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COOK COUNTY HEALTHCARE ACCESS PROTECTION INITIATIVE(“HAPI”) ORDINANCE

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Text of Amendment
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Date Introduced: Tuesday, June 16, 2009
Date Passed:

Committees:
,Finance Committee
Sponsors:
Roberto Maldonado
Co-Sponsors:
John P. Daley,Joseph Mario Moreno

Summary:

Creates the Cook County Healthcare Access Protection Initiative.  Requires hospitals that do not qualify for Medicaid Disproportionate Share Hospital (DSH) payment adjustments to provide financial assistance to eligible individuals on a yearly basis in a total amount at least equal to 4.5% of the hospital’s total yearly hospital expenses.   Requires hospitals that do qualify for Medicaid Disproportionate Share Hospital (DSH) payment adjustments to provide financial assistance to eligible individuals on a yearly basis in a total amount at least equal to 2.3% of the hospital’s total yearly hospital expenses.   Hospital may pay a Healthcare Access Protection Initiative "HAPI" fee in lieu of providing financial assistance to eligible individuals.  The HAPI fee shall be placed in a HAPI Fund in the County Treasury.  Subject to appropriation, monies in the HAPI Fund shall be expended exclusively for uncompensated indigent care at the Cook County Health & Hospital System.  The penalty for violating any part of this ordinace shall be $1,000 per violation.


Activity Log:


Tuesday, June 16, 2009 Introduced County Board : by Commissioner Roberto Maldonado.
Tuesday, June 16, 2009 Referred to Finance Committee :

Full Text of Legislation:

Submitting a Proposed Ordinance sponsored by 

ROBERTO MALDONADO, County Commissioner

 

Co-Sponsored by 

JOHN P. DALEY and JOSEPH MARIO MORENO, County Commissioners

 

PROPOSED ORDINANCE

 

COOK COUNTY HEALTHCARE ACCESS PROTECTION INITIATIVE

(“HAPI”) ORDINANCE

 

BE IT ORDAINED, by the Cook County Board of Commissioners that Chapter 38 Health and Human Services, Article V, Section 38-94 of the Cook County Code is hereby enacted as follows: 

ARTICLE V:  COOK COUNTY HEALTH & HOSPITALS SYSTEM 

Sec. 38-94.      Healthcare Access Protection Initiative (HAPI)

(a)        Short Title.  This Ordinance may be cited as the Healthcare Access Protection Initiative (“HAPI”). 

(b)        Purpose.   The purpose of this Ordinance is to improve access to basic, affordable health care services for all Cook County residents – especially poor and low-income uninsured residents – through regulation of local general hospitals, which play an important role in the local health care safety-net.  Access to necessary, quality health services is vital to the health, safety and welfare of all individuals living in Cook County, and should not be based upon one’s ability to pay.   

(c)        Authority.  This Ordinance is within the County’s home rule regulatory powers granted by Article VII, Section 6(a) of the Illinois Constitution. 

(d)        Findings.  The Cook County Board of Commissioners finds that: 

(1)        Rising health care costs have pushed private health insurance beyond financial reach for many poor and low-income working families, thereby increasing the number of the uninsured.  Since 1999, average health insurance premiums for family coverage have increased 119%, according to the 2008 Kaiser Family Foundation’s Employer Health Benefits Survey. 

(2)        According to 2007 U.S. Census Bureau data, 1.2 million individuals living in the City of Chicago and the surrounding Metropolitan Area are uninsured.  While the majority of the uninsured are working, many do not earn enough to afford private health coverage.  Fully 41% of the uninsured living in Chicago and the Metropolitan Area earn just $25,000 a year or less. 

(3)        Minorities in particular have been disproportionately affected by rising health care costs.  The overwhelming majority of the uninsured in Chicago and the Metropolitan Area are minorities: 37.3% are Latino, 29.7% are African-American and 25.3% are White.   

(4)        When the uninsured are struck by serious illness or injury, financial devastation is common as medical bills mount.  The Kaiser Family Foundation reports that nearly half – 46% – of low-income families (those making $30,000 or less a year) experience problems paying medical bills.  In 2007, overwhelming medical bills forced an estimated 20,349 Illinois residents to file for bankruptcy.  Fully 61% of these medical bankruptcies were Chicago families.   

(5)        Hospital behavior toward the uninsured plays a direct role in access to health care and health outcomes.  Many studies have found that exorbitant hospital charges combined with aggressive billing and collection practices discourages low-income, uninsured individuals from seeking medical care when it is needed.  Accordingly, the uninsured often wait until they are sicker to get care, which results in more expensive care.   

