[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9129 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 9129

 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 
  program, and to amend title III of the Public Health Service Act to 
     establish a grant program for purposes of medical debt relief.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2024

  Mr. Vasquez (for himself, Mr. Horsford, Mr. Ruiz, Mr. Thanedar, Ms. 
  Schrier, and Ms. Barragan) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committee on Ways and Means, for a period to be subsequently 
   determined by the Speaker, 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 
  program, and to amend title III of the Public Health Service Act to 
     establish a grant program for purposes of medical debt relief.

    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 ``Patient Debt Relief Act''.

SEC. 2. ESTABLISHING STANDARDS AND REQUIREMENTS WITH RESPECT TO 
              FINANCIAL ASSISTANCE AND MEDICAL DEBT COLLECTION AS 
              CONDITION OF PARTICIPATION IN THE MEDICARE PROGRAM.

    Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is 
amended--
            (1) in subsection (a)(1)--
                    (A) in subparagraph (X), by striking ``and'' at the 
                end;
                    (B) in subparagraph (Y), by striking the period at 
                the end and inserting ``, and''; and
                    (C) by inserting after subparagraph (Y) the 
                following new subparagraph:
            ``(Z) in the case of a hospital, beginning January 1, 2026, 
        to comply with the financial assistance and debt collection 
        requirements described in subsection (l).'';
            (2) in subsection (b), by adding at the end the following 
        new paragraph:
            ``(5)(A) A hospital that fails to comply with the 
        requirements of subsection (a)(1)(Z) (relating to financial 
        assistance and debt collection) is subject to a civil monetary 
        penalty under this paragraph.
            ``(B) The Secretary may impose a civil monetary penalty in 
        an amount specified by the Secretary (but not to exceed 
        $1,000,000) for each instance of noncompliance with the 
        requirements of subsection (a)(1)(Z), as determined by the 
        Secretary, if--
                    ``(i) not later than 90 days after the date on 
                which the Secretary determines such noncompliance 
                exists, the Secretary submits to such hospital a 
                notification of such determination; and
                    ``(ii) as of the date that is 45 days after such 
                notification is sent, the Secretary determines that 
                such hospital has not taken meaningful actions to come 
                into compliance with such requirements.
        The provisions of section 1128A (other than subsections (a) and 
        (b)) 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 1128A(a).''; and
            (3) by adding at the end the following new subsection:
    ``(l) Financial Assistance and Debt Collection Requirements.--
            ``(1) In general.--For purposes of subsection (a)(1)(Z), 
        the financial assistance and debt collection requirements are, 
        with respect to a hospital--
                    ``(A) the financial assistance and charity care 
                requirements described in paragraph (2); and
                    ``(B) the medical debt collection limitations 
                described in paragraph (3).
            ``(2) Financial assistance and charity care requirements.--
        For purposes of paragraph (1), the requirements described in 
        this paragraph are, with respect to a hospital, the following:
                    ``(A) The hospital--
                            ``(i) has established a charity care or 
                        financial assistance policy;
                            ``(ii) has established minimum eligibility 
                        requirements with respect to such charity care 
                        or financial assistance policy, and has made 
                        such requirements publicly available; and
                            ``(iii) 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 policy.
                    ``(B) 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 (A)(i), the hospital--
                            ``(i) determines, not later than 30 days 
                        before the date on which payment for such items 
                        or services is due, whether such individual is 
                        eligible for assistance with respect to such 
                        payment pursuant to such charity care or 
                        financial assistance policy;
                            ``(ii) in the case that a hospital 
                        determines pursuant to clause (i) that an 
                        individual is ineligible for such charity care 
                        or financial assistance policy with respect to 
                        such payment, permits such individual to appeal 
                        such determination; and
                            ``(iii) does not seek to collect such 
                        payment from such individual until the 
                        determination under clause (i) with respect to 
                        such individual has been made.
                    ``(C) The hospital includes with any bill for 
                payment with respect to items or services furnished by 
                the hospital to an individual--
                            ``(i) the minimum eligibility requirements 
                        described in subparagraph (A)(ii) with respect 
                        to the charity care or financial assistance 
                        policy of the hospital;
                            ``(ii) notice of the medical debt 
                        collection limitations described in paragraph 
                        (3), including the repayment program described 
                        in subparagraph (C)(ii) of such paragraph; and
                            ``(iii) 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 (D) of such 
                        paragraph.
            ``(3) Medical debt collection limitations.--For purposes of 
        paragraph (1), the limitations described in this paragraph are, 
        with respect to a hospital and medical debt owed to the 
        hospital by an individual, that--
                    ``(A) the hospital does not seek to place a lien on 
                or foreclose upon the home of such individual in order 
                to collect such medical debt;
                    ``(B) the hospital does not seek to garnish the 
                wages of such individual in order to collect such 
                medical debt;
                    ``(C) subject to subparagraph (D)(ii), the hospital 
                does not sell or assign such medical debt to a debt 
                collector unless--
                            ``(i) more than 1 year has elapsed since 
                        the date on which payment for such items or 
                        services was due;
                            ``(ii) the hospital makes available to the 
                        individual a repayment program under which the 
                        individual may make minimum monthly payments 
                        (provided that each such payment does not 
                        exceed 4 percent of the gross monthly income of 
                        such individual) toward the medical debt, and 
                        such individual fails to make 4 or more 
                        consecutive monthly payments under such 
                        repayment program or otherwise declines to 
                        participate in such repayment program; and
                            ``(iii) such debt collector agrees to abide 
                        by the limitations described in subparagraphs 
                        (A) and (B) for such hospital with respect to 
                        such medical debt; and
                    ``(D) in the case that the hospital has received 
                the necessary information to make the determination 
                described in paragraph (2)(C)(iii), if the hospital 
                determines that the household income of such individual 
                was not in excess of 250 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 furnished, the 
                hospital--
                            ``(i) does not impose an annual interest 
                        rate with respect to such payment; and
                            ``(ii) does not sell or assign such medical 
                        debt to a debt collector.
            ``(4) Monitoring compliance.--
                    ``(A) Audits.--Beginning January 1, 2027, and not 
                less frequently than annually thereafter, 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 (1).
                    ``(B) Online portal.--Not later than January 1, 
                2026, the Secretary shall establish a secure internet 
                website portal (or other successor technology) to 
                permit individuals to report the noncompliance of a 
                hospital with the requirements of paragraph (1), 
                including noncompliance with the limitations described 
                in subparagraphs (A) and (B) of paragraph (3) of a debt 
                collector to which the hospital has sold or assigned 
                medical debt.
            ``(5) Definitions.--In this subsection:
                    ``(A) Debt collector.--The term `debt collector' 
                has the meaning given such term in section 803(6) of 
                the Fair Debt Collection Practices Act (15 U.S.C. 
                1692a(6)).
                    ``(B) Medical debt.--The term `medical debt' means, 
                with respect to items or services furnished by a 
                hospital to an individual, the debt (as defined in 
                section 803(5) of the Fair Debt Collection Practices 
                Act (15 U.S.C. 1692a(5))) of such individual for such 
                items or services.''.

