|
Sen. Emil Jones Jr.
Filed: 10/25/2005
|
|
09400HB0806sam003 |
|
LRB094 03660 DRJ 49915 a |
|
|
1 |
| AMENDMENT TO HOUSE BILL 806
|
2 |
| AMENDMENT NO. ______. Amend House Bill 806 by replacing |
3 |
| everything after the enacting clause with the following:
|
4 |
| "Section 1. Short title. This Act may be cited as the |
5 |
| Covering ALL KIDS Health Insurance Act. |
6 |
| Section 5. Legislative intent. The General Assembly finds |
7 |
| that, for the economic and social benefit of all residents of |
8 |
| the State, it is important to enable all children of this State |
9 |
| to access affordable health insurance that offers |
10 |
| comprehensive coverage and emphasizes preventive healthcare. |
11 |
| Many children in working families, including many families |
12 |
| whose family income ranges between $40,000 and $80,000, are |
13 |
| uninsured. Numerous studies, including the Institute of |
14 |
| Medicine's report, "Health Insurance Matters", demonstrate |
15 |
| that lack of insurance negatively affects health status. The |
16 |
| General Assembly further finds that access to healthcare is a |
17 |
| key component for children's healthy development and |
18 |
| successful education. The effects of lack of insurance also |
19 |
| negatively impact those who are insured because the cost of |
20 |
| paying for care to the uninsured is often shifted to those who |
21 |
| have insurance in the form of higher health insurance premiums. |
22 |
| A Families USA 2005 report indicates that family premiums in |
23 |
| Illinois are increased by $1,059 due to cost-shifting from the |
24 |
| uninsured. It is, therefore, the intent of this legislation to |
|
|
|
09400HB0806sam003 |
- 2 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| provide access to affordable health insurance to all uninsured |
2 |
| children in Illinois. |
3 |
| Section 10. Definitions. In this Act: |
4 |
| "Application agent" means an organization or individual, |
5 |
| such as a licensed health care provider, school, youth service |
6 |
| agency, employer, labor union, local chamber of commerce, |
7 |
| community-based organization, or other organization, approved |
8 |
| by the Department to assist in enrolling children in the |
9 |
| Program.
|
10 |
| "Child" means a person under the age of 19.
|
11 |
| "Department" means the Department of Healthcare and Family |
12 |
| Services.
|
13 |
| "Medical assistance" means health care benefits provided |
14 |
| under Article V of the Illinois Public Aid Code.
|
15 |
| "Program" means the Covering ALL KIDS Health Insurance |
16 |
| Program.
|
17 |
| "Resident" means an individual (i) who is in the State for |
18 |
| other than a temporary or transitory purpose during the taxable |
19 |
| year or (ii) who is domiciled in this State but is absent from |
20 |
| the State for a temporary or transitory purpose during the |
21 |
| taxable year.
|
22 |
| Section 15. Operation of Program. The Covering ALL KIDS |
23 |
| Health Insurance Program is created. The Program shall be |
24 |
| administered by the Department of Healthcare and Family |
25 |
| Services. The Department shall have the same powers and |
26 |
| authority to administer the Program as are provided to the |
27 |
| Department in connection with the Department's administration |
28 |
| of the Illinois Public Aid Code and the Children's Health |
29 |
| Insurance Program Act. The Department shall coordinate the |
30 |
| Program with the existing children's health programs operated |
31 |
| by the Department and other State agencies. |
|
|
|
09400HB0806sam003 |
- 3 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| Section 20. Eligibility. |
2 |
| (a) To be eligible for the Program, a person must be a |
3 |
| child:
|
4 |
| (1) who is a resident of the State of Illinois; and
|
5 |
| (2) who is ineligible for medical assistance under the |
6 |
| Illinois Public Aid Code or benefits under the Children's |
7 |
| Health Insurance Program Act; and
|
8 |
| (3) either (i) who has been without health insurance |
9 |
| coverage for a period set forth by the Department in rules, |
10 |
| but not less than 6 months during the first month of |
11 |
| operation of the Program, 7 months during the second month |
12 |
| of operation, 8 months during the third month of operation, |
13 |
| 9 months during the fourth month of operation, 10 months |
14 |
| during the fifth month of operation, 11 months during the |
15 |
| sixth month of operation, and 12 months thereafter, (ii) |
16 |
| whose parent has lost employment that made available |
17 |
| affordable dependent health insurance coverage, until such |
18 |
| time as affordable employer-sponsored dependent health |
19 |
| insurance coverage is again available for the child as set |
20 |
| forth by the Department in rules, (iii) who is a newborn |
21 |
| whose responsible relative does not have available |
22 |
| affordable private or employer-sponsored health insurance, |
23 |
| or (iv) who, within one year of applying for coverage under |
24 |
