Bill
HB 4701
The bill restricts facility fees for most outpatient services, bans them for E/M and many Diagnostics unless carved out, and requires annual public reporting and enforcement.
Title: Limitations on Facility Fees Act
Jurisdiction: Illinois
Purpose and Intent
- Establishes clear prohibitions and limits on facility fees charged by health care providers.
- Aims to reduce patient exposure to facility fees for outpatient services and certain other services, by defining where fees can be charged and which services must be fee-free or subject to department-directed limitations.
Key Provisions and Changes
1) Definitions (Section 5)
- Facility fee: Any fee charged by a health care provider for outpatient services in a hospital-based facility or freestanding emergency center that (a) compensates for operational expenses, (b) is separate from a professional fee, and (c) applies regardless of service delivery modality.
- Campus: Broadly defined to include hospital main buildings, adjacent areas within 250 yards, and other areas CMS determines to be part of the campus.
- Hospital-based facility, freestanding emergency center (FEC), professional fee, health care provider, hospital, and health system are defined to clarify which entities and services fall under the Act.
- Freestanding emergency center: Licensed under EMS Act Section 32.5; explicitly excludes urgent care clinics.
2) Limits on Facility Fees (Section 10)
- Site-specific limits (a):
- No facility fee for most outpatient services unless one of three carve-outs applies:
- (i) Services provided on a hospital’s campus.
- (ii) Services provided at a facility that includes a licensed hospital emergency department.
- (iii) Emergency services at a freestanding emergency center.
- Service-specific limits (b):
- Regardless of campus status, no facility fee for:
- (i) Outpatient evaluation and management (E/M) services.
- (ii) Any other outpatient, diagnostic, or imaging services identified by the Department of Public Health.
- Department to annually identify services that may be reliably provided safely and effectively outside hospital settings (c).
3) Reporting and Transparency (Section 15)
- Annual reporting requirement for hospitals, health systems, and freestanding emergency centers detailing facility fees charged in the prior year.
- Public disclosure on a Department-designated website, including:
- Facility names/addresses and locations providing services with facility fees.
- Patient visits with facility fee charges.
- Amounts and ranges of facility fees paid by Medicare, Medicaid, and private insurance.
- Totals: billed facility fee amounts and actual revenue from facility fees.
- Top 10 procedures/services by CPT code that generated the most facility-fee revenue (both gross and net) and top 10 by patient volume, with corresponding revenue data.
- Any other Department-required information.
4) Audit and Compliance (Section 15 continuation; Section 20)
- Providers must retain and provide records upon written request by the Department for up to four years after furnishing services with facility fees (audit readiness).
5) Enforcement and Penalties (Section 25)
- Violations are treated as unlawful practices under the Consumer Fraud and Deceptive Business Practices Act.
- Administrative penalties up to $1,000 per occurrence.
- Department or designee may audit for compliance.
6) Rulemaking and Implementation (Section 20)
- Department may adopt rules to implement Act provisions, including reporting formats and penalties.
7) Conforming Amendments (Section 30)
- Amends the Fair Patient Billing Act (Sec. 12) to require hospitals with facility fees to inform patients that they may be charged a facility fee, including policy details, methods of notification, and contact information.
8) Consumer Fraud Act Connection (Section 35)
- Adds new Section 2MMMM to the Consumer Fraud and Deceptive Business Practices Act making violations of the Facility Fees Act an unlawful practice there as well.
Who Is Affected
- Health care providers: hospitals, health systems, hospital-based facilities, freestanding emergency centers, and urgent care clinics (as defined by the Act).
- Patients receiving outpatient, diagnostic, imaging, and E/M services at hospital-based facilities or freestanding emergency centers.
- Department of Public Health: responsible for identifying certain services subject to limitations and for administering reporting/auditing functions.
- Businesses and insurers: payment dynamics and reporting could affect payer mix, transparency, and potential consumer inquiries.
Timeline and Procedural Aspects
- Department obligation to annually identify services that can be delivered outside hospitals.
- Annual reporting cycle for facilities; public posting on a Department website.
- Audit rights and four-year data retention for services with facility fees.
- The bill references potential rulemaking by the Department to implement provisions and penalties.
Notes
- The bill sets explicit exceptions for campus-based and certain emergency settings; the core prohibition targets outpatient services and specified outpatient/diagnostic/imaging services unless explicitly authorized.
Overall Impact
- Aims to reduce the use of hospital-based facility fees for outpatient care.
- Increases transparency around facility fees and revenue.
- Creates enforcement mechanisms and potential penalties for noncompliance.
- Potentially shifts patient charges and payer reimbursements by restricting facility fees for many common outpatient services.
Compiled from official sources — confirm details with the bill’s official record.
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