I 

118TH CONGRESS 

2D SESSION H. R. 9129 

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 

JULY 24, 2024 

Mr. VASQUEZ (for himself, Mr. HORSFORD, Mr. RUIZ, Mr. THANEDAR, Ms. 

SCHRIER, and Ms. BARRAGA ́N) 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. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Patient Debt Relief 

3 Act’’. 

4 SEC. 2. ESTABLISHING STANDARDS AND REQUIREMENTS 

5 WITH RESPECT TO FINANCIAL ASSISTANCE 

6 AND MEDICAL DEBT COLLECTION AS CONDI7 TION OF PARTICIPATION IN THE MEDICARE 

8 PROGRAM. 

9 Section 1866 of the Social Security Act (42 U.S.C. 

10 1395cc) is amended— 

11 (1) in subsection (a)(1)— 

12 (A) in subparagraph (X), by striking 

13 ‘‘and’’ at the end; 

14 (B) in subparagraph (Y), by striking the 

15 period at the end and inserting ‘‘, and’’; and 

16 (C) by inserting after subparagraph (Y) 

17 the following new subparagraph: 

18 ‘‘(Z) in the case of a hospital, beginning Janu19 ary 1, 2026, to comply with the financial assistance 

20 and debt collection requirements described in sub21 section (l).’’; 

22 (2) in subsection (b), by adding at the end the 

23 following new paragraph: 

24 ‘‘(5)(A) A hospital that fails to comply with the 

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1 nancial assistance and debt collection) is subject to 

2 a civil monetary penalty under this paragraph. 

3 ‘‘(B) The Secretary may impose a civil mone4 tary penalty in an amount specified by the Secretary 

5 (but not to exceed $1,000,000) for each instance of 

6 noncompliance with the requirements of subsection 

7 (a)(1)(Z), as determined by the Secretary, if— 

8 ‘‘(i) not later than 90 days after the date 

9 on which the Secretary determines such non10 compliance exists, the Secretary submits to 

11 such hospital a notification of such determina12 tion; and 

13 ‘‘(ii) as of the date that is 45 days after 

14 such notification is sent, the Secretary deter15 mines that such hospital has not taken mean16 ingful actions to come into compliance with 

17 such requirements. 

18 The provisions of section 1128A (other than sub19 sections (a) and (b)) shall apply to a civil monetary 

20 penalty under this paragraph in the same manner as 

21 such provisions apply to a penalty or proceeding 

22 under section 1128A(a).’’; and 

23 (3) by adding at the end the following new sub24 section: 


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1 ‘‘(l) FINANCIAL ASSISTANCE AND DEBT COLLECTION

2 REQUIREMENTS.— 

3 ‘‘(1) IN GENERAL.—For purposes of subsection 

4 (a)(1)(Z), the financial assistance and debt collection 

5 requirements are, with respect to a hospital— 

6 ‘‘(A) the financial assistance and charity 

7 care requirements described in paragraph (2); 

8 and 

9 ‘‘(B) the medical debt collection limitations 

10 described in paragraph (3). 

11 ‘‘(2) FINANCIAL ASSISTANCE AND CHARITY

12 CARE REQUIREMENTS.—For purposes of paragraph 

13 (1), the requirements described in this paragraph 

14 are, with respect to a hospital, the following: 

15 ‘‘(A) The hospital— 

16 ‘‘(i) has established a charity care or 

17 financial assistance policy; 

18 ‘‘(ii) has established minimum eligi19 bility requirements with respect to such 

20 charity care or financial assistance policy, 

21 and has made such requirements publicly 

22 available; and 

23 ‘‘(iii) has established a process for 

24 screening individuals furnished items or 

25 services by the hospital to determine 


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1 whether each such individual may be eligi2 ble for assistance with respect to payment 

3 for such items or services pursuant to such 

4 charity care or financial assistance policy. 