| this Act, lost medical benefits under the Illinois Public |
25 |
| Aid Code or the Children's Health Insurance Program Act. |
26 |
| An entity that provides health insurance coverage (as |
27 |
| defined in Section 2 of the Comprehensive Health Insurance Plan |
28 |
| Act) to Illinois residents shall provide health insurance data |
29 |
| match to the Department of Healthcare and Family Services for |
30 |
| the purpose of determining eligibility for the Program under |
31 |
| this Act. |
32 |
| The Department of Healthcare and Family Services, in |
33 |
| collaboration with the Department of Financial and |
34 |
| Professional Regulation, Division of Insurance, shall adopt |
|
|
|
09400HB0806sam003 |
- 4 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| rules governing the exchange of information under this Section. |
2 |
| The rules shall be consistent with all laws relating to the |
3 |
| confidentiality or privacy of personal information or medical |
4 |
| records, including provisions under the Federal Health |
5 |
| Insurance Portability and Accountability Act (HIPAA). |
6 |
| (b) The Department shall monitor the availability and |
7 |
| retention of employer-sponsored dependent health insurance |
8 |
| coverage and shall modify the period described in subdivision |
9 |
| (a)(3) if necessary to promote retention of private or |
10 |
| employer-sponsored health insurance and timely access to |
11 |
| healthcare services, but at no time shall the period described |
12 |
| in subdivision (a)(3) be less than 6 months.
|
13 |
| (c) The Department, at its discretion, may take into |
14 |
| account the affordability of dependent health insurance when |
15 |
| determining whether employer-sponsored dependent health |
16 |
| insurance coverage is available upon reemployment of a child's |
17 |
| parent as provided in subdivision (a)(3). |
18 |
| (d) A child who is determined to be eligible for the |
19 |
| Program shall remain eligible for 12 months, provided that the |
20 |
| child maintains his or her residence in this State, has not yet |
21 |
| attained 19 years of age, and is not excluded under subsection |
22 |
| (e). |
23 |
| (e) A child is not eligible for coverage under the Program |
24 |
| if: |
25 |
| (1) the premium required under Section 40 has not been |
26 |
| timely paid; if the required premiums are not paid, the |
27 |
| liability of the Program shall be limited to benefits |
28 |
| incurred under the Program for the time period for which |
29 |
| premiums have been paid; if the required monthly premium is |
30 |
| not paid, the child is ineligible for re-enrollment for a |
31 |
| minimum period of 3 months; re-enrollment shall be |
32 |
| completed before the next covered medical visit, and the |
33 |
| first month's required premium shall be paid in advance of |
34 |
| the next covered medical visit; or |
|
|
|
09400HB0806sam003 |
- 5 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| (2) the child is an inmate of a public institution or |
2 |
| an institution for mental diseases.
|
3 |
| (f) The Department shall adopt eligibility rules, |
4 |
| including, but not limited to: rules regarding annual renewals |
5 |
| of eligibility for the Program; rules providing for |
6 |
| re-enrollment, grace periods, notice requirements, and hearing |
7 |
| procedures under subdivision (e)(1) of this Section; and rules |
8 |
| regarding what constitutes availability and affordability of |
9 |
| private or employer-sponsored health insurance, with |
10 |
| consideration of such factors as the percentage of income |
11 |
| needed to purchase children or family health insurance, the |
12 |
| availability of employer subsidies, and other relevant |
13 |
| factors. |
14 |
| Section 25. Enrollment in Program. The Department shall |
15 |
| develop procedures to allow application agents to assist in |
16 |
| enrolling children in the Program or other children's health |
17 |
| programs operated by the Department. At the Department's |
18 |
| discretion, technical assistance payments may be made |
19 |
| available for approved applications facilitated by an |
20 |
| application agent. |
21 |
| Section 30. Program outreach and marketing. The Department |
22 |
| may provide grants to application agents and other |
23 |
| community-based organizations to educate the public about the |
24 |
| availability of the Program. The Department shall adopt rules |
25 |
| regarding performance standards and outcomes measures expected |
26 |
| of organizations that are awarded grants under this Section, |
27 |
| including penalties for nonperformance of contract standards. |
28 |
| Section 35. Health care benefits for children. |
29 |
| (a) The Department shall purchase or provide health care |
30 |
| benefits for eligible children that are identical to the |
31 |
| benefits provided for children under the Illinois Children's |
|
|
|
09400HB0806sam003 |
- 6 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| Health Insurance Program Act, except for non-emergency |
2 |
| transportation.