(6)        As a result, the uninsured have worse health outcomes than those with coverage.  According to the Kaiser Commission on Medicaid and the Uninsured, uninsured heart-attack and trauma patients are less likely to receive surgical interventions; uninsured heart-attack patients have higher mortality; uninsured cancer patients are more likely to be diagnosed at late-stage and have shorter survival; uninsured patients with appendicitis are more likely to have a ruptured appendix; uninsured babies have a poorer survival rate than privately insured babies; and uninsured trauma patients are more likely to die. 

(7)        The local health care safety-net includes many different types of health care delivery organizations that deliver health care services to County residents with barriers to accessing health care.  Such barriers include, but are not limited to, lack of insurance; no or low income; and ethnic and cultural characteristics. 


(8)        This Ordinance focuses on the role of local general hospitals in providing affordable, necessary medical care to poor and low-income uninsured County residents because hospitals are typically where people go when they experience a traumatic injury or illness. 

(9)        Lawmakers intended that both public and private hospitals play an important role in delivering necessary health care services to poor and low-income uninsured individuals. 

 (10)      Cook County’s Health & Hospital System is the largest provider of indigent care in the County and the State.  Currently, the System spends more than half – 55.5% – of its total expenditures in delivering care to the uninsured who do not have the ability to pay for their medical services.  As such, the County does not receive payment for the overwhelming majority of this care.  Rather, it is subsidized by County taxpayers.  

(11)      According to an April 10, 2009 Chicago Tribune investigation, “[i]ndigent and under-insured patients are turning to Cook County’s Stroger Hospital after not getting fully treated at non-profit hospitals, swamping the cash-strapped public facility, while fueling the county’s sky-high sales tax…[t]axpayers provide nearly half of the county hospital’s revenues along with hundreds of millions of dollars in property and sales tax breaks to non-profits.” 

(12)      The same Chicago Tribune investigation found that some patients arriving at Stroger’s emergency room come “bearing discharge slips, prescriptions, even Yahoo and Google maps from non-profit hospitals,” and these hospitals are, according to Dr. Jesse Pines, an assistant professor of emergency medicine at the University of Pennsylvania School of Medicine and a member of the American College of Emergency Room Physicians, engaging in “legalized patient dumping.” 

(13)      While public hospitals are intended to play a far greater role than private hospitals in caring for the uninsured, private hospitals are expected to play a vital role.  However, numerous reports have concluded that many private hospitals do not do a good job of providing hospital care that is affordable to poor and low-income uninsured individuals, thereby effectively acting as a barrier to medical treatment when it is needed.   

(14)      When local hospitals do not provide affordable care to poor and low-income uninsured County residents, this impacts the County health care system, both in terms of patient load and financial burden.  In addition, such hospital behavior negatively affects access to care for individuals in need of medical care but who do not have the ability to pay full hospital charges.

(15)      Access to affordable quality health care – hospital care in particular – is in the local public interest to ensure that all County residents, rather than just those with the ability to pay, get the appropriate medical care when it is necessary.  This Ordinance seeks to provide a regulatory framework to protect access to care for the most vulnerable County residents by encouraging local hospitals to provide affordable health care services to this population, and discouraging hospital behavior that acts as an effective barrier to access to care.  In addition, this Ordinance will assist the County with its cost of caring for low-income, uninsured County residents that private general hospitals either cannot or will not provide care for. 

(e)        Definitions. 

Bad debt means an account receivable for services furnished to an individual which: (i) is regarded as uncollectible following reasonable collection action, (ii) is charged as a credit loss; and (iii) is not the obligation of any federal, state or local governmental unit.  Bad debt does not constitute financial assistance.

Charge means the price set by a hospital for a specific service or supply provided by that hospital. 


Collection action means any activity by which a hospital, a designated agent or assignee of a hospital, or a purchaser of a patient account receivable, requests payment for services from a patient or a patient’s family.  Collection actions include, without limitation, pre-admission or pre-treatment deposits, billing statements, letters, electronic mail, telephone and personal contacts related to hospital bills, court summonses and complaints, and any other activity related to collecting a hospital bill. 

Cost means the actual expense a hospital incurs to provide each service or supply. 

Effective date of eligibility means the later of the date on which medical services are rendered or the date of discharge from a hospital. 

