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| AN ACT concerning State government.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the |
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| Covering ALL KIDS Health Insurance Act. |
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| Section 5. Legislative intent. The General Assembly finds |
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| that, for the economic and social benefit of all residents of |
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| the State, it is important to enable all children of this State |
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| to access affordable health insurance that offers |
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| comprehensive coverage and emphasizes preventive healthcare. |
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| Many children in working families, including many families |
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| whose family income ranges between $40,000 and $80,000, are |
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| uninsured. Numerous studies, including the Institute of |
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| Medicine's report, "Health Insurance Matters", demonstrate |
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| that lack of insurance negatively affects health status. The |
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| General Assembly further finds that access to healthcare is a |
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| key component for children's healthy development and |
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| successful education. The effects of lack of insurance also |
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| negatively impact those who are insured because the cost of |
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| paying for care to the uninsured is often shifted to those who |
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| have insurance in the form of higher health insurance premiums. |
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| A Families USA 2005 report indicates that family premiums in |
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| Illinois are increased by $1,059 due to cost-shifting from the |
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| uninsured. It is, therefore, the intent of this legislation to |
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| provide access to affordable health insurance to all uninsured |
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| children in Illinois. |
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| Section 10. Definitions. In this Act: |
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| "Application agent" means an organization or individual, |
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| such as a licensed health care provider, school, youth service |
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| agency, employer, labor union, local chamber of commerce, |
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| community-based organization, or other organization, approved |
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| by the Department to assist in enrolling children in the |
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| Program.
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| "Child" means a person under the age of 19.
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| "Department" means the Department of Healthcare and Family |
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| Services.
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| "Medical assistance" means health care benefits provided |
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| under Article V of the Illinois Public Aid Code.
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| "Program" means the Covering ALL KIDS Health Insurance |
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| Program.
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| "Resident" means an individual (i) who is in the State for |
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| other than a temporary or transitory purpose during the taxable |
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| year or (ii) who is domiciled in this State but is absent from |
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| the State for a temporary or transitory purpose during the |
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| taxable year.
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| Section 15. Operation of Program. The Covering ALL KIDS |
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| Health Insurance Program is created. The Program shall be |
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| administered by the Department of Healthcare and Family |
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| Services. The Department shall have the same powers and |
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| authority to administer the Program as are provided to the |
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| Department in connection with the Department's administration |
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| of the Illinois Public Aid Code and the Children's Health |
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| Insurance Program Act. The Department shall coordinate the |
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| Program with the existing children's health programs operated |
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| by the Department and other State agencies. |
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| Section 20. Eligibility. |
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| (a) To be eligible for the Program, a person must be a |
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| child:
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| (1) who is a resident of the State of Illinois; and
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| (2) who is ineligible for medical assistance under the |
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| Illinois Public Aid Code or benefits under the Children's |
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| Health Insurance Program Act; and
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| (3) either (i) who has been without health insurance |
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| coverage for a period set forth by the Department in rules, |
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| but not less than 6 months during the first month of |
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| operation of the Program, 7 months during the second month |
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| of operation, 8 months during the third month of operation, |
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| 9 months during the fourth month of operation, 10 months |
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| during the fifth month of operation, 11 months during the |
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| sixth month of operation, and 12 months thereafter, (ii) |
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| whose parent has lost employment that made available |
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| affordable dependent health insurance coverage, until such |
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| time as affordable employer-sponsored dependent health |
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| insurance coverage is again available for the child as set |
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| forth by the Department in rules, (iii) who is a newborn |
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| whose responsible relative does not have available |
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| affordable private or employer-sponsored health insurance, |
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| or (iv) who, within one year of applying for coverage under |
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| this Act, lost medical benefits under the Illinois Public |
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| Aid Code or the Children's Health Insurance Program Act. |
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| An entity that provides health insurance coverage (as |
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| defined in Section 2 of the Comprehensive Health Insurance Plan |
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| Act) to Illinois residents shall provide health insurance data |
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| match to the Department of Healthcare and Family Services for |
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| the purpose of determining eligibility for the Program under |
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| this Act. |
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| The Department of Healthcare and Family Services, in |
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| collaboration with the Department of Financial and |
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| Professional Regulation, Division of Insurance, shall adopt |
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| rules governing the exchange of information under this Section. |
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| The rules shall be consistent with all laws relating to the |
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| confidentiality or privacy of personal information or medical |
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| records, including provisions under the Federal Health |
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| Insurance Portability and Accountability Act (HIPAA). |
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| (b) The Department shall monitor the availability and |
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| retention of employer-sponsored dependent health insurance |
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| coverage and shall modify the period described in subdivision |
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| (a)(3) if necessary to promote retention of private or |
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| employer-sponsored health insurance and timely access to |
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| healthcare services, but at no time shall the period described |
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| in subdivision (a)(3) be less than 6 months.