|
3 |
| (b) As an alternative to the benefits set forth in |
4 |
| subsection (a), and when cost-effective, the Department may |
5 |
| offer families subsidies toward the cost of privately sponsored |
6 |
| health insurance, including employer-sponsored health |
7 |
| insurance.
|
8 |
| (c) Notwithstanding clause (i) of subdivision (a)(3) of |
9 |
| Section 20, the Department may consider offering, as an |
10 |
| alternative to the benefits set forth in subsection (a), |
11 |
| partial coverage to children who are enrolled in a |
12 |
| high-deductible private health insurance plan.
|
13 |
| (d) Notwithstanding clause (i) of subdivision (a)(3) of |
14 |
| Section 20, the Department may consider offering, as an |
15 |
| alternative to the benefits set forth in subsection (a), a |
16 |
| limited package of benefits to children in families who have |
17 |
| private or employer-sponsored health insurance that does not |
18 |
| cover certain benefits such as dental or vision benefits.
|
19 |
| (e) The content and availability of benefits described in |
20 |
| subsections (b), (c), and (d), and the terms of eligibility for |
21 |
| those benefits, shall be at the Department's discretion and the |
22 |
| Department's determination of efficacy and cost-effectiveness |
23 |
| as a means of promoting retention of private or |
24 |
| employer-sponsored health insurance.
|
25 |
| Section 40. Cost-sharing. |
26 |
| (a) Children enrolled in the Program under subsection (a) |
27 |
| of Section 35 are subject to the following cost-sharing |
28 |
| requirements:
|
29 |
| (1) The Department, by rule, shall set forth |
30 |
| requirements concerning co-payments and coinsurance for |
31 |
| health care services and monthly premiums. This |
32 |
| cost-sharing shall be on a sliding scale based on family |
33 |
| income. The Department may periodically modify such |
|
|
|
09400HB0806sam003 |
- 7 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| cost-sharing.
|
2 |
| (2) Notwithstanding paragraph (1), there shall be no |
3 |
| co-payment required for well-baby or well-child health |
4 |
| care, including, but not limited to, age-appropriate |
5 |
| immunizations as required under State or federal law.
|
6 |
| (b) Children enrolled in a privately sponsored health |
7 |
| insurance plan under subsection (b) of Section 35 are subject |
8 |
| to the cost-sharing provisions stated in the privately |
9 |
| sponsored health insurance plan.
|
10 |
| (c) Notwithstanding any other provision of law, rates paid |
11 |
| by the Department shall not be used in any way to determine the |
12 |
| usual and customary or reasonable charge, which is the charge |
13 |
| for health care that is consistent with the average rate or |
14 |
| charge for similar services furnished by similar providers in a |
15 |
| certain geographic area. |
16 |
| Section 45. Study. |
17 |
| (a) The Department shall conduct a study that includes, but |
18 |
| is not limited to, the following: |
19 |
| (1) Establishing estimates, broken down by regions of |
20 |
| the State, of the number of children with and without |
21 |
| health insurance coverage; the number of children who are |
22 |
| eligible for Medicaid or the Children's Health Insurance |
23 |
| Program, and, of that number, the number who are enrolled |
24 |
| in Medicaid or the Children's Health Insurance Program; and |
25 |
| the number of children with access to dependent coverage |
26 |
| through an employer, and, of that number, the number who |
27 |
| are enrolled in dependent coverage through an employer. |
28 |
| (2) Surveying those families whose children have |
29 |
| access to employer-sponsored dependent coverage but who |
30 |
| decline such coverage as to the reasons for declining |
31 |
| coverage. |
32 |
| (3) Ascertaining, for the population of children |
33 |
| accessing employer-sponsored dependent coverage or who |
|
|
|
09400HB0806sam003 |
- 8 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| have access to such coverage, the comprehensiveness of |
2 |
| dependent coverage available, the amount of cost-sharing |
3 |
| currently paid by the employees, and the cost-sharing |
4 |
| associated with such coverage. |
5 |
| (4) Measuring the health outcomes or other benefits for |
6 |
| children utilizing the Covering ALL KIDS Health Insurance |
7 |
| Program and analyzing the effects on utilization of |
8 |
| healthcare services for children after enrollment in the |
9 |
| Program compared to the preceding period of uninsured |
10 |
| status. |
11 |
| (b) The studies described in subsection (a) shall be |
12 |
| conducted in a manner that compares a time period preceding or |
13 |
| at the initiation of the program with a later period. |
