An Act providing for medical debt collection protection; and imposing duties on the Attorney General and the Department of Health.

PRINTER'S NO. 319
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 371
Session of
2025
INTRODUCED BY HUGHES, HAYWOOD, KEARNEY, SCHWANK, TARTAGLIONE,
PISCIOTTANO, COSTA AND KANE, MARCH 6, 2025
REFERRED TO HEALTH AND HUMAN SERVICES, MARCH 6, 2025
AN ACT
Providing for medical debt collection protection; and imposing
duties on the Attorney General and the Department of Health.
TABLE OF CONTENTS
Section 1. Short title.
Section 2. Definitions.
Section 3. Screening for insurance, program eligibility and
patient status.
Section 4. Protections.
Section 5. Price information.
Section 6. Communications.
Section 7. Uninsured patients.
Section 8. Payment plans.
Section 9. Remedies.
Section 10. Enforcement.
Section 11. Medical debt settlement conferences.
Section 12. Prohibition of waiver of rights.
Section 13. Rules and regulations.
Section 14. Severability.
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Section 15. Construction.
Section 16. Applicability.
Section 17. Effective date.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Medical Debt
Collection Protection Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"CHIP." The children's health care program under Article
XXIII-A of the act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
"Consumer." A natural person.
"Consumer reporting agency." A person that, for monetary
fees or dues or on a cooperative nonprofit basis, regularly
engages in whole or in part in the practice of assembling or
evaluating consumer credit information or other information on
consumers for the purpose of furnishing consumer reports to
third parties.
"Department." The Department of Health of the Commonwealth.
"Emergency or medically necessary care." As follows:
(1) Health care services that are provided on an
emergency basis or are otherwise determined to be appropriate
for a patient's condition based on current standards of
acceptable medical practice.
(2) The term may exclude care or services that are
primarily for the convenience of the patient or the patient's
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health care provider.
"Government program." Any of the following:
(1) Medical assistance.
(2) CHIP.
"Gross charges." The full, established price for health care
services that a health care provider charges uninsured patients
before applying any contractual allowances, discounts or
deductions.
"Health care provider." Any of the following:
(1) A person registered, certified or licensed to
perform health care services within this Commonwealth.
(2) A health care facility licensed under Chapter 8 of
the act of July 19, 1979 (P.L.130, No.48), known as the
Health Care Facilities Act.
"Health care services." Services for the diagnosis,
prevention, treatment, cure or relief of a physical, behavioral
or mental health condition, substance use disorder, illness,
injury or disease, which services include procedures, products,
devices or medications.
"Health insurance decision." A decision by an insurer
regarding a claim for health care services.
"Household income." Income calculated by using the methods
used to calculate income for purposes of determining eligibility
for medical assistance.
"Impermissible collection action." Any of the following:
(1) Placing a lien on a person's primary residence.
(2) Reporting adverse information about a person to a
consumer reporting agency.
"Judicial officer." As defined in 42 Pa.C.S. § 102 (relating
to definitions).
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"LEP group." A population with limited English proficiency
that constitutes the lesser of 1,000 individuals or 5% of the
community served by a health care provider or the population
likely to be affected or encountered by the health care
provider. For purposes of this definition, a health care
provider may use any reasonable method to determine the
percentage or number of limited English proficiency individuals
in the health care provider's community or likely to be affected
or encountered by the health care provider.
"Medical assistance." The Commonwealth's medical assistance
program established under the act of June 13, 1967 (P.L.31,
No.21), known as the Human Services Code.
"Medical debt." A debt arising from the receipt of health
care services.
"Medical debt collector." Either of the following:
(1) A person engaged in the business of collecting or
attempting to collect, directly or indirectly, medical debts
originally owed or due or asserted to be owed or due to
another person.
(2) A person who purchases a medical debt for collection
purposes, whether the person collects the medical debt itself
or hires a third party for collection or an attorney for
litigation to collect the medical debt.