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| (c) The Department, at its discretion, may take into |
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| account the affordability of dependent health insurance when |
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| determining whether employer-sponsored dependent health |
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| insurance coverage is available upon reemployment of a child's |
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| parent as provided in subdivision (a)(3). |
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| (d) A child who is determined to be eligible for the |
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| Program shall remain eligible for 12 months, provided that the |
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| child maintains his or her residence in this State, has not yet |
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| attained 19 years of age, and is not excluded under subsection |
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| (e). |
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| (e) A child is not eligible for coverage under the Program |
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| if: |
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| (1) the premium required under Section 40 has not been |
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| timely paid; if the required premiums are not paid, the |
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| liability of the Program shall be limited to benefits |
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| incurred under the Program for the time period for which |
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| premiums have been paid; if the required monthly premium is |
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| not paid, the child is ineligible for re-enrollment for a |
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| minimum period of 3 months; re-enrollment shall be |
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| completed before the next covered medical visit, and the |
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| first month's required premium shall be paid in advance of |
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| the next covered medical visit; or |
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| (2) the child is an inmate of a public institution or |
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| an institution for mental diseases.
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| (f) The Department shall adopt eligibility rules, |
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| including, but not limited to: rules regarding annual renewals |
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| of eligibility for the Program; rules providing for |
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| re-enrollment, grace periods, notice requirements, and hearing |
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| procedures under subdivision (e)(1) of this Section; and rules |
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| regarding what constitutes availability and affordability of |
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| private or employer-sponsored health insurance, with |
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| consideration of such factors as the percentage of income |
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| needed to purchase children or family health insurance, the |
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| availability of employer subsidies, and other relevant |
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| factors. |
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| Section 25. Enrollment in Program. The Department shall |
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| develop procedures to allow application agents to assist in |
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| enrolling children in the Program or other children's health |
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| programs operated by the Department. At the Department's |
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| discretion, technical assistance payments may be made |
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| available for approved applications facilitated by an |
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| application agent. |
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| Section 30. Program outreach and marketing. The Department |
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| may provide grants to application agents and other |
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| community-based organizations to educate the public about the |
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| availability of the Program. The Department shall adopt rules |
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| regarding performance standards and outcomes measures expected |
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| of organizations that are awarded grants under this Section, |
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| including penalties for nonperformance of contract standards. |
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| Section 35. Health care benefits for children. |
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| (a) The Department shall purchase or provide health care |
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| benefits for eligible children that are identical to the |
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| benefits provided for children under the Illinois Children's |
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| Health Insurance Program Act, except for non-emergency |
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| transportation.
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| (b) As an alternative to the benefits set forth in |
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| subsection (a), and when cost-effective, the Department may |
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| offer families subsidies toward the cost of privately sponsored |
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| health insurance, including employer-sponsored health |
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| insurance.
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| (c) Notwithstanding clause (i) of subdivision (a)(3) of |
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| Section 20, the Department may consider offering, as an |
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| alternative to the benefits set forth in subsection (a), |
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| partial coverage to children who are enrolled in a |
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| high-deductible private health insurance plan.
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| (d) Notwithstanding clause (i) of subdivision (a)(3) of |
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| Section 20, the Department may consider offering, as an |
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| alternative to the benefits set forth in subsection (a), a |
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| limited package of benefits to children in families who have |
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| private or employer-sponsored health insurance that does not |
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| cover certain benefits such as dental or vision benefits.
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| (e) The content and availability of benefits described in |
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| subsections (b), (c), and (d), and the terms of eligibility for |
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| those benefits, shall be at the Department's discretion and the |
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| Department's determination of efficacy and cost-effectiveness |
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| as a means of promoting retention of private or |
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| employer-sponsored health insurance.