14 |
| (c) The Department shall submit the preliminary results of |
15 |
| the study to the Governor and the General Assembly no later |
16 |
| than July 1, 2008 and shall submit the final results to the |
17 |
| Governor and the General Assembly no later than July 1, 2010. |
18 |
| Section 50. Consultation with stakeholders. The Department |
19 |
| shall present details regarding implementation of the Program |
20 |
| to the Medicaid Advisory Committee, and the Committee shall |
21 |
| serve as the forum for healthcare providers, advocates, |
22 |
| consumers, and other interested parties to advise the |
23 |
| Department with respect to the Program. |
24 |
| Section 55. Charge upon claims and causes of action; right |
25 |
| of subrogation; recoveries. Sections 11-22, 11-22a, 11-22b, |
26 |
| and 11-22c of the Illinois Public Aid Code apply to health care |
27 |
| benefits provided to children under this Act, as provided in |
28 |
| those Sections. |
29 |
| Section 60. Federal financial participation. The |
30 |
| Department shall request any necessary state plan amendments or |
31 |
| waivers of federal requirements in order to allow receipt of |
|
|
|
09400HB0806sam003 |
- 9 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| federal funds for implementing any or all of the provisions of |
2 |
| the Program. The failure of the responsible federal agency to |
3 |
| approve a waiver or other State plan amendment shall not |
4 |
| prevent the implementation of any provision of this Act. |
5 |
| Section 65. Emergency rulemaking. The Department may adopt |
6 |
| rules necessary to establish and implement this Act through the |
7 |
| use of emergency rulemaking in accordance with Section 5-45 of |
8 |
| the Illinois Administrative Procedure Act. For the purposes of |
9 |
| that Act, the General Assembly finds that the adoption of rules |
10 |
| to implement this Act is deemed an emergency and necessary for |
11 |
| the public interest, safety, and welfare. This Section is |
12 |
| repealed on July 1, 2008. |
13 |
| Section 90. The Illinois Public Aid Code is amended by |
14 |
| changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
|
15 |
| (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
|
16 |
| Sec. 11-22. Charge upon claims and causes of action for |
17 |
| injuries. The Illinois Department shall have a charge upon all |
18 |
| claims, demands and
causes of action for injuries to an |
19 |
| applicant for or recipient of (i)
financial aid under Articles |
20 |
| III, IV, and V or (ii) health care benefits provided under the |
21 |
| Covering ALL KIDS Health Insurance Act for the total
amount of
|
22 |
| medical assistance provided the recipient from the time of |
23 |
| injury to the
date of recovery upon such claim, demand or cause |
24 |
| of action. In addition, if
the applicant or recipient was |
25 |
| employable, as defined by the Department, at
the time of the |
26 |
| injury, the Department shall also have a charge upon any
such |
27 |
| claims, demands and causes of action for the total amount of |
28 |
| aid
provided to the recipient and his
dependents, including all |
29 |
| cash assistance and medical assistance
only to the extent |
30 |
| includable in the claimant's action, from the
time of injury to |
31 |
| the date of recovery upon such
claim, demand or cause of |
|
|
|
09400HB0806sam003 |
- 10 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| action. Any definition of "employable"
adopted by the |
2 |
| Department shall apply only to persons above the age of
|
3 |
| compulsory school attendance.
|
4 |
| If the injured person was employable at the time of the |
5 |
| injury and is
provided aid under Articles III, IV, or V and any |
6 |
| dependent or
member of his family is provided aid under Article |
7 |
| VI, or vice versa,
both the Illinois Department and the local |
8 |
| governmental unit shall have
a charge upon such claims, demands |
9 |
| and causes of action for the aid
provided to the injured person |
10 |
| and any
dependent member of his family, including all cash |
11 |
| assistance, medical
assistance and food stamps, from the time |
12 |
| of the injury to the date
of recovery.
|
13 |
| "Recipient", as used herein, means (i) in the case of |
14 |
| financial aid provided under this Code, the grantee of record |
15 |
| and any
persons whose needs are included in the financial aid |
16 |
| provided to the
grantee of record or otherwise met by grants |
17 |
| under the appropriate
Article of this Code for which such |
18 |
| person is eligible and (ii) in the case of health care benefits |
19 |
| provided under the Covering ALL KIDS Health Insurance Act, the |
20 |
| child to whom those benefits are provided .