"Patient." As follows:
(1) A person who received health care services.
(2) The term includes the following:
(i) A parent or legal guardian of a person who
received health care services and is under 18 years of
age.
(ii) A guardian under 20 Pa.C.S. Ch. 55 (relating to
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incapacitated persons) of an incapacitated person who
received health care services.
"Permissible collection action." Any of the following:
(1) Selling a person's medical debt to another party,
including a medical debt collector.
(2) An action that requires a legal or judicial process,
including:
(i) Placing a lien on a person's real property,
other than a primary residence.
(ii) Attaching or seizing a person's bank account or
any other personal property.
(iii) Commencing a civil action against a person.
(iv) Garnishing a person's wages.
"Primary language." A language that is the preferred
communication language for an LEP group.
"Qualified patient." As follows:
(1) A patient with a household income that does not
exceed 300% of the Federal poverty level.
(2) The term does not include a patient who is
experiencing a temporary reduction in income below 300% of
the Federal poverty level by reason of a qualifying personal
event.
"Qualifying personal event." A temporary reduction in income
by reason of an unforeseen, unintended or unavoidable change in
financial circumstances, as determined by the department through
regulation.
Section 3. Screening for insurance, program eligibility and
patient status.
In addition to any other actions required by applicable
Federal or State law or local government ordinance, a health
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care provider shall take the following steps before seeking
payment for emergency or medically necessary care from a
patient:
(1) Verify whether the patient has health insurance.
(2) If the patient is uninsured, offer information about
and screen the patient for:
(i) All public insurance options, including
government programs, accepted by the health care
provider.
(ii) Any financial assistance offered by the health
care provider.
(3) If requested, provide assistance with the
application process for programs identified during screening.
Section 4. Protections.
(a) Prohibition.--Impermissible collection action.--A health
care provider or medical debt collector may not initiate or
pursue an impermissible collection action in pursuit of a
medical debt.
(b) Permissible collection actions.--
(1) A health care provider may not initiate or engage in
a permissible collection action with respect to a medical
debt of a patient prior to screening the patient as required
under section 3.
(2) At least 30 days before taking a permissible
collection action on a medical debt, a health care provider
shall notify the patient of potential permissible collection
actions and shall include with the notice a statement
developed by the department that explains the screening
process required under section 3 and includes information
regarding the complaint procedure developed by the Attorney
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General under section 10.
(3) If a health care provider initiates a permissible
collection action and it is later determined that the patient
was not screened as required under section 3, or it is
determined that the patient was eligible for coverage through
a government program or the health care provider's financial
assistance policy, the health care provider shall:
(i) Unless prohibited by law, if a court has entered
judgment on the medical debt, request the court to vacate
the judgment or reduce the amount of the judgment,
including any fees and costs related to the collection to
the total amount the patient owes pursuant to a
government program or the health care provider's
financial assistance policy.
(ii) Refund any amount paid by the patient in excess
of the amount the patient owes pursuant to a government
program on the health care provider's financial
assistance policy.
(iii) Remedy any other permissible collection
action.
(4) A health care provider shall not sell a medical debt
to a medical debt collector unless, prior to the sale, the
health care provider has entered into a legally binding
written agreement with the medical debt collector that
contains the following terms and conditions:
(i) The medical debt collector agrees not to pursue
impermissible collection actions to obtain payment.
(ii) The medical debt is returnable to or recallable
by the health care provider upon a determination that the
patient was not screened as required under section 3, or
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it is determined that the patient was eligible for
coverage through a government program or the health care
provider's financial assistance policy.
(iii) If it is determined that the patient was not
screened under section 3 or it is determined that the
patient was eligible for coverage through a government
program or the health care provider's financial
assistance policy, the medical debt collector agrees not
to pursue payment in excess of what the patient owes
pursuant to the government program or financial
assistance policy and to assist the health care provider
in performing the remediation actions required under
paragraph (3).
