SENATE BILL NO. 449

A bill to require hospitals to develop and implement financial assistance programs for certain patients; to provide for the powers and duties of certain state and local governmental officers and entities; to allow for the promulgation of rules; and to prescribe civil sanctions and remedies.

the people of the state of michigan enact:

Sec. 1. (1) This act may be cited as the "hospital financial assistance act".

(2) As used in this act, the words and phrases defined in sections 3 to 4 have the meanings ascribed to them in those sections.

Sec. 3. (1) "Department" means the department of health and human services.

(2) "Director" means the director of the department.

(3) "Federal poverty guidelines" means the poverty guidelines revised periodically and published in the Federal Register by the secretary of the United States Department of Health and Human Services under the secretary's authority to revise the poverty line under 42 USC 9902.

(4) "Financial assistance program" or "program" means the financial assistance program required under section 5.

(5) "Health benefit plan" means an individual or group expense-incurred hospital, medical, or surgical policy or certificate, an individual or group health maintenance organization contract, or a self-funded plan established or maintained by this state or a local unit of government for its employees. Health benefit plan does not include accident-only, credit, dental, or disability income insurance; long-term care insurance; coverage issued as a supplement to liability insurance; coverage only for a specified disease or illness; worker's compensation or similar insurance; or automobile medical-payment insurance.

(6) "Hospital" means that term as defined in section 20106 of the public health code, 1978 PA 368, MCL 333.20106.

Sec. 4. (1) "Income" means that term as defined in section 510 of the income tax act of 1967, 1967 PA 281, MCL 206.510.

(2) "Insured patient" means a patient who is enrolled in Medicaid or Medicare or is covered under a health benefit plan.

(3) "Medicaid" means the program of medical assistance established under title XIX of the social security act, 42 USC 1396 to 1396w-8, and administered by the department under the social welfare act, 1939 PA 280, MCL 400.1 to 400.119b.

(4) "Medicare" means the federal Medicare program established under title XVIII of the social security act, 42 USC 1395 to 1395lll.

(5) "Uninsured patient" means a patient who is not an insured patient.

Sec. 5. (1) By January 1, 2027, a hospital shall develop and implement a financial assistance program for patients receiving care from the hospital.

(2) A program must comply with all of the following:

(a) Base patient eligibility on objective metrics that are tied to federal poverty guidelines.

(b) Include in the program a patient who owes the hospital 1 or more unpaid bills in a 12-month period that, in total, are greater than 30% of the patient's annual income.

(c) Provide for up to a 100% discount based on a sliding scale for a patient who is an uninsured patient and whose annual income is at or below 350% of the federal poverty guidelines.

(d) Consider the financial resources and out-of-pocket expenses of a patient who is covered under a health benefit plan.

Sec. 7. (1) A hospital shall conspicuously publish information on the hospital's financial assistance program on all of the following:

(a) A bill, invoice, or summary of charges sent to a patient.

(b) A statement or written notification sent to a patient before a patient's medical debt to the hospital is sent to a collection agency.

(c) The hospital's website.

(2) A hospital shall ensure that information on the hospital's financial assistance program meets all of the following:

(a) Is written in easily understood, nontechnical terms.

(b) Includes information on how to reach a department or an employee of the hospital to inquire about the financial assistance program.

(c) Is available on request in English, Spanish, and in other languages, as determined appropriate by the department.

(d) Includes information on how to file a complaint for a violation of this act or a rule promulgated under this act.

Sec. 9. (1) Subject to subsection (2), by October 1, 2027, a hospital shall submit an annual report to the director that includes all of the following information:

(a) The number of applications for the hospital's financial assistance program that was received and processed by the hospital.

(b) The amount and types of benefits provided by the hospital under the hospital's financial assistance program.

(c) The amount of uncollected or forgiven debt that the hospital provides to patients who do not qualify for the hospital's financial assistance program.

(2) If a hospital is part of a health system with more than 1 hospital, the health system may file 1 annual report under this section containing the information for each hospital in the health system. If a health system files the report under this subsection, the health system shall ensure that the report is organized in a manner to identify the information required under subsection (1) for each hospital, by hospital name and location.

(3) The department shall publish the reports the department receives under this section on the department's website in an area that is accessible to the public.

Sec. 10. (1) The department shall establish by rule a uniform process for a hospital to collect information on a patient's income for determining eligibility for the hospital's financial assistance program. Subject to subsection (4), in establishing the process described in this subsection, the department shall consider all of the following:

(a) The convenience of a patient when submitting information to a hospital.

(b) A patient's ease of access to any technology that is required by the department.

(2) A hospital shall comply with the process developed by the department under subsection (1).

(3) A patient's failure to provide the information required under subsection (1) to a hospital using the process developed under this section is an affirmative defense to an action brought under section 11 or 13.

(4) In developing the process described in subsection (1), the department shall consult with hospitals and organizations representing hospitals and the department may consult with the department of treasury or any other department of this state that the department considers necessary or appropriate.

Sec. 11. (1) A person may notify the department of a violation of this act or a rule promulgated under this act on a form and in a manner prescribed by the department. The department shall investigate each complaint received in a timely manner.

(2) If, after investigation by the department, it is the judgment of the department that a person has engaged in an act or practice that constitutes a violation of this act, the director may request the attorney general to bring an action in the name of the people of this state to restrain, enjoin, prevent, or correct a violation of this act or a rule promulgated under this act.

Sec. 13. A hospital that violates this act is subject to a civil fine of not more than $10,000.00. The attorney general may bring an action to collect the fine. A fine collected must be deposited in the medical debt relief fund created in section 17.

Sec. 17. (1) The medical debt relief fund is created in the state treasury.

(2) The state treasurer shall deposit money received under section 13 or from any other source in the fund. The state treasurer shall direct the investment of money in the fund and credit interest and earnings from the investments to the fund.

(3) The department is the administrator of the fund for audits of the fund.

(4) The department shall expend money from the fund on appropriation only to implement programs to relieve medical debt in this state.

Sec. 19. The department may promulgate rules pursuant to the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, to implement this act.