II 

117TH CONGRESS 

2D SESSION S. 5150 

To amend the Public Health Service Act to provide additional transparency 

and consumer protections relating to medical debt collection practices. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 30 (legislative day, NOVEMBER 29), 2022 

Mr. MURPHY (for himself and Mr. VAN HOLLEN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to provide additional 

transparency and consumer protections relating to medical debt collection practices. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Strengthening Con5 sumer Protections and Medical Debt Transparency Act’’. 

6 SEC. 2. MEDICAL DEBT COLLECTIONS. 

7 (a) IN GENERAL.—Part C of title XXVII of the Pub8 lic Health Service Act (42 U.S.C. 300gg–91 et seq.) is 

9 amended by adding at the end the following: 


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1 ‘‘SEC. 2795. MEDICAL DEBT COLLECTIONS. 

2 ‘‘(a) DEFINITIONS.— 

3 ‘‘(1) IN GENERAL.—In this section: 

4 ‘‘(A) DATABASE.—The term ‘database’ 

5 means the medical debt collection database es6 tablished under subsection (e). 

7 ‘‘(B) DEBT COLLECTOR.—The term ‘debt 

8 collector’ has the meaning as defined under the 

9 Fair Debt Collection Practices Act. 

10 ‘‘(C) EXTRAORDINARY COLLECTION AC11 TION.—The term ‘extraordinary collection ac12 tion’ is as defined for purposes of section 

13 501(r) of the Internal Revenue Code of 1986 

14 (as in effect on the date of enactment of this 

15 section). 

16 ‘‘(D) HEALTH CARE ENTITY.—The term 

17 ‘health care entity’ means an entity defined 

18 pursuant to paragraph (2). 

19 ‘‘(E) MEDICAL DEBT.—The term ‘medical 

20 debt’ means debt arising from a patient’s re21 ceipt of medical services, products, or devices. 

22 ‘‘(2) HEALTH CARE ENTITY.—For purposes of 

23 this section, the Secretary shall develop a definition 

24 of the term ‘health care entity’ that shall include— 


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1 ‘‘(A) nonprofit, for-profit, critical access, 

2 and cancer hospitals, including hospital-owned 

3 facilities; 

4 ‘‘(B) independently licensed outpatient, 

5 ambulatory, behavioral, optical, radiology, lab6 oratory, dental, emergency departments, and 

7 urgent care centers; 

8 ‘‘(C) physician group practices, with an ex9 emption for small practices, as determined by 

10 the Secretary; 

11 ‘‘(D) physician staffing firms or physician 

12 services companies; 

13 ‘‘(E) nursing home, skilled nursing and 

14 long-term care facilities; 

15 ‘‘(F) any health care agent of an entity de16 scribed in this paragraph; and 

17 ‘‘(G) other entities as specified by the Sec18 retary. 

19 ‘‘(b) REQUIREMENTS AND PROHIBITIONS.— 

20 ‘‘(1) DEBT COLLECTION.—A health care entity, 

21 or its debt collector, shall not commence, or shall 

22 halt, an extraordinary collection action with respect 

23 to a patient if the entity or its designee is notified 

24 by any party that a health insurance appeal is pend25 ing. 


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1 ‘‘(2) DETERMINATION OF ELIGIBILITY FOR AS2 SISTANCE.—A health care entity, or its debt col3 lector, shall not commence any extraordinary collec4 tion actions with respect to a patient until the entity 

5 determines whether the patient qualifies for assist6 ance, either through enrollment in a Federal or 

7 State program or through the entity’s charity care 

8 or financial assistance policy, with respect to such 

9 debt. The entity shall refer such patient to any such 

10 assistance where available. 