(5) A health care provider that is subject to the
requirements of 26 U.S.C. § 501(r)(6) (relating to exemption
from tax on corporations, certain trusts, etc.) and has
complied with the section and any applicable rules or
regulations shall be deemed to have complied with this
subsection. In the event the statute, rules or regulations
are repealed, abrogated or otherwise determined to be
unenforceable, the requirements of this subsection shall
apply.
(c) Qualifying personal event.--
(1) A patient may petition a health care provider or
medical debt collector for a temporary cessation of a
permissible collection action during the period of a
qualifying personal event.
(2) Upon receipt of reasonable evidence of a qualifying
personal event from a patient, a health care provider or
medical debt collector shall grant a temporary cessation of a
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permissible collection action against the patient for the
duration of the qualifying personal event.
(3) The temporary cessation of a permissible collection
action shall be subject to redetermination every three
months.
(4) If a patient provides reasonable evidence that the
qualifying personal event is ongoing, a health care provider
or medical debt collector shall grant one or more extensions
for the duration of the qualifying personal event.
(d) Settlement offer.--Prior to engaging in a permissible
collection action with respect to a medical debt of a patient, a
health care provider or medical debt collector shall make a good
faith effort to settle the medical debt with the patient. The
following apply:
(1) The patient shall have no fewer than 30 calendar
days to consider a settlement offer under this subsection.
(2) In making a good faith settlement offer, the health
care provider or medical debt collector shall consider the
following:
(i) The amount of the medical debt in relation to
the patient's household income.
(ii) Whether a payment plan, a reasonable reduction
in the principal amount of the medical debt or interest
rate charged on the medical debt or other reasonable
compromise would allow recovery of a substantial portion
of the medical debt from the patient within a reasonable
time frame.
(iii) Whether the costs associated with a
permissible collection action would be unfavorable in
comparison to collecting less than the face value of the
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medical debt.
(e) Costs of collection action.--
(1) A health care provider or medical debt collector may
not assess late fees or other penalties to an outstanding
medical debt.
(2) A patient shall not be liable for any additional
fees or costs levied by a medical debt collector in
connection with the purchase, collection or attempts to
collect a medical debt.
(f) Health insurance appeals.--A health care provider or
medical debt collector who knows, or reasonably should know,
about an internal or external review or appeal of a health
insurance decision may not engage in a permissible collection
action with respect to unpaid charges for health care services
while the review or appeal is pending. Upon learning of a
pending internal or external review or appeal of a health
insurance decision, a health care provider or medical debt
collector shall immediately suspend any permissible collection
action with respect to the medical debt that is the subject of
the health insurance decision.
(g) Noncompliance.--A health care provider or medical debt
collector who is not in material compliance with this act may
not engage in a permissible collection action with respect to a
medical debt during the material noncompliance. A patient who
believes that a health care provider or medical debt collector
is not in material compliance with the provisions of this act
may file a complaint in accordance with the procedures
established by the Attorney General in accordance with section
10(b).
Section 5. Price information.
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(a) Requirement.--A health care provider shall post on its
publicly accessible Internet website price information, which
shall be kept up to date and accessible via a link from the
website's homepage.
(b) Contents.--At a minimum, the price information shall
include all of the following:
(1) A list of gross charges for each health care service
offered by the health care provider.
(2) The amount that Medicare would reimburse for the
health care service, next to the relevant gross charge.
(3) Plain-language titles or descriptions of health care
services that can be understood by the average consumer.
(c) Compliance with Federal law.--A health care provider
that is subject to the requirements of 42 U.S.C. § 300gg-18(e)
(relating to bringing down the cost of health care coverage) and
has complied with the section and any applicable rules or
regulations shall be deemed to have complied with this section.
In the event the statute, rules or regulations are repealed,
abrogated or otherwise determined to be unenforceable, the
requirements of this section shall apply.
