aafth ,,congress  #b;d ,session  
,s4 #dfig  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #bd1
 #bjbj,mr4 ,murphy 7for himself and ,mr4
 ,van ,hollen7 introduced the following 
bill2 which was read twice and referred 
to the ,committee on ,health1           
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to amend the ,public ,health   
,service ,act to provide additional     
transparency and consumer protections   
relating to medical debt collection     
practices4  #a4 ,short title ,this ,act 
may be cited as the ,strengthening      
,consumer ,protections and ,medical     
,debt ,transparency ,act4  #b4 ,medical 
debt collections  7a7 ,in general ,part 
,c of title ,,xxvii of the ,public      
,health ,service ,act 7#db ,u4,s4,c4    
#cjj;gg-#ia et seq47 is amended by      
adding at the end the following3  #bgie4
 ,medical debt collections  7a7         
,definitions  7#a7 ,in general ,in this 
section3 7,a7 ,database ,the term       
database means the medical debt         

collection database established under   
subsection 7e74  7,b7 ,debt collector   
,the term debt collector has the meaning
 as defined under the ,fair ,debt       
,collection ,practices ,act4  7,c7      
,extraordinary collection action ,the   
term extraordinary collection action is 
as defined for purposes of section      
#eja7r7 of the ,internal ,revenue ,code 
of #aihf 7as in effect on the date of   
enactment of this section74  7,d7       
,health care entity ,the term health    
care entity means an entity defined     
pursuant to paragraph 7#b74  7,e7       
,medical debt ,the term medical debt    
means debt arising from a patient's     
receipt of medical services1 products1  
or devices4  7#b7 ,health care entity   
,for purposes of this section1 the      
,secretary shall develop a definition of
 the term health care entity that shall 
include-- 7,a7 nonprofit1 for-profit1   
critical access1 and cancer hospitals1  
including hospital-owned facilities2    
7,b7 independently licensed outpatient1 

ambulatory1 behavioral1 optical1        
radiology1 laboratory1 dental1 and      
emergency departments2  7,c7 physician  
group practices1 with an exemption for  
small practices1 as determined by the   
,secretary2  7,d7 physician staffing    
firms or physician services companies2  
7,e7 any health care agent of an entity 
described in this paragraph2 and  7,f7  
other entities as specified by the      
,secretary4  7b7 ,requirements and      
prohibitions  7#a7 ,debt collection ,a  
health care entity1 or its debt         
collector1 shall not commence1 or shall 
halt1 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 
pending4  7#b7 ,determination of        
eligibility for assistance ,a health    
care entity1 or its debt collector1     
shall not commence any extraordinary    
collection actions with respect to a    
patient until the entity determines     
whether the patient qualifies for       

assistance1 either through enrollment in
 a ,federal or ,state program or through
 the entity's charity care or financial 
assistance policy1 with respect to such 
debt4 ,the entity shall refer such      
patient to any such assistance where    
available4  7#c7 ,prohibition on        
extraordinary collection ,with respect  
to medical debt collection relating to a
 patient1 a health care entity1 or its  
debt collector1 shall not take any      
extraordinary collection actions        
7including an action described in       
sections #a4eja7r7-#f7;a77#b7 of title  
#bf1 ,code of ,federal ,regulations 7as 
in effect on the date of enactment of   
this section77 until the expiration of  
the #ahj-;day period beginning on the   
date on which the initial bill is sent  
to the patient1 or a later date if      
applicable4  7#d7 ,providing information
 to patients ,a health care entity or   
its debt collector shall provide a      
patient with-- 7,a7 an                  
easy-to-understand itemized statement of

 the medical debt owed by the patient to
 the health care entity prior to such   
entity1 or the debt collector acting on 
behalf of the entity1 commencing        
collection activities relating to such  
debt2 and  7,b7 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 #cj days of such        
payments4  7#e7 ,limitation on recovery 
by nonprofit entities ,a health care    
entity that is a nonprofit entity1 or   
its debt collector1 shall not collect   
amounts for the medical debt of a       
patient who is not enrolled in health   
insurance coverage1 that are in excess  
of the amount generally billed1 as      
described in sections                   
#a4eja7r7-#a7;b77#a7 and                
#a4eja7r7-#e7;b7 of title #bf1 ,code of 
,federal ,regulations4  7#f7            
,requirement of health care entity or   
its debt collector ,prior to commencing 
any debt collection activity with       

