,i #aaith ,,congress #b;d ,session ,h4 ,r4 #gdgh ,,in ,,the ,,house ,,of ,,representatives ,february #aj1 #bjbf,mr4 ,vasquez 7for himself1 ,ms4 ,stansbury1 ,mr4 ,ruiz1 ,ms4 ,castor of ,florida1 ,mr4 ,thanedar1 ,ms4 ,clarke of ,new ,york1 ,ms4 ,schrier1 ,mr4 ,garcia of ,california1 ,ms4 ,barragn1 ,mr4 ,landsman1 ,mr4 ,frost1 ,ms4 ,norton1 ,ms4 ,craig1 ,mr4 ,garca of ,illinois1 ,ms4 ,simon1 ,mr4 ,goldman of ,new ,york1 ,mr4 ,horsford1 and ,ms4 ,del,bene7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 program1 and to amend title ,,iii of the ,public ,health ,service ,act to establish a grant program for purposes of medical debt relief4 #a4 ,short title ,this ,act may be cited as the ,patient ,debt ,relief ,act4 #b4 ,establishing standards and requirements with respect to financial assistance and medical debt collection as condition of participation in the ,medicare program ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,x71 by striking and at the end2 7,b7 in subparagraph 7,y71 by striking the period at the end and inserting 1 and2 and 7,c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of a hospital1 beginning ,january #a1 #bjbh1 to comply with the financial assistance and debt collection requirements described in subsection 7l74 2 7#b7 in subsection 7b71 by adding at the end the following new paragraph3 7#e7 7,a7 ,a hospital that fails to comply with the requirements of subsection 7a77#a77,z7 7relating to financial assistance and debt collection7 is subject to a civil monetary penalty under this paragraph4 7,b7 ,the ,secretary may impose a civil monetary penalty in an amount specified by the ,secretary 7but not to exceed #a1jjj1jjj7 for each instance of noncompliance with the requirements of subsection 7a77#a77,z71 as determined by the ,secretary1 if-- 7i7 not later than #ij days after the date on which the ,secretary determines such noncompliance exists1 the ,secretary submits to such hospital a notification of such determination2 and 7ii7 as of the date that is #de days after such notification is sent1 the ,secretary determines that such hospital has not taken meaningful actions to come into compliance with such requirements4 ,the provisions of section #aabh;,a 7other than subsections 7a7 and 7b77 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 #aabh;,a7a74 2 and 7#c7 by adding at the end the following new subsection3 7l7 ,financial assistance and debt collection requirements 7#a7 ,in general ,for purposes of subsection 7a77#a77,z71 the financial assistance and debt collection requirements are1 with respect to a hospital-- 7,a7 the financial assistance and charity care requirements described in paragraph 7#b72 and 7,b7 the medical debt collection limitations described in paragraph 7#c74 7#b7 ,financial assistance and charity care requirements ,for purposes of paragraph 7#a71 the requirements described in this paragraph are1 with respect to a hospital1 the following3 7,a7 ,the hospital-- 7i7 has established a charity care or financial assistance policy2 7ii7 has established minimum eligibility requirements with respect to such charity care or financial assistance policy1 and has made such requirements publicly available2 and 7iii7 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 policy4 7,b7 ,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 7,a77i71 the hospital-- 7i7 determines1 not later than #cj days before the date on which payment for such items or services is due1 whether such individual is eligible for assistance with respect to such payment pursuant to such charity care or financial assistance policy2 7ii7 in the case that a hospital determines pursuant to clause 7i7 that an individual is ineligible for such charity care or financial assistance policy with respect to such payment1 permits such individual to appeal such determination2 and 7iii7 does not seek to collect such payment from such individual until the determination under clause 7i7 with respect to such individual has been made4 7,c7 ,the hospital includes with any bill for payment with respect to items or services furnished by the hospital to an individual-- 7i7 the minimum eligibility requirements described in subparagraph 7,a77ii7 with respect to the charity care or financial assistance policy of the hospital2 7ii7 notice of the medical debt collection limitations described in paragraph 7#c71 including the repayment program described in subparagraph 7,c77ii7 of such paragraph2 and 7iii7 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 7,d7 of such paragraph4 7#c7 ,medical debt collection limitations ,for purposes of paragraph 7#a71 the limitations described in this paragraph are1 with respect to a hospital and medical debt owed to the hospital by an individual1 that-- 7,a7 the hospital does not seek to place a lien on or foreclose upon the home of such individual in order to collect such medical debt2 7,b7 the hospital does not seek to garnish the wages of such individual in order to collect such medical debt2 7,c7 