Section 6. Communications.
(a) Billing information.--
(1) All bills sent to a patient shall include a complete
and plain-language description of the date, amount and nature
of all charges and all efforts undertaken to bill insurance
or public or government programs for the health care services
provided.
(2) Prior to communicating with a consumer or initiating
a permissible collection action for a medical debt, a medical
debt collector shall have all billing information required in
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this subsection as allowed under the Health Insurance
Portability and Accountability Act of 1996 (Public Law 104-
191, 110 Stat. 1936).
(b) Availability of information.--In all communications with
a consumer about medical debt, including communication relating
to a permissible collection action, a health care provider or
medical debt collector shall inform the consumer of the
availability of the information specified under subsection (a)
and shall offer to and, if requested, provide the information to
the consumer.
(c) Receipts for payments.--
(1) A health care provider or medical debt collector
shall apply payments as of the date that payment was received
and use that date when assessing interest accumulation.
(2) Within 10 business days of receipt of a payment on a
medical debt, a health care provider, medical debt collector
or an agent of the health care provider or medical debt
collector receiving the payment shall furnish a receipt to
the person that made the payment.
(3) Each receipt under this subsection shall include the
following:
(i) The amount paid.
(ii) The date that payment was received.
(iii) The account balance before the most recent
payment.
(iv) The new balance after application of the
payment.
(v) The interest rate and interest accrued since the
consumer's last payment.
(vi) The consumer's account number.
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(vii) The name of the current owner of the medical
debt and, if different, the name of the health care
provider.
(viii) Whether the payment is accepted as payment in
full of the medical debt.
(d) Accessibility and notice.--
(1) All communications with a consumer regarding medical
debt, including all bills, receipts and other correspondence,
shall:
(i) Be written in plain language at a sixth grade
reading level.
(ii) Be made accessible to individuals with visual
impairments upon request.
(iii) Be translated into the patient's primary
language upon request.
(iv) Include a notice that the patient may qualify
for a payment plan or financial assistance.
(v) Include a notice that the patient is entitled to
a reasonable settlement offer prior to a collection
action.
(vi) Include a notice that the patient may file a
complaint with the Attorney General to enforce the
provisions of this act.
(vii) Include a notice that the patient may be
entitled to certain protections under 42 U.S.C. § 300gg-
111 (relating to preventing surprise medical bills)
regarding amounts charged for health care services and
may access additional information regarding these
protections by contacting the Insurance Department.
(viii) Comply with any other Federal or State
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requirements with respect to communications regarding
consumer debt, including the act of March 28, 2000
(P.L.23, No.7), known as the Fair Credit Extension
Uniformity Act.
(2) (Reserved).
Section 7. Uninsured patients.
For emergency or medically necessary health care services
provided to a patient who is determined to be uninsured and not
otherwise eligible for a government program, a health care
provider may not charge an amount greater than the applicable
payment rate for those health care services under the Federal
Medicare program.
Section 8. Payment plans.
(a) Petition.--
(1) No later than 60 days following receipt of the first
bill for a health care service, a patient may petition a
health care provider or medical debt collector to determine
the patient's status as a qualifying patient.
(2) Upon receipt of reasonable evidence that a patient
is a qualified patient, a health care provider or medical
debt collector shall offer a payment plan to the patient in
accordance with subsection (b) and subject to subsection (c).
(b) Monthly installments.--Upon determining that a patient
is a qualified patient, a health care provider or medical debt
collector shall offer a payment plan to recover amounts charged
for any emergency or medically necessary care. Under a payment
plan offered in accordance with this subsection, a health care
provider or medical debt collector shall collect amounts
charged, not including amounts owed by third-party payers, in
monthly installments such that the qualified patient is not
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paying more than 4% of the qualified patient's net monthly
household income. A health care provider or medical debt
collector must comply with this section before engaging in any
permissible collection action against the patient.