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| Section 40. Cost-sharing. |
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| (a) Children enrolled in the Program under subsection (a) |
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| of Section 35 are subject to the following cost-sharing |
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| requirements:
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| (1) The Department, by rule, shall set forth |
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| requirements concerning co-payments and coinsurance for |
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| health care services and monthly premiums. This |
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| cost-sharing shall be on a sliding scale based on family |
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| income. The Department may periodically modify such |
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| cost-sharing.
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| (2) Notwithstanding paragraph (1), there shall be no |
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| co-payment required for well-baby or well-child health |
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| care, including, but not limited to, age-appropriate |
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| immunizations as required under State or federal law.
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| (b) Children enrolled in a privately sponsored health |
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| insurance plan under subsection (b) of Section 35 are subject |
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| to the cost-sharing provisions stated in the privately |
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| sponsored health insurance plan.
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| (c) Notwithstanding any other provision of law, rates paid |
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| by the Department shall not be used in any way to determine the |
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| usual and customary or reasonable charge, which is the charge |
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| for health care that is consistent with the average rate or |
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| charge for similar services furnished by similar providers in a |
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| certain geographic area. |
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| Section 45. Study. |
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| (a) The Department shall conduct a study that includes, but |
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| is not limited to, the following: |
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| (1) Establishing estimates, broken down by regions of |
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| the State, of the number of children with and without |
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| health insurance coverage; the number of children who are |
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| eligible for Medicaid or the Children's Health Insurance |
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| Program, and, of that number, the number who are enrolled |
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| in Medicaid or the Children's Health Insurance Program; and |
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| the number of children with access to dependent coverage |
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| through an employer, and, of that number, the number who |
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| are enrolled in dependent coverage through an employer. |
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| (2) Surveying those families whose children have |
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| access to employer-sponsored dependent coverage but who |
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| decline such coverage as to the reasons for declining |
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| coverage. |
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| (3) Ascertaining, for the population of children |
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| accessing employer-sponsored dependent coverage or who |
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| have access to such coverage, the comprehensiveness of |
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| dependent coverage available, the amount of cost-sharing |
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| currently paid by the employees, and the cost-sharing |
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| associated with such coverage. |
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| (4) Measuring the health outcomes or other benefits for |
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| children utilizing the Covering ALL KIDS Health Insurance |
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| Program and analyzing the effects on utilization of |
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| healthcare services for children after enrollment in the |
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| Program compared to the preceding period of uninsured |
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| status. |
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| (b) The studies described in subsection (a) shall be |
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| conducted in a manner that compares a time period preceding or |
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| at the initiation of the program with a later period. |
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| (c) The Department shall submit the preliminary results of |
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| the study to the Governor and the General Assembly no later |
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| than July 1, 2008 and shall submit the final results to the |
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| Governor and the General Assembly no later than July 1, 2010. |
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| Section 50. Consultation with stakeholders. The Department |
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| shall present details regarding implementation of the Program |
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| to the Medicaid Advisory Committee, and the Committee shall |
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| serve as the forum for healthcare providers, advocates, |
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| consumers, and other interested parties to advise the |
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| Department with respect to the Program. |
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| Section 55. Charge upon claims and causes of action; right |
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| of subrogation; recoveries. Sections 11-22, 11-22a, 11-22b, |
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| and 11-22c of the Illinois Public Aid Code apply to health care |
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| benefits provided to children under this Act, as provided in |
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| those Sections. |
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| Section 60. Federal financial participation. The |
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| Department shall request any necessary state plan amendments or |
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| waivers of federal requirements in order to allow receipt of |
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| federal funds for implementing any or all of the provisions of |
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| the Program. The failure of the responsible federal agency to |
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| approve a waiver or other State plan amendment shall not |
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| prevent the implementation of any provision of this Act. |