SEC. 3. MEDICAL DEBT RELIEF PROGRAM.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following new 
section:

``SEC. 399V-8. MEDICAL DEBT RELIEF GRANT PROGRAM.

    ``(a) In General.--Not later than 1 year after the date of the 
enactment of this section, the Secretary shall establish a program 
under which the Secretary may make grants to not more than 1 eligible 
nonprofit organization to acquire and discharge the medical debt (as 
defined by the Secretary) of eligible individuals in accordance with 
this section.
    ``(b) Application.--An eligible nonprofit seeking a grant under 
this section shall submit an application at such time, in such form, 
and containing such information as the Secretary may require.
    ``(c) Use of Funds.--Amounts provided under a grant under this 
section shall be used to--
            ``(1) identify eligible individuals; and
            ``(2) acquire and discharge the medical debt of such 
        individuals.
    ``(d) Notice and Reporting Requirements.--
            ``(1) Notice requirement.--Not later than 60 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 (c), such eligible 
        nonprofit organization shall notify such individual of such 
        acquisition and discharge.
            ``(2) Reporting requirement.--Not less frequently than once 
        per calendar quarter, 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 quarter:
                    ``(A) The actions taken by the eligible nonprofit 
                organization to identify eligible individuals.
                    ``(B) The number of eligible individuals whose 
                medical debt was acquired and discharged by the 
                eligible nonprofit organization, and the amount of 
                medical debt so acquired and discharged.
                    ``(C) Such other information as the Secretary may 
                require.
    ``(e) Definitions.--In this section:
            ``(1) Eligible individual.--The term `eligible individual' 
        means an individual with medical debt if, for the most recent 
        taxable year--
                    ``(A) such medical debt is equivalent to 5 percent 
                or more of the modified adjusted gross income of such 
                individual; or
                    ``(B) the household income of such individual is 
                not in excess of 400 percent of the poverty line for 
                the size of the family involved.
            ``(2) Eligible nonprofit organization.--The term `eligible 
        nonprofit organization' means a nonprofit organization with the 
        mission of relieving individuals of their medical debt, as 
        determined by the Secretary.
            ``(3) IRC terms.--The terms `household income', `modified 
        adjusted gross income', and `poverty line' have the meaning 
        given each such term in section 36B of the Internal Revenue 
        Code of 1986 (26 U.S.C. 36B).
    ``(f) Funding.--There is authorized to be appropriated for purposes 
of carrying out this section $100,000,000 for fiscal year 2025, to 
remain available until expended.''.
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