(c) Accord and satisfaction.--
(1) If a qualified patient makes 36 consecutive monthly
installment payments as provided under subsection (b), a
health care provider or medical debt collector shall consider
the qualified patient's bill satisfied and shall permanently
cease any collection action of any remaining balance.
(2) If a qualified patient fails to make monthly
installment payments for six consecutive months, a health
care provider or medical debt collector may proceed to a
collection action. The health care provider or medical debt
collector shall comply with section 4(d) prior to engaging in
a collection action under this subsection.
(3) If a qualified patient misses a monthly installment
payment but resumes making payments, including arrearages for
any months missed, the payments shall be counted for purposes
of paragraph (1) if the number of missed payments does not
exceed six.
Section 9. Remedies.
(a) Unfair or deceptive act or practice.--A violation of
this act constitutes an unfair or deceptive act or practice
under the act of December 17, 1968 (P.L.1224, No.387), known as
the Unfair Trade Practices and Consumer Protection Law.
(b) Equitable relief available.--A consumer may bring an
action in court for injunctive or other appropriate equitable
relief to enforce the provisions of this act.
(c) Remedies not exclusive.--
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(1) The remedies provided in this section are not
intended to be the exclusive remedies available to a
consumer.
(2) A consumer shall not be required to exhaust any
administrative remedies provided by this act before bringing
an action in court.
(d) Financial assistance policy or agreement.--A financial
assistance policy or other written agreement between a patient
and a health care provider or medical debt collector shall not
contain a provision that, prior to a dispute arising, waives or
has the practical effect of waiving, the rights of the patient
to resolve that dispute by obtaining any of the following:
(1) Injunctive, declaratory or other equitable relief.
(2) Multiple or minimum damages as specified by statute.
(3) Attorney fees and costs as specified by statute or
as available at common law.
(4) A hearing at which that party can present evidence
in person.
(e) Provisions unenforceable.--A provision in a financial
assistance policy or other written agreement that violates the
provisions of subsection (d) is void and unenforceable. A court
may refuse to enforce other provisions of the financial
assistance policy or other written agreement as equity may
require.
Section 10. Enforcement.
(a) Authority of Attorney General.--The Attorney General
shall enforce the provisions of this act.
(b) Complaint procedure.--The Attorney General shall
establish a complaint process whereby an aggrieved patient may
file a complaint against a health care provider or medical debt
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collector that violates a provision of this act. All complaints
filed in accordance with this section shall be exempt from
access under the act of February 14, 2008 (P.L.6, No.3), known
as the Right-to-Know Law.
Section 11. Medical debt settlement conferences.
(a) Procedures.--Notwithstanding any other provision of law,
in a collection action arising from or relating to a claim for
medical debt not otherwise prohibited by this act, the parties
shall engage in a settlement conference prior to any hearing or
trial on the matter. The following apply:
(1) The court shall schedule the settlement conference
for a time and at a place determined by the court, provided
at least 20 days' notice is given to each party.
(2) The court shall serve the order scheduling the
settlement conference on all parties, which shall require the
attendance and participation of the parties at the settlement
conference.
(3) A settlement officer shall conduct the settlement
conference. The settlement officer may be a judicial officer
or an officer of the court with subject matter experience, as
designated by the presiding judicial officer.
(4) The settlement officer shall report the outcome of
the settlement conference to the presiding judicial officer
detailing the terms of the agreement, if authorized by the
parties, or the fact that no agreement was reached.
(5) If, after a bona fide attempt at settlement, the
parties cannot come to an agreement at the settlement
conference, a civil action may proceed.
(b) Waiver.--If a defendant fails to appear for a settlement
conference under this section, the requirements of this section
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may be waived and the action may proceed upon satisfaction of
the court that service under subsection (a)(2) was made and the
defendant did not request a rescheduling of the settlement
conference within 72 hours of the originally scheduled
settlement conference.