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| Section 65. Emergency rulemaking. The Department may adopt |
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| rules necessary to establish and implement this Act through the |
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| use of emergency rulemaking in accordance with Section 5-45 of |
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| the Illinois Administrative Procedure Act. For the purposes of |
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| that Act, the General Assembly finds that the adoption of rules |
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| to implement this Act is deemed an emergency and necessary for |
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| the public interest, safety, and welfare. This Section is |
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| repealed on July 1, 2008. |
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| Section 90. The Illinois Public Aid Code is amended by |
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| changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
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| (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
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| Sec. 11-22. Charge upon claims and causes of action for |
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| injuries. The Illinois Department shall have a charge upon all |
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| claims, demands and
causes of action for injuries to an |
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| applicant for or recipient of (i)
financial aid under Articles |
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| III, IV, and V or (ii) health care benefits provided under the |
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| Covering ALL KIDS Health Insurance Act for the total
amount of
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| medical assistance provided the recipient from the time of |
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| injury to the
date of recovery upon such claim, demand or cause |
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| of action. In addition, if
the applicant or recipient was |
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| employable, as defined by the Department, at
the time of the |
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| injury, the Department shall also have a charge upon any
such |
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| claims, demands and causes of action for the total amount of |
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| aid
provided to the recipient and his
dependents, including all |
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| cash assistance and medical assistance
only to the extent |
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| includable in the claimant's action, from the
time of injury to |
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| the date of recovery upon such
claim, demand or cause of |
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| action. Any definition of "employable"
adopted by the |
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| Department shall apply only to persons above the age of
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| compulsory school attendance.
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| If the injured person was employable at the time of the |
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| injury and is
provided aid under Articles III, IV, or V and any |
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| dependent or
member of his family is provided aid under Article |
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| VI, or vice versa,
both the Illinois Department and the local |
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| governmental unit shall have
a charge upon such claims, demands |
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| and causes of action for the aid
provided to the injured person |
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| and any
dependent member of his family, including all cash |
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| assistance, medical
assistance and food stamps, from the time |
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| of the injury to the date
of recovery.
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| "Recipient", as used herein, means (i) in the case of |
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| financial aid provided under this Code, the grantee of record |
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| and any
persons whose needs are included in the financial aid |
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| provided to the
grantee of record or otherwise met by grants |
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| under the appropriate
Article of this Code for which such |
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| person is eligible and (ii) in the case of health care benefits |
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| provided under the Covering ALL KIDS Health Insurance Act, the |
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| child to whom those benefits are provided .
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| In each case, the notice shall be served by certified mail |
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| or
registered mail, upon the party or parties against whom the |
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| applicant or
recipient has a claim, demand or cause of action. |
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| The notice shall
claim the charge and describe the interest the |
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| Illinois Department, the
local governmental unit, or the |
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| county, has in the claim, demand, or
cause of action. The |
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| charge shall attach to any verdict or judgment
entered and to |
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| any money or property which may be recovered on account
of such |
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| claim, demand, cause of action or suit from and after the time
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| of the service of the notice.
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| On petition filed by the Illinois Department, or by the |
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| local
governmental unit or county if either is claiming a |
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| charge, or by the
recipient, or by the defendant, the court, on |
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| written notice to all
interested parties, may adjudicate the |
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| rights of the parties and enforce
the charge. The court may |
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| approve the settlement of any claim, demand
or cause of action |
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| either before or after a verdict, and nothing in this
Section |
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| shall be construed as requiring the actual trial or final
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| adjudication of any claim, demand or cause of action upon which |
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| the
Illinois Department, the local governmental unit or county |
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| has charge.
The court may determine what portion of the |
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| recovery shall be paid to
the injured person and what portion |
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| shall be paid to the Illinois
Department, the local |
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| governmental unit or county having a charge
against the |
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| recovery.