|
21 |
| In each case, the notice shall be served by certified mail |
22 |
| or
registered mail, upon the party or parties against whom the |
23 |
| applicant or
recipient has a claim, demand or cause of action. |
24 |
| The notice shall
claim the charge and describe the interest the |
25 |
| Illinois Department, the
local governmental unit, or the |
26 |
| county, has in the claim, demand, or
cause of action. The |
27 |
| charge shall attach to any verdict or judgment
entered and to |
28 |
| any money or property which may be recovered on account
of such |
29 |
| claim, demand, cause of action or suit from and after the time
|
30 |
| of the service of the notice.
|
31 |
| On petition filed by the Illinois Department, or by the |
32 |
| local
governmental unit or county if either is claiming a |
33 |
| charge, or by the
recipient, or by the defendant, the court, on |
34 |
| written notice to all
interested parties, may adjudicate the |
|
|
|
09400HB0806sam003 |
- 11 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| rights of the parties and enforce
the charge. The court may |
2 |
| approve the settlement of any claim, demand
or cause of action |
3 |
| either before or after a verdict, and nothing in this
Section |
4 |
| shall be construed as requiring the actual trial or final
|
5 |
| adjudication of any claim, demand or cause of action upon which |
6 |
| the
Illinois Department, the local governmental unit or county |
7 |
| has charge.
The court may determine what portion of the |
8 |
| recovery shall be paid to
the injured person and what portion |
9 |
| shall be paid to the Illinois
Department, the local |
10 |
| governmental unit or county having a charge
against the |
11 |
| recovery.
In making this determination, the court shall conduct |
12 |
| an evidentiary hearing
and shall consider competent evidence |
13 |
| pertaining
to the following matters:
|
14 |
| (1) the amount of the charge sought to be enforced |
15 |
| against the recovery
when expressed as a percentage of the |
16 |
| gross amount of the recovery; the
amount of the charge |
17 |
| sought to be enforced against the recovery when expressed
|
18 |
| as a percentage of the amount obtained by subtracting from |
19 |
| the gross amount
of the recovery the total attorney's fees |
20 |
| and other costs incurred by the
recipient incident to the |
21 |
| recovery; and whether the Department, unit of
local |
22 |
| government or county seeking to enforce the charge against |
23 |
| the recovery
should as a matter of fairness and equity bear |
24 |
| its proportionate share of
the fees and costs incurred to |
25 |
| generate the recovery from which the charge
is sought to be |
26 |
| satisfied;
|
27 |
| (2) the amount, if any, of the attorney's fees and |
28 |
| other costs incurred
by the recipient incident to the |
29 |
| recovery and paid by the recipient up to the
time of |
30 |
| recovery, and the amount of such fees and costs remaining |
31 |
| unpaid
at the time of recovery;
|
32 |
| (3) the total hospital, doctor and other medical |
33 |
| expenses incurred for
care and treatment of the injury to |
34 |
| the date of recovery therefor, the portion
of such expenses |
|
|
|
09400HB0806sam003 |
- 12 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| theretofore paid by the recipient, by insurance provided
by |
2 |
| the recipient, and by the Department, unit of local |
3 |
| government and county
seeking to enforce a charge against |
4 |
| the recovery, and the amount of such
previously incurred |
5 |
| expenses which remain unpaid at the time of recovery
and by |
6 |
| whom such incurred, unpaid expenses are to be paid;
|
7 |
| (4) whether the recovery represents less than |
8 |
| substantially full
recompense
for the injury and the |
9 |
| hospital, doctor and other medical expenses incurred
to the |
10 |
| date of recovery for the care and treatment of the injury, |
11 |
| so that
reduction of the charge sought to be enforced |
12 |
| against the recovery would
not likely result in a double |
13 |
| recovery or unjust enrichment to the recipient;
|
14 |
| (5) the age of the recipient and of persons dependent |
15 |
| for support upon
the recipient, the nature and permanency |
16 |
| of the recipient's injuries as
they affect not only the |
17 |
| future employability and education of the recipient
but |
18 |
| also the reasonably necessary and foreseeable future |
19 |
| material, maintenance,
medical, rehabilitative and |
20 |
| training needs of the recipient, the cost of
such |
21 |
| reasonably necessary and foreseeable future needs, and the |
22 |
| resources
available to meet such needs and pay such costs;
|
23 |
| (6) the realistic ability of the recipient to repay in |
24 |
| whole or in part
the charge sought to be enforced against |
25 |
| the recovery when judged in light
of the factors enumerated |
26 |
| above.
|
27 |
| The burden of producing evidence sufficient to support the |
28 |
| exercise by
the court of its discretion to reduce the amount of |
29 |
| a proven charge sought
to be enforced against the recovery |
30 |
| shall rest with the party seeking such reduction.
|
31 |
| The court may reduce and apportion the Illinois
|
32 |
| Department's lien proportionate to the recovery of the |
33 |
| claimant. The court may
consider the nature and extent of the |
34 |
| injury, economic and noneconomic
loss, settlement offers, |
|
|
|
09400HB0806sam003 |
- 13 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| comparative negligence as it applies to the case
at hand, |
2 |
| hospital costs, physician costs, and all other appropriate |
3 |
| costs.
