HB 79 — An Act establishing requirements for hospital-based financial assistance; providing for hospital-based financial assistance forms, for information about hospital-based financial assistance programs and for reporting of hospital-based financial assistance policies; and imposing duties on the Department of Health.

PRINTER'S NO.   30

                    THE GENERAL ASSEMBLY OF PENNSYLVANIA



                        HOUSE BILL
                        No. 79
                                                  Session of
                                                    2025

     INTRODUCED BY VENKAT, DAVIDSON, KHAN, KOSIEROWSKI, KUZMA, RIGBY,
        TWARDZIK, GUENST, PROBST, ABNEY, D. MILLER, GIRAL, HANBIDGE,
        CIRESI, SANCHEZ, HOWARD, FIEDLER, HADDOCK, POWELL, BOROWSKI,
        HILL-EVANS, FREEMAN, KENYATTA, DONAHUE, FRANKEL, FLEMING,
        FRIEL, MALAGARI, SHUSTERMAN, PIELLI, PASHINSKI, CEPEDA-
        FREYTIZ, BOYD, SIEGEL, O'MARA AND OTTEN, JANUARY 10, 2025

     REFERRED TO COMMITTEE ON HEALTH, JANUARY 10, 2025


                                       AN ACT
 1   Establishing the Medical Debt Relief Program; establishing
 2      requirements for hospital-based financial assistance; and
 3      imposing duties on the Department of Health.
 4      The General Assembly of the Commonwealth of Pennsylvania
 5   hereby enacts as follows:
 6   Section 1.    Short title.
 7      This act shall be known and may be cited as the Medical Debt
 8   Relief Act.
 9   Section 2.    Definitions.
10      The following words and phrases when used in this act shall
11   have the meanings given to them in this section unless the
12   context clearly indicates otherwise:
13      "Bad debt expense."       The cost of care for which a health care
14   provider expected payment from the patient or a third-party
15   payor, but which the health care provider or commercial debt
16   collection agency subsequently determines to be uncollectible.
 1      "Department."   The Department of Health of the Commonwealth.
 2      "Eligible patient."    An individual who meets all of the
 3   following requirements:
 4          (1)   Is a resident of this Commonwealth.
 5          (2)   Can demonstrate an inability to pay the cost of
 6      medical care even after the application of payments for
 7      third-party health coverage.
 8          (3)   Provides financial information and documentation
 9      showing that their income and assets make them eligible for
10      hospital-based financial assistance under the policies of the
11      hospital and of this act.
12      "Eligible resident."   An individual eligible for relief who
13   meets all of the following conditions:
14          (1)   Is a resident of this Commonwealth.
15          (2)   Has a household income at or below 400% of the
16      Federal poverty guidelines or has medical debt equal to 5% or
17      more of the individual's household income.
18      "Health care provider."    Either of the following:
19          (1)   A health care provider, as defined in section 1201
20      of the act of May 17, 1921 (P.L.682, No.284), known as The
21      Insurance Company Law of 1921.
22          (2)   An emergency medical services agency, as defined in
23      35 Pa.C.S. § 8103 (relating to definitions).
24      "Hospital-based financial assistance."    Financial assistance
25   provided by hospitals to patients that includes charity care or
26   discounted care where the cost of care ordinarily charged by a
27   hospital is provided free of charge or at a reduced rate or a
28   hospital relieves an eligible patient's medical bill in part or
29   in full based on eligibility criteria.
30      "Medical debt."   An obligation to pay money arising from the

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 1   receipt of health care services.
 2      "Medical debt relief."    The discharge of a patient's medical
 3   debt.
 4      "Medical debt relief coordinator."     A person, company,
 5   partnership or other entity that is able to discharge medical
 6   debt of an eligible resident in a manner that does not result in
 7   a taxable event for the eligible resident.
 8      "Primary language."    A language that is the preferred
 9   language for communication during at least 5% of the annual
10   patient visits by patients who do not have the proficiency in
11   English necessary to speak, read and write about health care-
12   related matters.
13      "Program."     The Medical Debt Relief Program established under
14   section 3.
15      "Public health coverage option."     A program administered by
16   the Department of Human Services, including Medical Assistance
17   and the Children's Health Insurance Program, and by the
18   Pennsylvania Health Insurance Exchange Authority.
19   Section 3.   Medical Debt Relief Program.
20      (a)   Establishment and purpose.--The Medical Debt Relief
21   Program is established within the department for the purpose of
22   discharging medical debt of eligible residents by contracting
23   with a medical debt relief coordinator as described in
24   subsection (c).
25      (b)   Use of money.--Money appropriated to the department for
26   the program shall be used exclusively for the program, including
27   contracting with a medical debt relief coordinator and providing
28   money to be used by the medical debt relief coordinator to
29   discharge medical debt of eligible residents. Money used in
30   contracting with a medical debt relief coordinator may also be