In making this determination, the court shall conduct |
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| an evidentiary hearing
and shall consider competent evidence |
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| pertaining
to the following matters:
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| (1) the amount of the charge sought to be enforced |
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| against the recovery
when expressed as a percentage of the |
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| gross amount of the recovery; the
amount of the charge |
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| sought to be enforced against the recovery when expressed
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| as a percentage of the amount obtained by subtracting from |
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| the gross amount
of the recovery the total attorney's fees |
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| and other costs incurred by the
recipient incident to the |
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| recovery; and whether the Department, unit of
local |
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| government or county seeking to enforce the charge against |
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| the recovery
should as a matter of fairness and equity bear |
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| its proportionate share of
the fees and costs incurred to |
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| generate the recovery from which the charge
is sought to be |
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| satisfied;
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| (2) the amount, if any, of the attorney's fees and |
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| other costs incurred
by the recipient incident to the |
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| recovery and paid by the recipient up to the
time of |
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| recovery, and the amount of such fees and costs remaining |
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| unpaid
at the time of recovery;
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| (3) the total hospital, doctor and other medical |
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| expenses incurred for
care and treatment of the injury to |
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| the date of recovery therefor, the portion
of such expenses |
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| theretofore paid by the recipient, by insurance provided
by |
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| the recipient, and by the Department, unit of local |
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| government and county
seeking to enforce a charge against |
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| the recovery, and the amount of such
previously incurred |
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| expenses which remain unpaid at the time of recovery
and by |
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| whom such incurred, unpaid expenses are to be paid;
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| (4) whether the recovery represents less than |
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| substantially full
recompense
for the injury and the |
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| hospital, doctor and other medical expenses incurred
to the |
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| date of recovery for the care and treatment of the injury, |
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| so that
reduction of the charge sought to be enforced |
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| against the recovery would
not likely result in a double |
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| recovery or unjust enrichment to the recipient;
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| (5) the age of the recipient and of persons dependent |
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| for support upon
the recipient, the nature and permanency |
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| of the recipient's injuries as
they affect not only the |
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| future employability and education of the recipient
but |
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| also the reasonably necessary and foreseeable future |
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| material, maintenance,
medical, rehabilitative and |
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| training needs of the recipient, the cost of
such |
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| reasonably necessary and foreseeable future needs, and the |
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| resources
available to meet such needs and pay such costs;
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| (6) the realistic ability of the recipient to repay in |
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| whole or in part
the charge sought to be enforced against |
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| the recovery when judged in light
of the factors enumerated |
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| above.
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| The burden of producing evidence sufficient to support the |
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| exercise by
the court of its discretion to reduce the amount of |
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| a proven charge sought
to be enforced against the recovery |
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| shall rest with the party seeking such reduction.
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| The court may reduce and apportion the Illinois
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| Department's lien proportionate to the recovery of the |
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| claimant. The court may
consider the nature and extent of the |
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| injury, economic and noneconomic
loss, settlement offers, |
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| comparative negligence as it applies to the case
at hand, |
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| hospital costs, physician costs, and all other appropriate |
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| costs.
The Illinois Department shall pay its pro rata share of |
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| the attorney fees
based on the Illinois Department's lien as it |
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| compares to the total
settlement agreed upon. This Section |
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| shall not affect the priority of an
attorney's lien under the |
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| Attorneys Lien Act. The charges of
the Illinois Department |
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| described in this Section, however, shall take
priority over |
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| all other liens and charges existing under the laws of the
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| State of Illinois with the exception of the attorney's lien |
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| under said statute.
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| Whenever the Department or any unit of local government
has |
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| a statutory charge under this Section against a recovery for |
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| damages
incurred by a recipient because of its advancement of |
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| any assistance, such
charge shall not be satisfied out of any |
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| recovery until the attorney's claim
for fees is satisfied, |
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| irrespective of whether or not an action based on
recipient's |
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| claim has been filed in court.
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| This Section shall be inapplicable to any claim, demand or |
26 |
| cause of
action arising under (a) the Workers' Compensation Act |
27 |
| or the predecessor
Workers' Compensation Act
of
June 28, 1913, |
28 |
| (b) the Workers' Occupational Diseases Act or the predecessor
|
29 |
| Workers' Occupational
Diseases Act of March 16, 1936; and (c) |
30 |
| the Wrongful Death Act.