Eligible individual means an individual who does not have public or private health insurance and whose family income is at or below 400% of the federal poverty guidelines. 

Family means, for an individual 18 years of age and older, the individual’s spouse or domestic partner, and dependent children under age 21, whether living at home or not.  For an individual under 18 years of age, family means parents or caretaker relatives. 

Federal poverty guidelines means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of 42 U.S.C. 9902(2). 

Financial assistance means medical services provided free-of-charge or at reduced charges to an eligible individual, and must be rendered with no expectation of payment from the patient or such patient’s family.  Financial assistance shall be measured at the cost of the medical services provided based on the total cost-to-charge ratio derived from the hospital’s Medicare Cost Report (CMS 2552-96 Worksheet C, Part 1 PPS Inpatient Ratios).  Financial assistance shall not be recorded as revenue, an account receivable or bad debt.  Financial Assistance shall include only “full financial assistance” and “partial financial assistance” as defined in section (f)(1) of this Ordinance. 

General hospital means any institution required to be licensed by the State of Illinois pursuant to the Hospital Licensing Act or the University of Illinois Licensing Act and holds a General license pursuant to Title 77, Section 250.120(g)(1) of the Illinois Administrative Code.  This Ordinance does not apply to hospitals that hold a specialized license. 

HAPI means Healthcare Access Protection Initiative. 

Income means a family’s annual gross earnings and cash benefits from all sources before taxes, less payments for child support. 

Medical services means services or supplies that are reasonably expected to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure a condition that endangers life, causes suffering or pain, causes physical deformity or malfunction, threatens to cause or aggravate a handicap, or results in illness or infirmity.  Medical services include any inpatient or outpatient hospital services mandated under Title XIX of the federal Social Security Act and emergency care.  Medical services also include plastic surgery designed to correct disfigurement caused by injury, illness or congenital defect or deformity.  Social or vocational services and elective cosmetic surgery are not included as medical services covered by this Ordinance.   

Safety-net hospital means a freestanding general hospital that qualified for Medicaid Disproportionate Share Hospital (DSH) payment adjustments, pursuant to Title 89, Section 148.120(a) of the Illinois Administrative Code, for the most recent year that such payments were made. 

(f)        Financial Assistance Requirements.  Unless a “safety-net hospital” as defined in subsection (e) of this Ordinance, each general hospital operating in the County must provide financial assistance to eligible individuals on a yearly basis in a total amount at least equal to 4.5% of the hospital’s total yearly hospital expenses in accordance with subsections (f)(1)(a) and (f)(1)(b) of this Ordinance.  Each safety-net hospital, as defined in subsection (e), must provide financial assistance to eligible individuals on a yearly basis in a total amount at least equal to 2.3% of the hospital’s total yearly hospital expenses in accordance with subsections (f)(1)(a) and (f)(1)(b) of this Ordinance. 


(1)        Types of Financial Assistance and Eligibility.

a.         Full Financial Assistance means the provision of medical services provided to an eligible individual free-of-charge to the individual.   

1.         Individuals qualifying for full financial assistance.  At a minimum, a general hospital must provide full financial assistance to an eligible individual who applies for financial assistance and whose annual income is equal to or less than 200% of the federal poverty guidelines. 

2.         Collection actions prohibited.  A general hospital must not take any collection action, including but not limited to, the issuance of a bill or invoice, against any individual or such individual’s family who has applied, and qualifies for full financial assistance under this Ordinance. 

b.         Partial Financial Assistance means the provision of medical services provided to an eligible individual at partially discounted charges, which shall not exceed 25% of the individual’s income.  A general hospital must limit any bill or invoice sent to an eligible individual or the individual’s family who applies, and qualifies for financial assistance to the following amounts: 

1.         Individuals qualifying for partial financial assistance.  At a minimum, for an eligible individual whose annual income is more than 200% of the federal poverty guidelines but equal to or less than 300% of the federal poverty guidelines, the amount billed to such individual or such individual’s family shall not exceed the lesser of 20% of the general hospital’s cost of providing the medical services or 25% of the individual’s income.  At a minimum, for an eligible individual whose annual income is more than 300% of the federal poverty guidelines, but equal to or less than 400% of the federal poverty guidelines, the amount billed to such individual or such individual’s family shall not exceed the lesser of 30% of the general hospital’s cost of providing the medical services or 25% of the individual’s income. 