5 ‘‘(B) With respect to items or services fur6 nished by the hospital to an individual who has 

7 applied for charity care or financial assistance 

8 under the policy described in subparagraph 

9 (A)(i), the hospital— 

10 ‘‘(i) determines, not later than 30 

11 days before the date on which payment for 

12 such items or services is due, whether such 

13 individual is eligible for assistance with re14 spect to such payment pursuant to such 

15 charity care or financial assistance policy; 

16 ‘‘(ii) in the case that a hospital deter17 mines pursuant to clause (i) that an indi18 vidual is ineligible for such charity care or 

19 financial assistance policy with respect to 

20 such payment, permits such individual to 

21 appeal such determination; and 

22 ‘‘(iii) does not seek to collect such 

23 payment from such individual until the de24 termination under clause (i) with respect 

25 to such individual has been made. 


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1 ‘‘(C) The hospital includes with any bill for 

2 payment with respect to items or services fur3 nished by the hospital to an individual— 

4 ‘‘(i) the minimum eligibility require5 ments described in subparagraph (A)(ii) 

6 with respect to the charity care or financial 

7 assistance policy of the hospital; 

8 ‘‘(ii) notice of the medical debt collec9 tion limitations described in paragraph (3), 

10 including the repayment program described 

11 in subparagraph (C)(ii) of such paragraph; 

12 and 

13 ‘‘(iii) instructions for the individual to 

14 submit to the hospital any information 

15 that would be necessary for the hospital to 

16 make a determination with respect to the 

17 household income of such individual at the 

18 time such items or services were furnished 

19 for purposes of carrying out subparagraph 

20 (D) of such paragraph. 

21 ‘‘(3) MEDICAL DEBT COLLECTION LIMITA22 TIONS.—For purposes of paragraph (1), the limita23 tions described in this paragraph are, with respect to 

24 a hospital and medical debt owed to the hospital by 

25 an individual, that— 


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1 ‘‘(A) the hospital does not seek to place a 

2 lien on or foreclose upon the home of such indi3 vidual in order to collect such medical debt; 

4 ‘‘(B) the hospital does not seek to garnish 

5 the wages of such individual in order to collect 

6 such medical debt; 

7 ‘‘(C) subject to subparagraph (D)(ii), the 

8 hospital does not sell or assign such medical 

9 debt to a debt collector unless— 

10 ‘‘(i) more than 1 year has elapsed 

11 since the date on which payment for such 

12 items or services was due; 

13 ‘‘(ii) the hospital makes available to 

14 the individual a repayment program under 

15 which the individual may make minimum 

16 monthly payments (provided that each 

17 such payment does not exceed 4 percent of 

18 the gross monthly income of such indi19 vidual) toward the medical debt, and such 

20 individual fails to make 4 or more consecu21 tive monthly payments under such repay22 ment program or otherwise declines to par23 ticipate in such repayment program; and 

24 ‘‘(iii) such debt collector agrees to 

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1 paragraphs (A) and (B) for such hospital 

2 with respect to such medical debt; and 

3 ‘‘(D) in the case that the hospital has re4 ceived the necessary information to make the 

5 determination described in paragraph 

6 (2)(C)(iii), if the hospital determines that the 

7 household income of such individual was not in 

8 excess of 250 percent of the poverty line for the 

9 size of the family involved for the most recent 

10 taxable year at the time the items or services 

11 that are the subject of such medical debt were 

12 furnished, the hospital— 

13 ‘‘(i) does not impose an annual inter14 est rate with respect to such payment; and 

15 ‘‘(ii) does not sell or assign such med16 ical debt to a debt collector. 

17 ‘‘(4) MONITORING COMPLIANCE.— 

18 ‘‘(A) AUDITS.—Beginning January 1, 

19 2027, and not less frequently than annually 

20 thereafter, the Secretary shall conduct an audit 

21 of a random sample of hospitals to determine 

22 whether each such hospital is in compliance 

23 with the requirements of paragraph (1). 

24 ‘‘(B) ONLINE PORTAL.—Not later than 

25 January 1, 2026, the Secretary shall establish 


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1 a secure internet website portal (or other suc2 cessor technology) to permit individuals to re3 port the noncompliance of a hospital with the 

4 requirements of paragraph (1), including non5 compliance with the limitations described in 

6 subparagraphs (A) and (B) of paragraph (3) of 

7 a debt collector to which the hospital has sold 

8 or assigned medical debt. 