11 ‘‘(3) PROHIBITION ON EXTRAORDINARY COL12 LECTION.—With respect to medical debt collection 

13 relating to a patient, a health care entity, or its debt 

14 collector, shall not take any extraordinary collection 

15 actions (including an action described in sections 

16 1.501(r)–6(a)(2) of title 26, Code of Federal Regu17 lations (as in effect on the date of enactment of this 

18 section)) until the expiration of the 180-day period 

19 beginning on the date on which the initial bill is sent 

20 to the patient, or a later date if applicable. 

21 ‘‘(4) PROVIDING INFORMATION TO PATIENTS.— 

22 A health care entity or its debt collector shall pro23 vide a patient with— 

24 ‘‘(A) an easy-to-understand itemized state25 ment of the medical debt owed by the patient 


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1 to the health care entity prior to such entity, or 

2 the debt collector acting on behalf of the entity, 

3 commencing collection activities relating to such 

4 debt; 

5 ‘‘(B) a copy of the detailed receipts of any 

6 payments made to the entity or its debt col7 lector by the patient relating to the medical 

8 debt involved within 30 days of such payments; 

9 and 

10 ‘‘(C) information about the availability of 

11 language-assistance services for individuals with 

12 limited English proficiency (LEP). 

13 ‘‘(5) LIMITATION ON RECOVERY BY NONPROFIT

14 ENTITIES.—A health care entity that is a nonprofit 

15 entity, or its debt collector, shall not collect amounts 

16 for the medical debt of a patient who is not enrolled 

17 in health insurance coverage, that are in excess of 

18 the amount generally billed, as described in sections 

19 1.501(r)–1(b)(1) and 1.501(r)–5(b) of title 26, Code 

20 of Federal Regulations. 

21 ‘‘(6) REQUIREMENT OF HEALTH CARE ENTITY

22 OR ITS DEBT COLLECTOR.—Prior to commencing 

23 any debt collection activity with respect to a medical 

24 debt, the health care entity or its debt collector shall 


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1 make all reasonable efforts to confirm the identity of 

2 the debtor. 

3 ‘‘(7) LIMIT ON MEDICAL DEBT INTEREST.—The 

4 interest rate growth applied with respect to any 

5 medical debt collected under this section shall be set 

6 forth on the initial medical bill, but shall not exceed 

7 5 percent annually or the annual rate set forth 

8 under section 1961 of title 28, United States Code, 

9 for the calendar week preceding the date of the ini10 tial medical bill plus 2 percent, whichever is lower. 

11 This subsection shall not be construed to limit as12 sistance or a lower interest rate for a patient who 

13 is otherwise eligible for financial assistance. 

14 ‘‘(c) PENALTIES.—Except as provided in this section, 

15 a health care entity, or its debt collector, that fails to com16 ply with any provision of this section with respect to a 

17 patient shall be liable to such patient for damages in an 

18 amount equal to the sum of— 

19 ‘‘(1) any actual damages sustained by such pa20 tient as a result of such failure to comply; 

21 ‘‘(2) in the case of an action commenced— 

22 ‘‘(A) by an individual, any additional dam23 ages as the court may permit, but not to exceed 

24 $1,000 for each failure to comply; or 

25 ‘‘(B) by a class of patients— 


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1 ‘‘(i) such amount for each named 

2 plaintiff as could be recovered under para3 graph (1) and subparagraph (A); and 

4 ‘‘(ii) such amount as the court may 

5 allow for all other class members, without 

6 regard to a minimum individual recovery, 

7 not to exceed the lesser of $2,000,000 or 

8 1 percent of the annual net income of the 

9 covered provider; and 

10 ‘‘(3) in the case of any successful action under 

11 this section, the costs of the action, together with a 

12 reasonable attorney’s fee as determined appropriate 

13 by the court. 

14 ‘‘(d) ESTABLISHMENT OF DATABASE.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall estab16 lish and regularly update a medical debt collection 

17 public database. 

