[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4697 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 4697

     To amend the Public Health Service Act to provide additional 
    transparency and consumer protections relating to medical debt 
                         collection practices.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 24, 2020

 Mr. Murphy (for himself and Mr. Van Hollen) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
     To amend the Public Health Service Act to provide additional 
    transparency and consumer protections relating to medical debt 
                         collection practices.

    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 ``Strengthening Consumer Protections 
and Medical Debt Transparency Act''.

SEC. 2. MEDICAL DEBT COLLECTIONS.

    (a) In General.--Part C of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-91 et seq.) is amended by adding at the end the 
following:

``SEC. 2795. MEDICAL DEBT COLLECTIONS.

    ``(a) Definitions.--
            ``(1) In general.--In this section:
                    ``(A) Database.--The term `database' means the 
                medical debt collection database established under 
                subsection (e).
                    ``(B) Debt collector.--The term `debt collector' 
                has the meaning as defined under the Fair Debt 
                Collection Practices Act.
                    ``(C) Extraordinary collection action.--The term 
                `extraordinary collection action' is as defined for 
                purposes of section 501(r) of the Internal Revenue Code 
                of 1986 (as in effect on the date of enactment of this 
                section).
                    ``(D) Health care entity.--The term `health care 
                entity' means an entity defined pursuant to paragraph 
                (2).
                    ``(E) Medical debt.--The term `medical debt' means 
                debt arising from a patient's receipt of medical 
                services, products, or devices.
            ``(2) Health care entity.--For purposes of this section, 
        the Secretary shall develop a definition of the term `health 
        care entity' that shall include--
                    ``(A) nonprofit, for-profit, critical access, and 
                cancer hospitals, including hospital-owned facilities;
                    ``(B) independently licensed outpatient, 
                ambulatory, behavioral, optical, radiology, laboratory, 
                dental, and emergency departments;
                    ``(C) physician group practices, with an exemption 
                for small practices, as determined by the Secretary;
                    ``(D) physician staffing firms or physician 
                services companies;
                    ``(E) any health care agent of an entity described 
                in this paragraph; and
                    ``(F) other entities as specified by the Secretary.
    ``(b) Requirements and Prohibitions.--
            ``(1) Debt collection.--A health care entity, or its debt 
        collector, shall not commence, or shall halt, 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 pending.
            ``(2) Determination of eligibility for assistance.--A 
        health care entity, or its debt collector, shall not commence 
        any extraordinary collection actions with respect to a patient 
        until the entity determines whether the patient qualifies for 
        assistance, either through enrollment in a Federal or State 
        program or through the entity's charity care or financial 
        assistance policy, with respect to such debt. The entity shall 
        refer such patient to any such assistance where available.
            ``(3) Prohibition on extraordinary collection.--With 
        respect to medical debt collection relating to a patient, a 
        health care entity, or its debt collector, shall not take any 
        extraordinary collection actions (including an action described 
        in sections 1.501(r)-6(a)(2) of title 26, Code of Federal 
        Regulations (as in effect on the date of enactment of this 
        section)) until the expiration of the 180-day period beginning 
        on the date on which the initial bill is sent to the patient, 
        or a later date if applicable.
            ``(4) Providing information to patients.--A health care 
        entity or its debt collector shall provide a patient with--
                    ``(A) an easy-to-understand itemized statement of 
                the medical debt owed by the patient to the health care 
                entity prior to such entity, or the debt collector 
                acting on behalf of the entity, commencing collection 
                activities relating to such debt; and
                    ``(B) 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 30 days of such payments.
            ``(5) Limitation on recovery by nonprofit entities.--A 
        health care entity that is a nonprofit entity, or its debt 
        collector, shall not collect amounts for the medical debt of a 
        patient who is not enrolled in health insurance coverage, that 
        are in excess of the amount generally billed, as described in 
        sections 1.501(r)-1(b)(1) and 1.501(r)-5(b) of title 26, Code 
        of Federal Regulations.
            ``(6) Requirement of health care entity or its debt 
        collector.--Prior to commencing any debt collection activity 