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 1   used for the payment of services provided by the medical debt
 2   relief coordinator to discharge medical debt of eligible
 3   residents based on a budget approved by the department.
 4      (c)   Contracts.--
 5            (1)   The department is authorized to and shall enter into
 6      a contract with a medical debt relief coordinator to purchase
 7      and discharge medical debt owed by an eligible resident with
 8      money allocated for the program.
 9            (2)   The department shall implement a competitive bidding
10      process to determine which medical debt relief coordinator to
11      use, unless the department determines that only a single
12      medical debt relief coordinator has the capacity and
13      willingness to carry out the duties specified in this act.
14            (3)   In contracting with the department, a medical debt
15      relief coordinator shall adhere to the following:
16                  (i)    The medical debt relief coordinator shall review
17            the medical debt accounts of each commercial debt
18            collection agency or health care provider willing to sell
19            medical debt accounts in this Commonwealth.
20                  (ii)    The medical debt relief coordinator may elect
21            to buy the dischargeable medical debt from the commercial
22            debt collection agency or health care provider that
23            identifies the accounts described in subparagraph (i) as
24            a bad debt expense.
25                  (iii)   After the purchase and discharge of medical
26            debt from a commercial debt collection agency or health
27            care provider, the medical debt relief coordinator shall
28            notify all eligible residents whose medical debt has been
29            discharged under the program, in a manner approved by the
30            department, that they no longer have specified medical

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 1            debt owed to the relevant health care provider or
 2            commercial debt collection agency.
 3                  (iv)   A medical debt relief coordinator shall make a
 4            best effort to ensure parity and equity in the purchasing
 5            and discharging of medical debt to ensure that all
 6            eligible residents have an equal opportunity of receiving
 7            medical debt relief regardless of their geographical
 8            location or identities and characteristics as identified
 9            in section 2 of the act of October 27, 1955 (P.L.744,
10            No.222), known as the Pennsylvania Human Relations Act.
11                  (v)    A medical debt relief coordinator shall report
12            to the department the summary statistics regarding
13            eligible residents whose medical debt has been
14            discharged.
15                  (vi)   A medical debt relief coordinator may not
16            attempt to seek payment from an eligible resident for
17            medical debt purchased by the medical debt relief
18            coordinator.
19            (4)   A medical debt relief coordinator shall continue to
20      fulfill its contractual obligations to the department until
21      all money contracted to the medical debt relief coordinator
22      is exhausted, regardless of whether money allocated to the
23      program has been exhausted.
24      (d)   Breach of contract.--If a medical debt relief
25   coordinator attempts to seek payment from an eligible resident
26   for medical debt purchased by the medical debt relief
27   coordinator or fails to carry out the responsibilities described
28   in its contract with the department, the medical debt relief
29   coordinator shall be considered in breach of contract and the
30   contract provisions that apply in the case of a breach of

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 1   contract shall apply.
 2   Section 4.      Reporting on program.
 3      (a)    Requirement.--Beginning one year after the effective
 4   date of this section and annually thereafter for as long as
 5   medical debt relief coordinators are fulfilling their
 6   contractual obligations under this act, the department shall
 7   submit an annual report regarding the program in accordance with
 8   this section.
 9      (b)    Contents.--Each report under this section shall contain
10   the following information for the annual period covered by the
11   report:
12             (1)   The amount of medical debt purchased and discharged
13      under the program.
14             (2)   The number of eligible residents who received
15      medical debt relief under the program.
16             (3)   The characteristics of the eligible residents as
17      described in section 3(c)(3)(iv).
18             (4)   The number and characteristics of health care
19      providers from whom medical debt was purchased and
20      discharged.
21             (5)   The number of eligible residents whose income was
22      calculated at 100%, 150% or 200% of the Federal poverty
23      level.
24             (6)   The number of and characteristics of medical debt
25      relief coordinators contracted with for the purposes of
26      purchasing and discharging medical debt.
27      (c)    Submittal.--Each report under this section shall be
28   submitted to the following:
29             (1)   The Governor.
30             (2)   The President pro tempore of the Senate.

