H.R. 7478

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7478 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 7478

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

February 10, 2026

Mr. Vasquez (for himself, Ms. Stansbury, Mr. Ruiz, Ms. Castor of 
Florida, Mr. Thanedar, Ms. Clarke of New York, Ms. Schrier, Mr. Garcia 
of California, Ms. Barragan, Mr. Landsman, Mr. Frost, Ms. Norton, Ms. 
Craig, Mr. Garcia of Illinois, Ms. Simon, Mr. Goldman of New York, Mr. 
Horsford, and Ms. DelBene) 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, 2028, 
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, 2029, 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, 
2028, 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 2027, to 
remain available until expended.''.
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