respect to a medical debt1 the health   
care entity or its debt collector shall 
make all reasonable efforts to confirm  
the identity of the debtor4  7#g7 ,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 bill1 but shall not     
exceed #e percent annually or the annual
 rate set forth under section #aifa of  
title #bh1 ,united ,states ,code1 for   
the calendar week preceding the date of 
the initial medical bill plus #b        
percent1 whichever is lower4 ,this      
subsection shall not be construed to    
limit assistance or a lower interest    
rate for a patient who is otherwise     
eligible for financial assistance4  7c7 
,penalties ,except as provided in this  
section1 a health care entity1 or its   
debt collector1 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-- 7#a7 any actual   
damages sustained by such patient as a  
result of such failure to comply2  7#b7 
in the case of an action commenced--    
7,a7 by an individual1 any additional   
damages as the court may permit1 but not
 to exceed #a1jjj for each failure to   
comply2 or  7,b7 by a class of          
patients-- 7i7 such amount for each     
named plaintiff as could be recovered   
under paragraph 7#a7 and subparagraph   
7,a72 and  7ii7 such amount as the court
 may allow for all other class members1 
without regard to a minimum individual  
recovery1 not to exceed the lesser of   
#b1jjj1jjj or #a percent of the annual  
net income of the covered provider2 and 
7#c7 in the case of any successful      
action under this section1 the costs of 
the action1 together with a reasonable  
attorney's fee as determined appropriate
 by the court4  7d7 ,establishment of   
database  7#a7 ,in general ,the         
,secretary shall establish and regularly
 update a medical debt collection public

 database4  7#b7 ,required information  
,not later than #ab months after the    
date of enactment of this section1 and  
annually thereafter1 a health care      
entity shall submit to the database a   
debt collection report that shall       
include-- 7,a7 the name and contact     
information of any debt collector owned1
 utilized1 or retained by the entity or 
to which the entity assigned or sold    
medical debt during the year2  7,b7 a   
description1 or link to such            
description1 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 entity2  7,c7  
the type and number of extraordinary    
collection practices the entity1 or debt
 collector reported by the entity       
pursuant to subparagraph 7,a71          
undertakes or seeks to undertake1 such  
as wage garnishment1 bank account       
attachments1 liens1 arrest warrants1    
reporting to a consumer reporting       

agency1 and lawsuits2  7,d7 the         
breakdown1 by zip code1 of medical debt 
collection accounts referred to a debt  
collector2  7,e7 the recovery rate on   
medical debt collection cases assigned  
to the debt collector1 as defined by the
 ,secretary2  7,f7 the number of bills  
paid using a credit card2 and  7,g7 any 
other information determined appropriate
 by the ,secretary4  7#c7 ,availability 
of information ,the information         
contained in the database shall be      
available on a public1 searchable       
internet website regularly updated by   
the ,secretary4 ,the ,secretary shall   
annually publish a public list on       
,,hhs4gov of any health care entity that
 fails to submit such required          
information4  7#d7 ,,cfpb report ,not   
later than #ab months after the         
expiration of two annual reporting      
periods under paragraph 7#b71 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 
,persons1 including the ,risk-,based    
,supervision ,program 7under section    
#ajbd of ,public ,law #aaa-bjc74 ,such  
report shall include recommendations to 
improve the disclosures by health care  
entities for the purposes of supervising
 the medical debt industry1 including   
for predictive analytics1 machine       
learning1 or other analysis techniques  
used in its ,risk-,based ,supervision   
,program4  4  7b7 ,,cfpb report ,not    
later than #ab months after the date of 
enactment of this ,act1 and every #b    
years thereafter1 the ,consumer         
,financial ,protection ,bureau shall    
publicly report on medical debt         
collections1 incorporating data from the
 medical debt collection public database
 established pursuant to section        

#bgie7;a7 of the ,public ,health        
,service ,act1 anonymized data from the 
three largest credit bureaus1 the       
,consumer ,financial ,protection ,bureau
 database of consumer complaints1       
information from the ,consumer          
,financial ,protection ,bureau's        
,supervision of ,nondepository ,covered 
,persons program including the          
,risk-,based ,supervision ,program1 and 
relevant complaints and information from
 other sources as available4