[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4289 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 4289

        To cancel existing medical debt, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 8, 2024

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

_______________________________________________________________________

                                 A BILL


 
        To cancel existing medical debt, and for other purposes.

    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 ``Medical Debt Cancellation Act''.

SEC. 2. GRANTS TO CANCEL MEDICAL DEBT OWED BY PATIENTS.

    Section 2799B-10 of the Public Health Service Act, as added by 
section 3, is amended by adding at the end the following:
    ``(e) Grants To Cancel Medical Debt Owed by Patients.--
            ``(1) In general.--The Secretary shall establish a grant 
        program under which the Secretary, beginning not later than 1 
        year after the date of enactment of the Medical Debt 
        Cancellation Act, awards grants on a competitive basis to 
        hospitals in the United States in order to eliminate all 
        eligible medical debt owed by residents of the United States to 
        such hospitals.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection, a hospital shall--
                    ``(A) submit an application to the Secretary at 
                such time, in such manner, and containing such 
                information as the Secretary may require; and
                    ``(B) agree to submit to the Secretary such reports 
                regarding the use of grant funds as the Secretary may 
                require.
            ``(3) Prioritization.--In awarding grants under this 
        subsection, the Secretary shall--
                    ``(A) prioritize awards to hospitals that--
                            ``(i) are safety net hospitals; and
                            ``(ii) agree to cancel, at a minimum, all 
                        medical debt that is--
                                    ``(I) 15 months old or less;
                                    ``(II) owed by low-income and 
                                vulnerable patient populations; and
                                    ``(III) attributable to emergency 
                                and non-elective care; and
                    ``(B) ensure that awards are distributed to 
                hospitals across diverse geographical areas of the 
                United States.
            ``(4) Supplement, not supplant.--Grants awarded to a 
        hospital under this subsection shall be used to supplement, and 
        not supplant, other sources of funding and investments made by 
        the hospital for the purposes of providing financial assistance 
        to patients.
            ``(5) Expansion of medical debt cancellation.--Not later 
        than 2 years after the date of enactment of the Medical Debt 
        Cancellation Act, the Secretary shall expand the program under 
        this subsection to allow providers and health care facilities 
        other than hospitals, and individuals, to receive medical debt 
        cancellation.
            ``(6) Guidance.--Not later than 1 year after the date of 
        enactment of the Medical Debt Cancellation Act, the Secretary 
        shall instruct Federal health care programs to eliminate 
        medical debt collections.
            ``(7) Consultation.--In carrying out this subsection, the 
        Secretary shall consult with relevant Federal agencies, 
        departments, and health programs, patient advocates, community-
        based organizations with experience in medical debt 
        cancellation, providers, and other key stakeholders.
            ``(8) Reporting.--Beginning 2 years after the date of 
        enactment of the Medical Debt Cancellation Act, and annually 
        thereafter until the date on which the program under this 
        subsection sunsets pursuant to paragraph (10), the Secretary 
        shall submit to relevant congressional committees a progress 
        report on the implementation, administration, and impact of the 
        program under this subsection.
            ``(9) Definitions.--In this subsection--
                    ``(A) the term `eligible medical debt'--
                            ``(i) means the out-of-pocket unpaid amount 
                        owed by a resident of the United States for 
                        items or services furnished to such individual 
                        by a hospital, provided that--
                                    ``(I) such medical debt is in 
                                compliance with applicable Federal laws 
                                and regulations, including--
                                            ``(aa) the medical billing 
                                        requirements of subsection (a);
                                            ``(bb) the medical debt 
                                        collection requirements of 
                                        subsection (b); and
                                            ``(cc) the contracting 
                                        limitation under subsection 
                                        (c);
                                    ``(II) such medical debt is with 
                                respect to items and services furnished 
                                to an individual on or before the date 
                                of enactment of the Medical Debt 
                                Cancellation Act; and
                                    ``(III) any dispute resolution 
                                process under section 2799B-7 is 
                                complete; and
                            ``(ii) excludes--
                                    ``(I) any amount paid or payable by 
                                any Federal health care program; and
                                    ``(II) with respect to items and 
                                services furnished to an individual by 
                                the hospital, any amount that is in 
                                excess of the sum of the amount 
                                reimbursable by a Federal health care 
                                program or other payer and copayment 
                                amounts under such a program or other 
                                health insurance plan with respect to 
                                such items and services.
                    ``(B) the term `Federal health care program' has 
                the meaning given such term in section 1128B(f) of the 
                Social Security Act.
            ``(10) Sunset.--The authorities under this subsection shall 
        sunset on the date the Secretary certifies all eligible medical 
        debt in the United States has been canceled under this 
        subsection.''.

SEC. 3. REQUIREMENTS FOR MEDICAL BILLING PRACTICES AND MEDICAL DEBT 
              COLLECTION; MEDICAL PAYMENT ASSISTANCE.

    (a) In General.--Part E of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-131 et seq.) is amended by adding at the end the 
following new section:

``SEC. 2799B-10. REQUIREMENTS FOR MEDICAL BILLING AND MEDICAL DEBT 
              COLLECTION; MEDICAL PAYMENT ASSISTANCE RESOURCE.