        with respect to a medical debt, the health care entity or its 
        debt collector shall make all reasonable efforts to confirm the 
        identity of the debtor.
            ``(7) 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 bill, 
        but shall not exceed 5 percent annually or the annual rate set 
        forth under section 1961 of title 28, United States Code, for 
        the calendar week preceding the date of the initial medical 
        bill plus 2 percent, whichever is lower. This subsection shall 
        not be construed to limit assistance or a lower interest rate 
        for a patient who is otherwise eligible for financial 
        assistance.
    ``(c) Penalties.--Except as provided in this section, a health care 
entity, or its debt collector, 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--
            ``(1) any actual damages sustained by such patient as a 
        result of such failure to comply;
            ``(2) in the case of an action commenced--
                    ``(A) by an individual, any additional damages as 
                the court may permit, but not to exceed $1,000 for each 
                failure to comply; or
                    ``(B) by a class of patients--
                            ``(i) such amount for each named plaintiff 
                        as could be recovered under paragraph (1) and 
                        subparagraph (A); and
                            ``(ii) such amount as the court may allow 
                        for all other class members, without regard to 
                        a minimum individual recovery, not to exceed 
                        the lesser of $2,000,000 or 1 percent of the 
                        annual net income of the covered provider; and
            ``(3) in the case of any successful action under this 
        section, the costs of the action, together with a reasonable 
        attorney's fee as determined appropriate by the court.
    ``(d) Establishment of Database.--
            ``(1) In general.--The Secretary shall establish and 
        regularly update a medical debt collection public database.
            ``(2) Required information.--Not later than 12 months after 
        the date of enactment of this section, and annually thereafter, 
        a health care entity shall submit to the database a debt 
        collection report that shall include--
                    ``(A) the name and contact information of any debt 
                collector owned, utilized, or retained by the entity or 
                to which the entity assigned or sold medical debt 
                during the year;
                    ``(B) a description, or link to such description, 
                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 entity;
                    ``(C) the type and number of extraordinary 
                collection practices the entity, or debt collector 
                reported by the entity pursuant to subparagraph (A), 
                undertakes or seeks to undertake, such as wage 
                garnishment, bank account attachments, liens, arrest 
                warrants, reporting to a consumer reporting agency, and 
                lawsuits;
                    ``(D) the breakdown, by zip code, of medical debt 
                collection accounts referred to a debt collector;
                    ``(E) the recovery rate on medical debt collection 
                cases assigned to the debt collector, as defined by the 
                Secretary;
                    ``(F) the number of bills paid using a credit card; 
                and
                    ``(G) any other information determined appropriate 
                by the Secretary.
            ``(3) Availability of information.--The information 
        contained in the database shall be available on a public, 
        searchable internet website regularly updated by the Secretary. 
        The Secretary shall annually publish a public list on HHS.gov 
        of any health care entity that fails to submit such required 
        information.
            ``(4) CFPB report.--Not later than 12 months after the 
        expiration of two annual reporting periods under paragraph (2), 
        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 Persons, including the Risk-Based 
        Supervision Program (under section 1024 of Public Law 111-203). 
        Such report shall include recommendations to improve the 
        disclosures by health care entities for the purposes of 
        supervising the medical debt industry, including for predictive 
        analytics, machine learning, or other analysis techniques used 
        in its Risk-Based Supervision Program.''.
    (b) CFPB Report.--Not later than 12 months after the date of 
enactment of this Act, and every 2 years thereafter, the Consumer 
Financial Protection Bureau shall publicly report on medical debt 
collections, incorporating data from the medical debt collection public 
database established pursuant to section 2795(a) of the Public Health 
Service Act, anonymized data from the three largest credit bureaus, the 
Consumer Financial Protection Bureau database of consumer complaints, 
information from the Consumer Financial Protection Bureau's Supervision 
of Nondepository Covered Persons program including the Risk-Based 
Supervision Program, and relevant complaints and information from other 
sources as available.
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