18 ‘‘(2) REQUIRED INFORMATION.—Not later than 

19 12 months after the date of enactment of this sec20 tion, and annually thereafter, a health care entity 

21 shall submit to the database a debt collection report 

22 that shall include— 

23 ‘‘(A) the name and contact information of 

24 any debt collector owned, utilized, or retained 


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1 by the entity or to which the entity assigned or 

2 sold medical debt during the year; 

3 ‘‘(B) a description, or link to such descrip4 tion, of the processes and policies of the entity 

5 for assigning a medical debt to the debt col6 lector and for compensating such collector for 

7 services provided to the entity; 

8 ‘‘(C) the type and number of extraordinary 

9 collection practices the entity, or debt collector 

10 reported by the entity pursuant to subpara11 graph (A), undertakes or seeks to undertake, 

12 such as wage garnishment, bank account at13 tachments, liens, arrest warrants, reporting to a 

14 consumer reporting agency, and lawsuits; 

15 ‘‘(D) the breakdown, by race and ethnicity, 

16 gender, and ZIP Code of residence, of medical 

17 debt collection accounts referred to a debt col18 lector; 

19 ‘‘(E) the breakdown, by race or ethnicity, 

20 gender, and ZIP Code of residence, against 

21 whom the health entity, or a debt collector used 

22 by the health entity, filed an action to collect a 

23 debt owed on a medical bill; 

24 ‘‘(F) the breakdown, by race or ethnicity, 

25 gender, and ZIP Code of residence, of medical 


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1 debt collection accounts the health entity has 

2 and has not reported or classified as bad debt; 

3 ‘‘(G) the total dollar amount of the cost of 

4 charges for health care services provided to pa5 tients but not collected by the health entity for 

6 patients covered by insurance, including the 

7 out-of-pocket costs for patients covered by in8 surance, and patients without insurance; 

9 ‘‘(H) the recovery rate on medical debt col10 lection cases assigned to the debt collector, as 

11 defined by the Secretary; 

12 ‘‘(I) the number of bills paid using a credit 

13 card; and 

14 ‘‘(J) any other information determined ap15 propriate by the Secretary. 

16 ‘‘(3) AVAILABILITY OF INFORMATION.—The in17 formation contained in the database shall be avail18 able on a public, searchable internet website regu19 larly updated by the Secretary. The Secretary shall 

20 annually publish a public list on HHS.gov of any 

21 health care entity that fails to submit such required 

22 information. 

23 ‘‘(4) CFPB REPORT.—Not later than 12 

24 months after the expiration of two annual reporting 

25 periods under paragraph (2), the Director of the 


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1 Consumer Financial Protection Bureau shall submit 

2 to Congress a report containing an analysis of the 

3 reports submitted under that paragraph and an ex4 planation of whether the findings based on the data5 base under this subsection are a useful tool for the 

6 agency’s Supervision of Nondepository Covered Per7 sons, including the Risk-Based Supervision Program 

8 (under section 1024 of Public Law 111–203). Such 

9 report shall include recommendations to improve the 

10 disclosures by health care entities for the purposes 

11 of supervising the medical debt industry, including 

12 for predictive analytics, machine learning, or other 

13 analysis techniques used in its Risk-Based Super14 vision Program.’’. 

15 (b) CFPB REPORT.—Not later than 12 months after 

16 the date of enactment of this Act, and every 2 years there17 after, the Consumer Financial Protection Bureau shall 

18 publicly report on medical debt collections, incorporating 

19 data from the medical debt collection public database es20 tablished pursuant to section 2795(a) of the Public Health 

21 Service Act, anonymized data from the three largest credit 

22 bureaus, the Consumer Financial Protection Bureau data23 base of consumer complaints, information from the Con24 sumer Financial Protection Bureau’s Supervision of Non25 depository Covered Persons program including the RiskVerDate Sep 11 2014 02:58 Dec 01, 2022 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S5150.IS S5150

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1 Based Supervision Program, and relevant complaints and 

2 information from other sources as available. 

Æ 


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