|
31 |
| (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
|
32 |
| (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
|
33 |
| Sec. 11-22a. Right of Subrogation. To the extent of the |
34 |
| amount of (i) medical
assistance provided by the Department to |
35 |
| or on behalf of a recipient under
Article V or VI or (ii) |
|
|
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| health care benefits provided for a child under the Covering |
2 |
| ALL KIDS Health Insurance Act , the Department shall be
|
3 |
| subrogated
to any right of
recovery such recipient may have |
4 |
| under the terms of any private or public
health care coverage |
5 |
| or casualty coverage, including coverage under the
"Workers' |
6 |
| Compensation Act", approved July 9, 1951, as amended, or the
|
7 |
| "Workers' Occupational Diseases Act", approved July 9, 1951, as |
8 |
| amended,
without the necessity of assignment of claim or other |
9 |
| authorization to secure
the right of recovery to the |
10 |
| Department. To enforce its subrogation right, the
Department |
11 |
| may (i) intervene or join in an action or proceeding brought by |
12 |
| the
recipient, his or her guardian, personal representative, |
13 |
| estate, dependents, or
survivors against any person or public |
14 |
| or private entity that may be liable;
(ii) institute and |
15 |
| prosecute legal proceedings against any person or public or
|
16 |
| private entity that may be liable for the cost of such |
17 |
| services; or (iii)
institute and prosecute legal proceedings, |
18 |
| to the extent necessary to reimburse
the Illinois Department |
19 |
| for its costs, against any noncustodial parent who (A)
is |
20 |
| required by court or administrative order to provide insurance |
21 |
| or other
coverage of the cost of health care services for a |
22 |
| child eligible for medical
assistance under this Code and (B) |
23 |
| has received payment from a third party for
the costs of those |
24 |
| services but has not used the payments to reimburse either
the |
25 |
| other parent or the guardian of the child or the provider of |
26 |
| the services.
|
27 |
| (Source: P.A. 92-111, eff. 1-1-02.)
|
28 |
| (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
|
29 |
| Sec. 11-22b. Recoveries.
|
30 |
| (a) As used in this Section:
|
31 |
| (1) "Carrier" means any insurer, including any private |
32 |
| company,
corporation, mutual association, trust fund, |
33 |
| reciprocal or interinsurance
exchange authorized under the |
34 |
| laws of this State to insure persons against
liability or |
35 |
| injuries caused to another and any insurer providing
benefits |
|
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| under a policy of bodily injury liability insurance covering
|
2 |
| liability arising out of the ownership, maintenance or use of a |
3 |
| motor
vehicle which provides uninsured motorist endorsement or |
4 |
| coverage.
|
5 |
| (2) "Beneficiary" means any person or their dependents who |
6 |
| has received
benefits or will be provided benefits under this |
7 |
| Code or under the Covering ALL KIDS Health Insurance Act
|
8 |
| because of an injury for
which another person may be liable. It |
9 |
| includes such beneficiary's guardian,
conservator or other |
10 |
| personal representative, his estate or survivors.
|
11 |
| (b) (1) When benefits are provided or will be provided to a |
12 |
| beneficiary
under this Code or under the Covering ALL KIDS |
13 |
| Health Insurance Act because of an injury for which another |
14 |
| person is liable, or
for which a carrier is liable in |
15 |
| accordance with the provisions of any
policy of insurance |
16 |
| issued pursuant to the Illinois Insurance Code, the
Illinois |
17 |
| Department shall have a right to recover from such person or |
18 |
| carrier
the reasonable value of benefits so provided. The |
19 |
| Attorney General may, to
enforce such right, institute and |
20 |
| prosecute legal proceedings against the
third person or carrier |
21 |
| who may be liable for the injury in an appropriate
court, |
22 |
| either in the name of the Illinois Department or in the name of |
23 |
| the
injured person, his guardian, personal representative, |
24 |
| estate, or survivors.
|
25 |
| (2) The Department may:
|
26 |
| (A) compromise or settle and release any such claim for |
27 |
| benefits
provided under this Code, or
|
28 |
| (B) waive any such claims for benefits provided under |
29 |
| this Code, in
whole or in part, for the convenience of the |
30 |
| Department or if the Department
determines that collection |
31 |
| would result in undue hardship upon the person who
suffered |
32 |
| the injury or, in a wrongful death action, upon the heirs |
33 |
| of the
deceased.
|
34 |
| (3) No action taken on behalf of the Department pursuant to |
35 |
| this Section
or any judgment rendered in such action shall be a |
36 |
| bar to any action upon
the claim or cause of action of the |
|
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| beneficiary, his guardian, conservator,
personal |
2 |
| representative, estate, dependents or survivors against the |
3 |
| third
person who may be liable for the injury, or shall operate |
4 |
| to deny to the
beneficiary the recovery for that portion of any |
5 |
| damages not covered hereunder.
