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 de-
termined 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 finan-
cial 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 Representa-
tives of the United States of America in Congress assembled, 
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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 CONDI-
TION 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 Janu-
ary 1, 2026, to comply with the financial assistance 
and debt collection requirements described in sub-
section (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 fi-
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nancial assistance and debt collection) is subject to 
a civil monetary penalty under this paragraph. 
‘‘(B) The Secretary may impose a civil mone-
tary 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 non-
compliance exists, the Secretary submits to 
such hospital a notification of such determina-
tion; and 
‘‘(ii) as of the date that is 45 days after 
such notification is sent, the Secretary deter-
mines that such hospital has not taken mean-
ingful actions to come into compliance with 
such requirements. 
The provisions of section 1128A (other than sub-
sections (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 sub-
section: 
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‘‘(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 eligi-
bility 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 
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paragraphs (A) and (B) for such hospital 
with respect to such medical debt; and 
‘‘(D) in the case that the hospital has re-
ceived 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 inter-
est rate with respect to such payment; and 
‘‘(ii) does not sell or assign such med-
ical debt to a debt collector. 
‘‘(4) MONITORING COMPLIANCE.— 
‘‘(A) 
AUDITS.—Beginning 
January 
1, 
2027, 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, 2026, the Secretary shall establish 
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a secure internet website portal (or other suc-
cessor technology) to permit individuals to re-
port the noncompliance of a hospital with the 
requirements of paragraph (1), including non-
compliance 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: 
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‘‘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 organi-
zation shall notify such individual of such acquisition 
and discharge. 
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‘‘(2) REPORTING REQUIREMENT.—Not less fre-
quently than once per calendar quarter, an eligible 
nonprofit organization that has received a grant 
under this section shall submit to the Secretary a re-
port containing the following information with re-
spect to the preceding calendar quarter: 
‘‘(A) The actions taken by the eligible non-
profit organization to identify eligible individ-
uals. 
‘‘(B) The number of eligible individuals 
whose medical debt was acquired and dis-
charged by the eligible nonprofit organization, 
and the amount of medical debt so acquired 
and discharged. 
‘‘(C) Such other information as the Sec-
retary 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 
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‘‘(B) the household income of such indi-
vidual 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 in-
come’, ‘modified adjusted gross income’, and ‘pov-
erty 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 appro-
priated for purposes of carrying out this section 
$100,000,000 for fiscal year 2025, to remain available 
until expended.’’. 
Æ 
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