2.         Payment plan.  If an individual applies and qualifies for partial financial assistance but indicates an inability to pay the full amount of a bill or invoice for such financial assistance in one payment, a general hospital must offer such individual or his or her family a reasonable payment plan without interest.  The hospital may require such individual or his or her family to provide reasonable verification of his or her inability to pay the full amount of the bill or invoice in one payment.

c.         If a general hospital has provided full financial assistance or partial financial assistance in a total amount at least equal to 4.5% of the hospital’s total yearly hospital expenses (2.3% of the hospital’s total yearly hospital expenses in the case of a safety-net hospital) prior to the end of the hospital’s fiscal year, the hospital’s obligation to provide financial assistance pursuant to subsections (f)(1)(a) and (f)(1)(b) of this ordinance shall cease until the beginning of the next fiscal year, whereupon this obligation shall resume.  This section is not intended to interfere or conflict with any duty established by the Hospital Uninsured Patient Discount Act [210 ILCS 89/10] upon hospitals to provide discounts to uninsured patients.   Pursuant to subsection (g), a general hospital may elect to pay a HAPI Fee in an amount equal to 4.5% of the hospital’s total expenses in lieu of providing financial assistance to eligible individuals, as provided in this subsection (f).   In the case of a safety-net hospital, pursuant to subsection (g), such hospital may elect to pay a HAPI Fee in an amount equal to 2.3% of the hospital’s total expenses in lieu of providing financial assistance to eligible individuals, as provided in this subsection (f) 

(2)        Application procedures for financial assistance. 

a.         Screening requirements.   


1.         Screening for uninsured individuals.  General hospitals must screen each individual, on or prior to the effective date of eligibility, to determine whether such individual is uninsured.  If an individual is determined to be uninsured, he or she, or the individual’s representative, shall be provided an application for financial assistance no later than the effective date of eligibility.  

 

2.         Billing.  General hospitals must refrain from issuing any bill or invoice to an individual who is uninsured, or his or her family, until at least 90 days after the effective date of eligibility and, if the individual files a financial assistance application before the end of the 90 day period, must further refrain from issuing any bill or invoice until the hospital determines the individual’s eligibility for financial assistance pursuant to this Ordinance. 

b.         Application submission.  An individual or individual’s representative may submit a financial assistance application to a general hospital within 90 days after the effective date of eligibility. 

c.         Determination of financial assistance eligibility.  Each general hospital must deliver written notice of a financial assistance determination to an individual or such individual’s representative who has applied for financial assistance within 14 days after receipt of a completed financial assistance application.  A general hospital must not deny or delay an individual’s medical care while his or her application for financial assistance is pending.   

d.         Application form.  General hospitals may use their own financial assistance application forms to determine eligibility for financial assistance in compliance with this Ordinance.  The application form must state eligibility criteria for full and partial financial assistance as set forth in section (f)(1) of this Ordinance.  The application form must be easy to understand and must request only information that is reasonably necessary to determine eligibility. 

e.         Language of application forms.  Each general hospital must translate and distribute its financial assistance application form in accordance with the Language Assistance Services Act [210 ILCS 87/1] and must also translate the application form into the non-English languages most frequently used in the service area of the hospital and make those translations of the form readily available. 

(3)        Financial assistance availability notification.  General hospitals must provide notification of the availability of financial assistance as follows:  

a.         Signs.  Each general hospital must post signs in the inpatient, outpatient, emergency, admissions and registration areas of the facility, and in the business office areas that are customarily used by patients, that conspicuously inform patients of the availability of full and partial financial assistance, as defined in this Ordinance, and the location within the hospital at which to apply for financial assistance.  Signs must be in English and in the languages other than English that are most frequently spoken in the hospital’s service area, as well as in the languages required under the Language Assistance Services Act. 

b.         Website.  Each general hospital must post a notice in a prominent place on its website that financial assistance is available at the facility.  The notice must include a brief description of the financial assistance application process, qualifications for financial assistance and a copy of the application form.  The notice must be in the same language as the signs that are required pursuant to subsection (f)(3)(a) of this section. 

c.         Individual notice.  Each general hospital must provide individual notice, in the appropriate language, of the availability of full or partial financial assistance, as defined in this Ordinance, to any patient who is identified as uninsured.

d.         Notice in patient bills.  Each general hospital must provide notice, or ensure that notice is provided, of the availability of full or partial financial assistance in any patient bill, invoice or collection action issued by the hospital or by a collection agent, assignee, or account purchaser the hospital retains or with which the hospital has contracted. 

e.         Notice in newspaper.  Each general hospital must, on a quarterly basis, publish notice in a newspaper of general circulation in the hospital’s service area, indicating that financial assistance is available at the facility.  The notice must include a brief description of the financial assistance application process.  Each general hospital must provide a similar notice to all community medical centers located in its service area.  These notices must be provided in the same languages as the signs that are required in subsection (f)(3)(a) above.