|
6 |
| (c) (1) When an action is brought by the Department |
7 |
| pursuant to
subsection (b), it shall be commenced within the |
8 |
| period prescribed by
Article XIII of the Code of Civil |
9 |
| Procedure.
|
10 |
| However, the Department may not commence the action prior |
11 |
| to 5 months
before the end of the applicable period prescribed |
12 |
| by Article XIII of the
Code of Civil Procedure. Thirty days |
13 |
| prior to commencing an action, the
Department shall notify the |
14 |
| beneficiary of the Department's intent to
commence such an |
15 |
| action.
|
16 |
| (2) The death of the beneficiary does not abate any right |
17 |
| of action
established by subsection (b).
|
18 |
| (3) When an action or claim is brought by persons entitled |
19 |
| to bring such
actions or assert such claims against a third |
20 |
| person who may be liable for
causing the death of a |
21 |
| beneficiary, any settlement, judgment or award
obtained is |
22 |
| subject to the Department's claim for reimbursement of the
|
23 |
| benefits provided to the beneficiary under this Code or under |
24 |
| the Covering ALL KIDS Health Insurance Act .
|
25 |
| (4) When the action or claim is brought by the beneficiary |
26 |
| alone and
the beneficiary incurs a personal liability to pay |
27 |
| attorney's fees and
costs of litigation, the Department's claim |
28 |
| for reimbursement of the
benefits provided to the beneficiary |
29 |
| shall be the full amount of benefits
paid on behalf of the |
30 |
| beneficiary under this Code or under the Covering ALL KIDS |
31 |
| Health Insurance Act less a pro rata
share which represents the |
32 |
| Department's reasonable share of attorney's fees
paid by the |
33 |
| beneficiary and that portion of the cost of litigation expenses
|
34 |
| determined by multiplying by the ratio of the full amount of |
35 |
| the
expenditures of the full amount of the judgment, award or |
36 |
| settlement.
|
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| (d) (1) If either the beneficiary or the Department brings |
2 |
| an action or
claim against such third party or carrier, the |
3 |
| beneficiary or the
Department shall within 30 days of filing |
4 |
| the action give to the other
written notice by personal service |
5 |
| or registered mail of the action or
claim and of the name of |
6 |
| the court in which the
action or claim is brought. Proof of |
7 |
| such notice shall be filed in such
action or claim. If an |
8 |
| action or claim is brought by either the Department
or the |
9 |
| beneficiary, the other may, at any time before trial on the |
10 |
| facts,
become a party to such action or claim or shall |
11 |
| consolidate his action or
claim with the other if brought |
12 |
| independently.
|
13 |
| (2) If an action or claim is brought by the Department |
14 |
| pursuant to
subsection (b)(1), written notice to the |
15 |
| beneficiary, guardian, personal
representative, estate or |
16 |
| survivor given pursuant to this Section shall
advise him of his |
17 |
| right to intervene in the proceeding, his right to obtain
a |
18 |
| private attorney of his choice and the Department's right to |
19 |
| recover the
reasonable value of the benefits provided.
|
20 |
| (e) In the event of judgment or award in a suit or claim |
21 |
| against such
third person or carrier:
|
22 |
| (1) If the action or claim is prosecuted by the beneficiary |
23 |
| alone, the
court shall first order paid from any judgment or |
24 |
| award the
reasonable litigation expenses incurred in |
25 |
| preparation and prosecution of
such action or claim, together |
26 |
| with reasonable attorney's fees, when an
attorney has been |
27 |
| retained. After payment of such expenses and attorney's
fees |
28 |
| the court shall, on the application of the Department, allow
as |
29 |
| a first lien against the amount of such judgment or award the |
30 |
| amount of
the Department's expenditures for the benefit of the |
31 |
| beneficiary under this
Code or under the Covering ALL KIDS |
32 |
| Health Insurance Act , as provided in subsection (c)(4).