    ``(a) Medical Billing Requirements.--In the case of a health care 
provider or facility that furnishes items or services to an individual, 
such provider or facility shall, not later than 45 days before the date 
on which payment for such items or services is due--
            ``(1)(A) determine whether such individual is eligible for 
        assistance with respect to such payment pursuant to the charity 
        care or financial assistance policy of such provider or 
        facility; and
            ``(B) if such individual is eligible for such assistance, 
        provide information to such individual regarding such 
        assistance; and
            ``(2) on or after the date on which the medical payment 
        assistance resource list under subsection (d)(1) is made 
        available, provide such individual with such list.
    ``(b) Medical Debt Collection Requirements.--
            ``(1) In general.--In the case of a health care provider or 
        facility that furnishes items or services to an individual, if 
        payment for such items or services is past due, such provider 
        or facility shall--
                    ``(A) not later than 30 days after the date on 
                which the payment was due, provide to such individual a 
                statement (in clear and understandable language) that 
                includes--
                            ``(i) subject to paragraph (2)(A), the 
                        total amount of the payment that remains due;
                            ``(ii) a description of the attempts made 
                        by such provider or facility to determine 
                        whether such individual is eligible for 
                        assistance (as described in subsection (a)(1)) 
                        with respect to the payment; and
                            ``(iii) in each of the 15 most commonly 
                        language (other than English), as determined by 
                        the Secretary, information about language-
                        assistance services related to the payment that 
                        are available to individuals with limited 
                        English proficiency; and
                    ``(B) not later than 30 days after a payment 
                related to such items or services is made, provide to 
                such individual a detailed receipt of such payment and 
                a statement of the amount that remains due, if 
                applicable.
            ``(2) Limitations on medical debt amounts.--
                    ``(A) Uninsured individuals.--In the case of items 
                or services furnished to an uninsured individual by an 
                organization that is described in section 501(r)(2) of 
                the Internal Revenue Code of 1986 and is exempt from 
                taxation under section 501(c)(3) of such Code, such 
                organization may not collect payment from such 
                individual with respect to such items or services in an 
                amount greater than the amounts generally billed 
                (within the meaning of section 501(r) of such Code).
                    ``(B) Interest rate.--A health care provider or 
                facility may not collect interest on past-due payments 
                for items or services furnished to an individual.
    ``(c) Limitation on Contracting for Purposes of Medical Billing and 
Medical Debt Collection.--A health care provider or facility may not 
enter into a contract with an entity for purposes of collecting payment 
with respect to items or services furnished by such provider or 
facility unless such entity agrees to comply with the requirements 
described in subsections (a) and (b) for such provider or facility with 
respect to such payment.
    ``(d) Medical Payment Assistance Resource List.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of the Medical Debt Cancellation Act, the 
        Secretary shall make publicly available on the website of the 
        Department of Health and Human Services a comprehensive list of 
        Federal, State, and local programs that provide financial 
        assistance with respect to payment for items or services 
        furnished by a health care provider or facility.
            ``(2) Updates.--The Secretary shall update the list 
        described in paragraph (1) not less frequently than 
        annually.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to items and services furnished on or after the date 
that is 1 year after the date of the enactment of this Act.
    (c) Coordination and Consultation.--In carrying out this section, 
the Secretary of Health and Human Services shall--
            (1) coordinate with relevant Federal departments and 
        agencies, including the Consumer Financial Protection Bureau 
        and the Department of the Treasury; and
            (2) consult with relevant stakeholders including patient 
        advocates, community-based organizations with experience in 
        medical debt cancellation, and health care providers.

SEC. 4. MEDICAL DEBT COLLECTION.

    (a) Collection of Medical Debt.--
            (1) In general.--The Fair Debt Collection Practices Act (15 
        U.S.C. 1692 et seq.) is amended by inserting after section 818 
        (15 U.S.C. 1692p) the following:
``Sec. 818A. Collection of medical debt
    ``(a) In General.--No debt collector or creditor may collect or 
attempt to collect debt that arose from the receipt of medical 
services, products, or devices if such debt was incurred by a consumer 
before the date of enactment of this section.
    ``(b) Private Right of Action.--Any consumer who is harmed by a 
violation of subsection (a) may bring a civil action in the appropriate 
United States district court against the debt collector or creditor 
that violated subsection (a) for--
            ``(1) compensatory damages, including for economic losses 
        and for emotional harm;
            ``(2) punitive damages; and
            ``(3) reasonable attorney's fees and costs of the action to 
        a prevailing plaintiff.''.
    (b) Technical and Conforming Amendment.--The table of sections for 
the Fair Debt Collection Practices Act (15 U.S.C. 1692 et seq.) is 
amended by inserting after the item relating to section 818 the 
following:

``818A. Collection of medical debt.''.

SEC. 5. MEDICAL DEBT REPORTING.

    (a) In General.--Section 605(a) of the Fair Credit Reporting Act 
(15 U.S.C. 1681c(a)) is amended by adding at the end the following:
            ``(9) Any information related to debt that arose from the 
        receipt of medical services, products, or devices accrued by a 
        consumer.''.
    (b) Notice Requirements.--Each credit reporting agency that removes 
information from the consumer report of a consumer to comply with 
section 605(a)(9) of the Fair Credit Reporting Act, as added by 
subsection (a) of this section, shall notify the consumer of the 
removal.
    (c) Effective Date.--The amendment made by this section shall take 
effect on the date that is 30 days after the date of enactment of this 
section.
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