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 1            (3)   The Speaker of the House of Representatives.
 2            (4)   The Majority Leader and Minority Leader of the
 3      Senate.
 4            (5)   The Majority Leader and Minority Leader of the House
 5      of Representatives.
 6            (6)   The chairperson and minority chairperson of the
 7      Health and Human Services Committee of the Senate.
 8            (7)   The chairperson and minority chairperson of the
 9      Health Committee of the House of Representatives.
10   Section 5.     Hospital-based financial assistance forms and
11                  policies.
12      (a)   Forms.--The department shall develop the following forms
13   and make them available to hospitals and the general public:
14            (1)   A uniform application for financial assistance that
15      shall be used in every hospital in this Commonwealth to
16      determine if an individual is an eligible patient.
17            (2)   A uniform one-page template all hospitals shall use
18      to summarize eligibility information for financial
19      assistance. At a minimum, the summary shall include:
20                  (i)    Income eligibility guidelines for hospital-based
21            financial assistance expressed as both a percent of the
22            Federal Poverty Income Guidelines and a dollar amount
23            based on common household sizes.
24                  (ii)    Information about the limits on amounts and
25            type of assets.
26                  (iii)    Information on income eligibility guidelines
27            for a public health coverage option expressed as both a
28            percent of the Federal Poverty Income Guidelines and a
29            dollar amount based on common household sizes and how to
30            apply for those coverage options.

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 1                  (iv)   Contact information for how to apply for
 2            hospital-based financial assistance and how to get help
 3            applying for hospital-based financial assistance.
 4            (3)   A brief uniform statement of the availability of
 5      hospital-based financial assistance and of the application
 6      for hospital-based financial assistance to be stated
 7      prominently on hospital materials.
 8      (b)   Development of form.--The department shall include input
 9   from hospitals and the general public in developing the forms
10   described in subsection (a)(1).
11      (c)   Accessibility of forms.--Each form outlined in
12   subsection (a) shall be:
13            (1)   Written in plain language at a sixth grade reading
14      level.
15            (2)   Translated by the department into all primary
16      languages identified by a hospital.
17            (3)   Made accessible by the hospital to individuals with
18      visual impairments upon request.
19            (4)   Posted by hospitals online in a publicly accessible
20      format. A full copy of the hospital's financial assistance
21      policies shall also be published along with the summary in
22      subsection (a)(2).
23      (d)   Disclosure to patients.--
24            (1)   A hospital shall provide the form discussed in
25      subsection (a)(2) to all patients upon intake and discharge.
26      Additionally, a hospital shall place the uniform statement
27      provided for in subsection (a)(3) on all bills, billing
28      statements, good faith estimates, admittance forms and
29      discharge paperwork.
30            (2)   A hospital shall provide a full copy of its

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 1    financial assistance policies upon request.
 2          (3)   A hospital shall provide assistance understanding
 3    and completing a financial assistance application upon
 4    request.
 5    (e)   Alignment with public health coverage options.--
 6          (1)   Hospitals shall use the income counting rules and
 7    household composition rules consistent with 42 CFR 435.603
 8    (relating to application of modified adjusted gross income
 9    (MAGI)) and shall adjust their policies according to rules
10    within 180 days after the effective date of this paragraph.
11          (2)   The Department of Human Services shall explore a
12    process for connecting the uniform application for financial
13    assistance with the department's electronic eligibility
14    system in order to evaluate an applicant's eligibility for a
15    public health coverage option.
16          (3)   A patient seeking financial assistance may provide
17    the following financial information and documentation in
18    support of their application:
19                (i)    paychecks or pay stubs;
20                (ii)    unemployment documentation;
21                (iii)    Social Security income;
22                (iv)    rent receipts;
23                (v)    a letter from the patient's employer attesting
24          to the patient's gross income;
25                (vi)    copies of recent tax returns; or
26                (vii)    if none of the aforementioned information and
27          documentation are available, a written self-attestation
28          of the patient's income.
29          (4)   Hospitals may provide hospital-based financial
30    assistance to any patient who is already enrolled in the

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 1      Supplemental Nutrition Assistance Program (SNAP), Special
 2      Supplemental Nutrition Program for Women, Infants and
 3      Children (WIC) or Low-Income Home Energy Assistance Program
 4      (LIHEAP), based on presumptive eligibility through use of
 5      electronic verification data.
 6          (5)   Upon submission of a completed application form, the
 7      patient is not liable for any bills until the hospital has
 8      rendered a decision on the application.
 9   Section 6.   Tax applicability.
10      The amount of interest and principal balance of medical debt
11   discharged under the program shall not be included in the
12   classes of income identified in section 303 of the act of March
13   4, 1971 (P.L.6, No.2), known as the Tax Reform Code of 1971.
14   Section 7.   Effective date.
15      This act shall take effect immediately.




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