(c) Confidentiality.--Except as otherwise provided by law,
the confidentiality provisions of 42 Pa.C.S. § 5949 (relating to
confidential mediation communications and documents) shall apply
to all settlement conferences under this section.
(d) Local rules.--Each judicial district may adopt local
rules to implement the provisions of this act in accordance with
201 Pa. Code (relating to rules of judicial administration).
(e) Construction.--Nothing in this section shall be
construed to preclude the parties from engaging in settlement or
making an agreement at any time prior to the entry of a
judgment.
Section 12. Prohibition of waiver of rights.
A waiver by a patient or other consumer of any protection
provided by or any right of the patient or other consumer in
accordance with this act is void and may not be enforced by any
court or any other person.
Section 13. Rules and regulations.
(a) Authorization.--The department may promulgate or adopt
rules and regulations as may be necessary and appropriate to
carry out the provisions of this act.
(b) Temporary regulations.--
(1) Notwithstanding any other provision of law, in order
to facilitate the prompt implementation of this act, the
department may issue temporary regulations. The following
apply:
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(i) The department shall issue the temporary
regulations within 180 days of the effective date of this
subsection. Regulations adopted after this 180-day period
shall be promulgated as provided by statute.
(ii) Notice of the temporary regulations shall be
transmitted to the Legislative Reference Bureau for
publication in the next available issue of the
Pennsylvania Bulletin.
(iii) The department shall post the temporary
regulations on the department's publicly accessible
Internet website.
(iv) The temporary regulations shall expire no later
than two years following publication of the temporary
regulations in the Pennsylvania Bulletin.
(2) The temporary regulations under paragraph (1) shall
be exempt from the following:
(i) Section 612 of the act of April 9, 1929
(P.L.177, No.175), known as The Administrative Code of
1929.
(ii) Sections 201, 202, 203, 204 and 205 of the act
of July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(iii) Sections 204(b) and 301(10) of the act of
October 15, 1980 (P.L.950, No.164), known as the
Commonwealth Attorneys Act.
(iv) The act of June 25, 1982 (P.L.633, No.181),
known as the Regulatory Review Act.
(c) Contents.--Rules and regulations under this section
shall establish minimum standards governing the requirements of
this act and shall address, at a minimum, the following:
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(1) A process for determining a patient's status as a
qualified patient.
(2) Guidance on billing and screening best practices
based on the type and size of the health care provider,
including policies to prevent the disclosure of patients'
personal information to third parties.
(3) Specifying the circumstances that constitute a
qualifying personal event, which at a minimum shall include:
(i) Involuntary loss of employment.
(ii) A short-term disability resulting in the
inability to earn an income.
(iii) Temporary leave from employment authorized
under 29 U.S.C. Ch. 28 (relating to family and medical
leave).
(d) Permanent regulations.--Prior to the expiration of the
temporary regulations, the department shall propose for approval
permanent regulations as provided by statute. The proposed
permanent regulations shall be consistent with subsection (c)
and may be the same as the temporary regulations.
Section 14. Severability.
The provisions of this act are severable. If any provision of
this act or its application to any individual or circumstance is
held invalid, the invalidity shall not affect other provisions
or applications of this act which can be given effect without
the invalid provision or application.
Section 15. Construction.
Nothing in this act shall be construed to:
(1) Require a health care provider to refund a payment
made to the health care provider for a health care service
provided to the patient if no permissible collection action
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or impermissible collection action is taken in violation of
this act.
(2) Prohibit a health care provider or medical debt
collector from engaging in a permissible collection action
not in violation of this act.
Section 16. Applicability.
This act shall apply to medical debts incurred and collection
actions filed on or after the effective date of this section.
Section 17. Effective date.
This act shall take effect as follows:
(1) The following sections shall take effect
immediately:
Section 1.
Section 2.
Section 13.
Section 16.
This section.
(2) The remainder of this act shall take effect in 180
days.
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