9 ‘‘(5) DEFINITIONS.—In this subsection: 

10 ‘‘(A) DEBT COLLECTOR.—The term ‘debt 

11 collector’ has the meaning given such term in 

12 section 803(6) of the Fair Debt Collection 

13 Practices Act (15 U.S.C. 1692a(6)). 

14 ‘‘(B) MEDICAL DEBT.—The term ‘medical 

15 debt’ means, with respect to items or services 

16 furnished by a hospital to an individual, the 

17 debt (as defined in section 803(5) of the Fair 

18 Debt Collection Practices Act (15 U.S.C. 

19 1692a(5))) of such individual for such items or 

20 services.’’. 

21 SEC. 3. MEDICAL DEBT RELIEF PROGRAM. 

22 Part P of title III of the Public Health Service Act 

23 (42 U.S.C. 280g et seq.) is amended by adding at the end 

24 the following new section: 


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1 ‘‘SEC. 399V–8. MEDICAL DEBT RELIEF GRANT PROGRAM. 

2 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

3 date of the enactment of this section, the Secretary shall 

4 establish a program under which the Secretary may make 

5 grants to not more than 1 eligible nonprofit organization 

6 to acquire and discharge the medical debt (as defined by 

7 the Secretary) of eligible individuals in accordance with 

8 this section. 

9 ‘‘(b) APPLICATION.—An eligible nonprofit seeking a 

10 grant under this section shall submit an application at 

11 such time, in such form, and containing such information 

12 as the Secretary may require. 

13 ‘‘(c) USE OF FUNDS.—Amounts provided under a 

14 grant under this section shall be used to— 

15 ‘‘(1) identify eligible individuals; and 

16 ‘‘(2) acquire and discharge the medical debt of 

17 such individuals. 

18 ‘‘(d) NOTICE AND REPORTING REQUIREMENTS.— 

19 ‘‘(1) NOTICE REQUIREMENT.—Not later than 

20 60 days after an eligible nonprofit organization that 

21 has received a grant under this section acquires and 

22 discharges the medical debt of an eligible individual 

23 under subsection (c), such eligible nonprofit organi24 zation shall notify such individual of such acquisition 

25 and discharge. 


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1 ‘‘(2) REPORTING REQUIREMENT.—Not less fre2 quently than once per calendar quarter, an eligible 

3 nonprofit organization that has received a grant 

4 under this section shall submit to the Secretary a re5 port containing the following information with re6 spect to the preceding calendar quarter: 

7 ‘‘(A) The actions taken by the eligible non8 profit organization to identify eligible individ9 uals. 

10 ‘‘(B) The number of eligible individuals 

11 whose medical debt was acquired and dis12 charged by the eligible nonprofit organization, 

13 and the amount of medical debt so acquired 

14 and discharged. 

15 ‘‘(C) Such other information as the Sec16 retary may require. 

17 ‘‘(e) DEFINITIONS.—In this section: 

18 ‘‘(1) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

19 individual’ means an individual with medical debt if, 

20 for the most recent taxable year— 

21 ‘‘(A) such medical debt is equivalent to 5 

22 percent or more of the modified adjusted gross 

23 income of such individual; or 


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1 ‘‘(B) the household income of such indi2 vidual is not in excess of 400 percent of the 

3 poverty line for the size of the family involved. 

4 ‘‘(2) ELIGIBLE NONPROFIT ORGANIZATION.— 

5 The term ‘eligible nonprofit organization’ means a 

6 nonprofit organization with the mission of relieving 

7 individuals of their medical debt, as determined by 

8 the Secretary. 

9 ‘‘(3) IRC TERMS.—The terms ‘household in10 come’, ‘modified adjusted gross income’, and ‘pov11 erty line’ have the meaning given each such term in 

12 section 36B of the Internal Revenue Code of 1986 

13 (26 U.S.C. 36B). 

14 ‘‘(f) FUNDING.—There is authorized to be appro15 priated for purposes of carrying out this section 

16 $100,000,000 for fiscal year 2025, to remain available 

17 until expended.’’. 

Æ 


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