The Illinois Department shall pay its pro rata share of |
4 |
| the attorney fees
based on the Illinois Department's lien as it |
5 |
| compares to the total
settlement agreed upon. This Section |
6 |
| shall not affect the priority of an
attorney's lien under the |
7 |
| Attorneys Lien Act. The charges of
the Illinois Department |
8 |
| described in this Section, however, shall take
priority over |
9 |
| all other liens and charges existing under the laws of the
|
10 |
| State of Illinois with the exception of the attorney's lien |
11 |
| under said statute.
|
12 |
| Whenever the Department or any unit of local government
has |
13 |
| a statutory charge under this Section against a recovery for |
14 |
| damages
incurred by a recipient because of its advancement of |
15 |
| any assistance, such
charge shall not be satisfied out of any |
16 |
| recovery until the attorney's claim
for fees is satisfied, |
17 |
| irrespective of whether or not an action based on
recipient's |
18 |
| claim has been filed in court.
|
19 |
| This Section shall be inapplicable to any claim, demand or |
20 |
| cause of
action arising under (a) the Workers' Compensation Act |
21 |
| or the predecessor
Workers' Compensation Act
of
June 28, 1913, |
22 |
| (b) the Workers' Occupational Diseases Act or the predecessor
|
23 |
| Workers' Occupational
Diseases Act of March 16, 1936; and (c) |
24 |
| the Wrongful Death Act.
|
25 |
| (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
|
26 |
| (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
|
27 |
| Sec. 11-22a. Right of Subrogation. To the extent of the |
28 |
| amount of (i) medical
assistance provided by the Department to |
29 |
| or on behalf of a recipient under
Article V or VI or (ii) |
30 |
| health care benefits provided for a child under the Covering |
31 |
| ALL KIDS Health Insurance Act , the Department shall be
|
32 |
| subrogated
to any right of
recovery such recipient may have |
33 |
| under the terms of any private or public
health care coverage |
|
|
|
09400HB0806sam003 |
- 14 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| or casualty coverage, including coverage under the
"Workers' |
2 |
| Compensation Act", approved July 9, 1951, as amended, or the
|
3 |
| "Workers' Occupational Diseases Act", approved July 9, 1951, as |
4 |
| amended,
without the necessity of assignment of claim or other |
5 |
| authorization to secure
the right of recovery to the |
6 |
| Department. To enforce its subrogation right, the
Department |
7 |
| may (i) intervene or join in an action or proceeding brought by |
8 |
| the
recipient, his or her guardian, personal representative, |
9 |
| estate, dependents, or
survivors against any person or public |
10 |
| or private entity that may be liable;
(ii) institute and |
11 |
| prosecute legal proceedings against any person or public or
|
12 |
| private entity that may be liable for the cost of such |
13 |
| services; or (iii)
institute and prosecute legal proceedings, |
14 |
| to the extent necessary to reimburse
the Illinois Department |
15 |
| for its costs, against any noncustodial parent who (A)
is |
16 |
| required by court or administrative order to provide insurance |
17 |
| or other
coverage of the cost of health care services for a |
18 |
| child eligible for medical
assistance under this Code and (B) |
19 |
| has received payment from a third party for
the costs of those |
20 |
| services but has not used the payments to reimburse either
the |
21 |
| other parent or the guardian of the child or the provider of |
22 |
| the services.
|
23 |
| (Source: P.A. 92-111, eff. 1-1-02.)
|
24 |
| (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
|
25 |
| Sec. 11-22b. Recoveries.
|
26 |
| (a) As used in this Section:
|
27 |
| (1) "Carrier" means any insurer, including any private |
28 |
| company,
corporation, mutual association, trust fund, |
29 |
| reciprocal or interinsurance
exchange authorized under the |
30 |
| laws of this State to insure persons against
liability or |
31 |
| injuries caused to another and any insurer providing
benefits |
32 |
| under a policy of bodily injury liability insurance covering
|
33 |
| liability arising out of the ownership, maintenance or use of a |
|
|
|
09400HB0806sam003 |
- 15 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| motor
vehicle which provides uninsured motorist endorsement or |
2 |
| coverage.