|
33 |
| (2) If the action or claim is prosecuted both by the |
34 |
| beneficiary and the
Department, the court shall first order |
35 |
| paid from any judgment or
award the reasonable litigation |
36 |
| expenses incurred in preparation and
prosecution of such action |
|
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| or claim, together with reasonable attorney's
fees for |
2 |
| plaintiffs attorneys based solely on the services rendered for |
3 |
| the
benefit of the beneficiary. After payment of such expenses |
4 |
| and attorney's
fees, the court shall apply out of the balance |
5 |
| of such judgment or award an
amount sufficient to reimburse the |
6 |
| Department the full amount of benefits
paid on behalf of the |
7 |
| beneficiary under this Code or under the Covering ALL KIDS |
8 |
| Health Insurance Act .
|
9 |
| (f) The court shall, upon further application at any time
|
10 |
| before the judgment or award is satisfied, allow as a further |
11 |
| lien the
amount of any expenditures of the Department in |
12 |
| payment of additional
benefits arising out of the same cause of |
13 |
| action or claim provided on
behalf of the beneficiary under |
14 |
| this Code or under the Covering ALL KIDS Health Insurance Act , |
15 |
| when such benefits were
provided or became payable subsequent |
16 |
| to the original order.
|
17 |
| (g) No judgment, award, or settlement in any action or |
18 |
| claim by a
beneficiary to recover damages for injuries, when |
19 |
| the Department has an
interest, shall be satisfied without |
20 |
| first giving the Department notice and
a reasonable opportunity |
21 |
| to perfect and satisfy its lien.
|
22 |
| (h) When the Department has perfected a lien upon a |
23 |
| judgment or award in
favor of a beneficiary against any third |
24 |
| party for an injury for which the
beneficiary has received |
25 |
| benefits under this Code or under the Covering ALL KIDS Health |
26 |
| Insurance Act , the Department shall be
entitled to a writ of |
27 |
| execution as lien claimant to enforce payment of said
lien |
28 |
| against such third party with interest and other accruing costs |
29 |
| as in
the case of other executions. In the event the amount of |
30 |
| such judgment or
award so recovered has been paid to the |
31 |
| beneficiary, the Department shall
be entitled to a writ of |
32 |
| execution against such beneficiary to the extent of
the |
33 |
| Department's lien, with interest and other accruing costs as in |
34 |
| the case
of other executions.
|
35 |
| (i) Except as otherwise provided in this Section, |
36 |
| notwithstanding any
other provision of law, the entire amount |
|
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|
1 |
| of any settlement of the injured
beneficiary's action or claim, |
2 |
| with or without suit, is subject to the
Department's claim for |
3 |
| reimbursement of the benefits provided and any lien
filed |
4 |
| pursuant thereto to the same extent and subject to the same
|
5 |
| limitations as in Section 11-22 of this Code.
|
6 |
| (Source: P.A. 92-651, eff. 7-11-02.)
|
7 |
| (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
|
8 |
| Sec. 11-22c. (a) As used in this Section, "recipient" means |
9 |
| any person
receiving financial assistance under Article IV or |
10 |
| Article VI of this Code or receiving health care benefits under |
11 |
| the Covering ALL KIDS Health Insurance Act .
|
12 |
| (b) If a recipient maintains any suit, charge or other |
13 |
| court or
administrative action against an employer seeking back |
14 |
| pay for a period
during which the recipient received financial |
15 |
| assistance under Article IV
or Article VI of this Code or |
16 |
| health care benefits under the Covering ALL KIDS Health |
17 |
| Insurance Act , the recipient shall report such fact to the
|
18 |
| Department. To the extent of the amount of assistance provided |
19 |
| to or on
behalf of the recipient under Article IV or Article VI |
20 |
| or health care benefits provided under the Covering ALL KIDS |
21 |
| Health Insurance Act , the Department may
by intervention or |
22 |
| otherwise without the necessity of assignment of claim,
attach |
23 |
| a lien on the recovery of back wages equal to the amount of
|
24 |
| assistance provided by the Department to the recipient under |
25 |
| Article IV or
Article VI or under the Covering ALL KIDS Health |
26 |
| Insurance Act .
|
27 |
| (Source: P.A. 86-497.)
|
28 |
| Section 97. Severability. If any provision of this Act or |
29 |
| its application to any person or circumstance is held invalid, |
30 |
| the invalidity of that provision or application does not affect |
31 |
| other provisions or applications of this Act that can be given |
32 |
| effect without the invalid provision or application, and to |
33 |
| this end the provisions of this Act are severable. |