subject to subparagraph 7,d77ii71 the hospital does not sell or assign such medical debt to a debt collector unless-- 7i7 more than #a year has elapsed since the date on which payment for such items or services was due2 7ii7 the hospital makes available to the individual a repayment program under which the individual may make minimum monthly payments 7provided that each such payment does not exceed #d percent of the gross monthly income of such individual7 toward the medical debt1 and such individual fails to make #d or more consecutive monthly payments under such repayment program or otherwise declines to participate in such repayment program2 and 7iii7 such debt collector agrees to abide by the limitations described in subparagraphs 7,a7 and 7,b7 for such hospital with respect to such medical debt2 and 7,d7 in the case that the hospital has received the necessary information to make the determination described in paragraph 7#b77;,c77iii71 if the hospital determines that the household income of such individual was not in excess of #bej 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 furnished1 the hospital-- 7i7 does not impose an annual interest rate with respect to such payment2 and 7ii7 does not sell or assign such medical debt to a debt collector4 7#d7 ,monitoring compliance 7,a7 ,audits ,beginning ,january #a1 #bjbi1 and not less frequently than annually thereafter1 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 7#a74 7,b7 ,online portal ,not later than ,january #a1 #bjbh1 the ,secretary shall establish a secure internet website portal 7or other successor technology7 to permit individuals to report the noncompliance of a hospital with the requirements of paragraph 7#a71 including noncompliance with the limitations described in subparagraphs 7,a7 and 7,b7 of paragraph 7#c7 of a debt collector to which the hospital has sold or assigned medical debt4 7#e7 ,definitions ,in this subsection3 7,a7 ,debt collector ,the term debt collector has the meaning given such term in section #hjc7f7 of the ,fair ,debt ,collection ,practices ,act 7#ae ,u4,s4,c4 #afib;a7#f774 7,b7 ,medical debt ,the term medical debt means1 with respect to items or services furnished by a hospital to an individual1 the debt 7as defined in section #hjc7e7 of the ,fair ,debt ,collection ,practices ,act 7#ae ,u4,s4,c4 #afib;a7#e777 of such individual for such items or services4 4 #c4 ,medical debt relief program ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following new section3 #cii,v-#h4 ,medical debt relief grant program 7a7 ,in general ,not later than #a year after the date of the enactment of this section1 the ,secretary shall establish a program under which the ,secretary may make grants to not more than #a eligible nonprofit organization to acquire and discharge the medical debt 7as defined by the ,secretary7 of eligible individuals in accordance with this section4 7b7 ,application ,an eligible nonprofit seeking a grant under this section shall submit an application at such time1 in such form1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts provided under a grant under this section shall be used to-- 7#a7 identify eligible individuals2 and 7#b7 acquire and discharge the medical debt of such individuals4 7d7 ,notice and reporting requirements 7#a7 ,notice requirement ,not later than #fj 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 7c71 such eligible nonprofit organization shall notify such individual of such acquisition and discharge4 7#b7 ,reporting requirement ,not less frequently than once per calendar quarter1 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 quarter3 7,a7 ,the actions taken by the eligible nonprofit organization to identify eligible individuals4 7,b7 ,the number of eligible individuals whose medical debt was acquired and discharged by the eligible nonprofit organization1 and the amount of medical debt so acquired and discharged4 7,c7 ,such other information as the ,secretary may require4 7e7 ,definitions ,in this section3 7#a7 ,eligible individual ,the term eligible individual means an individual with medical debt if1 for the most recent taxable year-- 7,a7 such medical debt is equivalent to #e percent or more of the modified adjusted gross income of such individual2 or 7,b7 the household income of such individual is not in excess of #djj percent of the poverty line for the size of the family involved4 7#b7 ,eligible nonprofit organization ,the term eligible nonprofit organization means a nonprofit organization with the mission of relieving individuals of their medical debt1 as determined by the ,secretary4 7#c7 ,,irc terms ,the terms household income1 modified adjusted gross income1 and poverty line have the meaning given each such term in section #cf;,b of the ,internal ,revenue ,code of #aihf 7#bf ,u4,s4,c4 #cf;,b74 7f7 ,funding ,there is authorized to be appropriated for purposes of carrying out this section #ajj1jjj1jjj for fiscal year #bjbg1 to remain available until expended4 4