|
3 |
| (2) "Beneficiary" means any person or their dependents who |
4 |
| has received
benefits or will be provided benefits under this |
5 |
| Code or under the Covering ALL KIDS Health Insurance Act |
6 |
| because of an injury for
which another person may be liable. It |
7 |
| includes such beneficiary's guardian,
conservator or other |
8 |
| personal representative, his estate or survivors.
|
9 |
| (b) (1) When benefits are provided or will be provided to a |
10 |
| beneficiary
under this Code or under the Covering ALL KIDS |
11 |
| Health Insurance Act because of an injury for which another |
12 |
| person is liable, or
for which a carrier is liable in |
13 |
| accordance with the provisions of any
policy of insurance |
14 |
| issued pursuant to the Illinois Insurance Code, the
Illinois |
15 |
| Department shall have a right to recover from such person or |
16 |
| carrier
the reasonable value of benefits so provided. The |
17 |
| Attorney General may, to
enforce such right, institute and |
18 |
| prosecute legal proceedings against the
third person or carrier |
19 |
| who may be liable for the injury in an appropriate
court, |
20 |
| either in the name of the Illinois Department or in the name of |
21 |
| the
injured person, his guardian, personal representative, |
22 |
| estate, or survivors.
|
23 |
| (2) The Department may:
|
24 |
| (A) compromise or settle and release any such claim for |
25 |
| benefits
provided under this Code, or
|
26 |
| (B) waive any such claims for benefits provided under |
27 |
| this Code, in
whole or in part, for the convenience of the |
28 |
| Department or if the Department
determines that collection |
29 |
| would result in undue hardship upon the person who
suffered |
30 |
| the injury or, in a wrongful death action, upon the heirs |
31 |
| of the
deceased.
|
32 |
| (3) No action taken on behalf of the Department pursuant to |
33 |
| this Section
or any judgment rendered in such action shall be a |
34 |
| bar to any action upon
the claim or cause of action of the |
|
|
|
09400HB0806sam003 |
- 16 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| 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 |
|
|
|
09400HB0806sam003 |
- 17 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| the
expenditures of the full amount of the judgment, award or |
2 |
| settlement.
|
3 |
| (d) (1) If either the beneficiary or the Department brings |
4 |
| an action or
claim against such third party or carrier, the |
5 |
| beneficiary or the
Department shall within 30 days of filing |
6 |
| the action give to the other
written notice by personal service |
7 |
| or registered mail of the action or
claim and of the name of |
8 |
| the court in which the
action or claim is brought. Proof of |
9 |
| such notice shall be filed in such
action or claim. If an |
10 |
| action or claim is brought by either the Department
or the |
11 |
| beneficiary, the other may, at any time before trial on the |
12 |
| facts,
become a party to such action or claim or shall |
13 |
| consolidate his action or
claim with the other if brought |
14 |
| independently.
|
15 |
| (2) If an action or claim is brought by the Department |
16 |
| pursuant to
subsection (b)(1), written notice to the |
17 |
| beneficiary, guardian, personal
representative, estate or |
18 |
| survivor given pursuant to this Section shall
advise him of his |
19 |
| right to intervene in the proceeding, his right to obtain
a |
20 |
| private attorney of his choice and the Department's right to |
21 |
| recover the
reasonable value of the benefits provided.
|
22 |
| (e) In the event of judgment or award in a suit or claim |
23 |
| against such
third person or carrier:
|
24 |
| (1) If the action or claim is prosecuted by the beneficiary |
25 |
| alone, the
court shall first order paid from any judgment or |
26 |
| award the
reasonable litigation expenses incurred in |
27 |
| preparation and prosecution of
such action or claim, together |
28 |
| with reasonable attorney's fees, when an
attorney has been |
29 |
| retained. After payment of such expenses and attorney's
fees |
30 |
| the court shall, on the application of the Department, allow
as |
31 |
| a first lien against the amount of such judgment or award the |
32 |
| amount of
the Department's expenditures for the benefit of the |
33 |
| beneficiary under this
Code or under the Covering ALL KIDS |
34 |
| Health Insurance Act , as provided in subsection (c)(4).