(4)        Patient rights and responsibilities. 

a.         Written notice.  General hospitals must distribute to every patient, on or before the effective date of eligibility, a written statement regarding financial assistance.  This statement must include the following: 

1.         The availability of full or partial financial assistance as provided in section (f)(1) of this Ordinance; 

2.         A patient’s right to apply for financial assistance within 90 days after the effective date of eligibility;  

3.         A determination of eligibility for full or partial financial assistance must be made, in writing, within 14 days after a completed application is made; and 

4.         A patient has the right to enter into a payment plan pursuant to section (f)(1)(b)(2) if he or she is determined eligible for partial financial assistance. 

b.         Financial assistance counseling.  If a patient qualifies for financial assistance pursuant to this Ordinance, the general hospital shall provide the patient assistance in filling out the application and determining what types of documentation are necessary. 

c.         Patient responsibilities.  Individuals applying for or receiving financial assistance from any general hospital must: 

1.         Cooperate with the hospital to provide the information and documentation necessary to apply for other public or private existing programs or resources that may be available to pay for health care, including, without limitation, Medicare, Medicaid, or the State Children’s Health Insurance Program. 

2.         Promptly provide the hospital with accurate and complete documentation and information.

3.         Promptly notify the hospital of any significant change in financial status that is likely to adversely affect eligibility for financial assistance. 

4.         An individual who qualifies for partial financial assistance must cooperate with the hospital to establish a reasonable payment plan that takes into account available income and assets, the amount of the discounted bill or bills, and any prior payments and must make a good faith effort to comply with this payment plan.  The patient is responsible for promptly communicating to the hospital any change in financial situation that may impact his or her ability to pay the discounted hospital bills or to honor the provisions of the payment plan.

(g)        Healthcare Access Protection Initiative (“HAPI”) Fee.

(1)        Healthcare Access Protection Initiative (“HAPI”) Fee.  To ensure that low-income, uninsured individuals living in the County have access to basic, affordable health care, and to assist the County with its cost of caring for uninsured patients other hospitals either cannot or will not care for, each general hospital operating in the County that is not a safety-net hospital as defined in subsection (e) of this Ordinance shall annually provide financial assistance as defined in subsection (f)(1), measured at cost, in an amount at least equal to 4.5% of the hospital’s total hospital expenses.  A safety-net hospital as defined in subsection (e) shall annually provide financial assistance as defined in subsection (f)(1), measured at cost, in an amount at least equal to 2.3% of the hospital’s total hospital expenses. If a hospital that is not a safety-net hospital does not provide financial assistance to eligible individuals in the required amount, the County shall impose a HAPI Fee on each general hospital operating within the County equal to the difference between the cost of financial assistance provided for the year, and 4.5% of total hospital expenses.  If a safety-net hospital does not provided financial assistance to eligible individuals in the required amount, the County shall impose a HAPI Fee on each safety-net hospital operating within the County equal to the difference between the cost of financial assistance provided for the year, and 2.3% of total hospital expenses.  A hospital may elect to pay the full amount of the HAPI Fee in lieu of providing financial assistance to eligible individuals pursuant to subsection (f). The fee shall be calculated annually on a stand-alone hospital basis as follows: 

a.         Determination of a general hospital’s total expenses for purposes of the healthcare access protection fee.  For purposes of calculating the fee, the amount of a general hospital’s total expenses shall be determined by the hospital’s most recent audited financial statements.  If a hospital is part of an affiliated or consolidated group that files audited financial statements on a group basis rather than individually, total expenses for the stand-alone hospital shall be determined from the consolidating statements in the affiliated or consolidated audited financial statements.   

b.         Amount of the HAPI Fee due.  If the financial assistance provided by a general hospital for the year in accordance with section (f)(1) of this Ordinance is less than 4.5% of the hospital’s total expenses, a fee shall be paid to the County in an amount equal to the difference between the cost of the financial assistance provided, and 4.5% of the hospital’s total expenses.  If the hospital is a safety-net hospital as defined in subsection (e) of this Ordinance, and if the financial assistance provided by a general hospital for the year in accordance with section (f)(1) of this Ordinance is less than 2.3% of the hospital’s total expenses, a fee shall be paid to the County in an amount equal to the difference between the cost of the financial assistance provided, and 2.3% of the hospital’s total expenses.  Any fee due under this Ordinance shall be paid to the County Treasurer within 90 days of receipt of notice of any fee due.