|
|
|
|
09400HB0806sam003 |
- 18 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| (2) If the action or claim is prosecuted both by the |
2 |
| beneficiary and the
Department, the court shall first order |
3 |
| paid from any judgment or
award the reasonable litigation |
4 |
| expenses incurred in preparation and
prosecution of such action |
5 |
| or claim, together with reasonable attorney's
fees for |
6 |
| plaintiffs attorneys based solely on the services rendered for |
7 |
| the
benefit of the beneficiary. After payment of such expenses |
8 |
| and attorney's
fees, the court shall apply out of the balance |
9 |
| of such judgment or award an
amount sufficient to reimburse the |
10 |
| Department the full amount of benefits
paid on behalf of the |
11 |
| beneficiary under this Code or under the Covering ALL KIDS |
12 |
| Health Insurance Act .
|
13 |
| (f) The court shall, upon further application at any time
|
14 |
| before the judgment or award is satisfied, allow as a further |
15 |
| lien the
amount of any expenditures of the Department in |
16 |
| payment of additional
benefits arising out of the same cause of |
17 |
| action or claim provided on
behalf of the beneficiary under |
18 |
| this Code or under the Covering ALL KIDS Health Insurance Act , |
19 |
| when such benefits were
provided or became payable subsequent |
20 |
| to the original order.
|
21 |
| (g) No judgment, award, or settlement in any action or |
22 |
| claim by a
beneficiary to recover damages for injuries, when |
23 |
| the Department has an
interest, shall be satisfied without |
24 |
| first giving the Department notice and
a reasonable opportunity |
25 |
| to perfect and satisfy its lien.
|
26 |
| (h) When the Department has perfected a lien upon a |
27 |
| judgment or award in
favor of a beneficiary against any third |
28 |
| party for an injury for which the
beneficiary has received |
29 |
| benefits under this Code or under the Covering ALL KIDS Health |
30 |
| Insurance Act , the Department shall be
entitled to a writ of |
31 |
| execution as lien claimant to enforce payment of said
lien |
32 |
| against such third party with interest and other accruing costs |
33 |
| as in
the case of other executions. In the event the amount of |
34 |
| such judgment or
award so recovered has been paid to the |
|
|
|
09400HB0806sam003 |
- 19 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| beneficiary, the Department shall
be entitled to a writ of |
2 |
| execution against such beneficiary to the extent of
the |
3 |
| Department's lien, with interest and other accruing costs as in |
4 |
| the case
of other executions.
|
5 |
| (i) Except as otherwise provided in this Section, |
6 |
| notwithstanding any
other provision of law, the entire amount |
7 |
| of any settlement of the injured
beneficiary's action or claim, |
8 |
| with or without suit, is subject to the
Department's claim for |
9 |
| reimbursement of the benefits provided and any lien
filed |
10 |
| pursuant thereto to the same extent and subject to the same
|
11 |
| limitations as in Section 11-22 of this Code.
|
12 |
| (Source: P.A. 92-651, eff. 7-11-02.)
|
13 |
| (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
|
14 |
| Sec. 11-22c. (a) As used in this Section, "recipient" means |
15 |
| any person
receiving financial assistance under Article IV or |
16 |
| Article VI of this Code or receiving health care benefits under |
17 |
| the Covering ALL KIDS Health Insurance Act .
|
18 |
| (b) If a recipient maintains any suit, charge or other |
19 |
| court or
administrative action against an employer seeking back |
20 |
| pay for a period
during which the recipient received financial |
21 |
| assistance under Article IV
or Article VI of this Code or |
22 |
| health care benefits under the Covering ALL KIDS Health |
23 |
| Insurance Act , the recipient shall report such fact to the
|
24 |
| Department. To the extent of the amount of assistance provided |
25 |
| to or on
behalf of the recipient under Article IV or Article VI |
26 |
| or health care benefits provided under the Covering ALL KIDS |
27 |
| Health Insurance Act , the Department may
by intervention or |
28 |
| otherwise without the necessity of assignment of claim,
attach |
29 |
| a lien on the recovery of back wages equal to the amount of
|
30 |
| assistance provided by the Department to the recipient under |
31 |
| Article IV or
Article VI or under the Covering ALL KIDS Health |
32 |
| Insurance Act .
|
33 |
| (Source: P.A. 86-497.)
|
|
|
|
09400HB0806sam003 |
- 20 - |
LRB094 03660 DRJ 49915 a |
|
|
1 |
| Section 97. Severability. If any provision of this Act or |
2 |
| its application to any person or circumstance is held invalid, |
3 |
| the invalidity of that provision or application does not affect |
4 |
| other provisions or applications of this Act that can be given |
5 |
| effect without the invalid provision or application, and to |
6 |
| this end the provisions of this Act are severable. |
7 |
| Section 98. Repealer. This Act is repealed on July 1, |
8 |
| 2011.
|
9 |
| Section 99. Effective date. This Act takes effect July 1, |
10 |
| 2006.".
|