(h)        Date of Determination of any HAPI Fee.  The HAPI Fee for a general hospital shall be calculated by the County Clerk no later than October 1st of each year, using the most recent audited financial statements of each hospital and the most recently filed hospital financial assistance statement, both of which are required to be filed with the County Clerk pursuant to section (j) of this Ordinance.  The HAPI Fee shall be calculated annually for each general hospital located within the County.  If a hospital elects to pay the full amount of the fee in lieu of providing assistance pursuant to subsection (f), the hospital shall notify the Clerk no later than October 1st of each year.  If the hospital has provided such notice to the Clerk, the hospital shall not be subject to the requirements of subsection (f) and shall not be subject to the penalties set forth in subsection (k)(3) for failure to provide notice and information otherwise required.  

(i)         HAPI Fund.  There is hereby created the HAPI Fund as a special fund in the County Treasury.  All HAPI fees and penalties paid under this Ordinance shall be deposited into the HAPI Fund.  Subject to appropriation, monies in the HAPI Fund shall be expended exclusively for uncompensated indigent care at the Cook County Health & Hospital System.  No HAPI Fees or penalties paid pursuant to this Ordinance may be transferred to the General Fund.

(j)         Financial Assistance Reporting.  Not later than March 31st of each calendar year, each general hospital operating in the County must submit the following to the County Clerk: 

(1)        Financial assistance statement.  A statement which identifies the aggregate dollar amount of financial assistance furnished by the hospital in its most recently completed fiscal year for which the data is available, in accordance with this Ordinance, to be reported at the actual cost of the services provided based on the total cost-to-charge ratio derived from the hospital’s most recently settled Medicare Cost Report.  If a hospital is required to file Form AG-CBP-1, Annual Non Profit Hospital Community Benefits Plan Report with the Illinois Attorney General, a copy of this form is sufficient as long as the financial assistance reported was provided in accordance with section (f)(1) of this Ordinance.  

(2)        Most recent annual audited financial statements.  The hospital’s most recent annual audited financial statements, including consolidating statements if the hospital is part of group or network that files consolidated or affiliated financial statements. 

(3)        Medicaid Disproportionate Share Hospital Statement.  A statement identifying whether the hospital received Medicaid Disproportionate Share Hospital Payments in the most recent year such payments were made by the State. 

(4)        Other necessary information.  Hospitals must report any other information the County Clerk deems necessary to ensure compliance with the provisions of this Ordinance. 

(k)        Implementation and Enforcement. 

(1)        Determination of the HAPI Fee.  The County Clerk shall be responsible for calculating each general hospital’s HAPI Fee due pursuant to section (g) of this Ordinance.  The County Clerk has the authority to issue any rules necessary to carry out this Ordinance.   

(2)        Financial assistance compliance review by the HAPI Officer.  The County shall create a position for a HAPI Officer.  Such Officer shall be responsible for ensuring that each general hospital in the County is in compliance with section (f) of this Ordinance.  If the Officer determines a general hospital is not in compliance with any of such provisions, the Officer  shall notify the hospital of the assessment of the appropriate penalty or penalties provided for in section (k)(3) of this Ordinance.  The HAPI Officer has the authority to issue any rules necessary to carry out this Ordinance. 

(3)        Enforcement.   

a.         A general hospital that fails to post any notice or provide any notification required under this Ordinance is subject to a civil penalty of $1,000 per day for each day the required notice is not posted or notification is not provided. 

b.         A general hospital that fails to provide information to the public as required under this Ordinance is subject to a civil penalty of $1,000 per violation. 

c.         A general hospital that violates any provision of this Ordinance other than the provisions of sections (f)(1), and (g) is subject to a civil penalty of $1,000 per violation. 

d.         All fees and penalties provided for in this Ordinance shall constitute a debt to the County.  The State’s Attorney is authorized to institute a civil suit in the name of the County to recover the amount of any such unpaid fee or penalty. 

(l)         Effective date.  This Ordinance shall take effect on the first day of the fiscal year of Cook County following enactment. 

(m)       Sunset.  This Ordinance, and all requirements hereunder shall terminate on November 30, 2016.

Text of Amendment:


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