Full Text of SB3402 100th General Assembly
SB3402ham001 100TH GENERAL ASSEMBLY | Rep. Katie Stuart Filed: 5/18/2018
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| 1 | | AMENDMENT TO SENATE BILL 3402
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 3402 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Veterans' Care Preventative Dental Program Act. | 6 | | Section 5. Definitions. As used in this Act: | 7 | | "Department" means the Department of Healthcare and Family | 8 | | Services, or any successor agency. | 9 | | "Director" means the Director of Healthcare and Family | 10 | | Services, or any successor agency. | 11 | | "Preventative dental service" includes the prevention and | 12 | | treatment of periodontal disease, and other dental diagnostic, | 13 | | preventative, or corrective procedures. | 14 | | "Program" means the Veterans' Care Preventative Dental | 15 | | Program. | 16 | | "Resident" means an individual who has an Illinois |
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| 1 | | residence, as provided in Section 5-3 of the Illinois Public | 2 | | Aid Code. | 3 | | "Veteran" means any person who has served in a branch of | 4 | | the United States military for greater than 180 days after | 5 | | initial training, as a member of the Illinois National Guard, | 6 | | or as a member of the United States Reserve Forces. | 7 | | "Veterans Affairs" or "VA" means the United States | 8 | | Department of Veterans Affairs. | 9 | | Section 10. Operation of the Program. | 10 | | (a) The Veterans' Care Preventative Dental Program is | 11 | | created. This Program is not an entitlement. Enrollment is | 12 | | based on the availability of funds, and enrollment may be | 13 | | capped based on funds appropriated for the Program. Coverage | 14 | | for the Program shall begin within one year after the effective | 15 | | date of this Act. The Program shall be administered by the | 16 | | Department of Healthcare and Family Services in collaboration | 17 | | with the Department of Veterans' Affairs. The Department shall | 18 | | have the same powers and authority to administer the Program as | 19 | | are provided to the Department in connection with the | 20 | | Department's administration of the Illinois Public Aid Code. | 21 | | The Department shall coordinate the Program with other health | 22 | | programs operated by the Department and other State and federal | 23 | | agencies. The Department shall contract with a vendor with a | 24 | | statewide dental network to include providers in all counties | 25 | | in the State. Preference for the awarding of the contract shall |
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| 1 | | be given to a veteran-owned business, however, a vendor does | 2 | | not need to be veteran-owned to be awarded the contract. The | 3 | | vendor awarded the contract may contract with any entity that | 4 | | currently provides pro bono dental services for veterans, | 5 | | including, but not limited to, the University of Illinois. | 6 | | (b) The Department shall operate the Program in a manner so | 7 | | that the estimated cost of the Program during the fiscal year | 8 | | will not exceed the total appropriation for the Program. The | 9 | | Department must operate the Program in accordance with any | 10 | | appropriations made available for the purposes of this Act. The | 11 | | Department may use moneys designated for the Veterans' Health | 12 | | Insurance Program established under the Veterans' Health | 13 | | Insurance Program of 2008 to fund the Veterans' Care | 14 | | Preventative Dental Program.
| 15 | | (c) Notwithstanding subsections (a) and (b) and with the | 16 | | mutual agreement of the Department of Veterans' Affairs and the | 17 | | Department of Healthcare and Family Services, the operation of | 18 | | the Program may be changed to simplify its administration and | 19 | | to take advantage of health insurance coverage that may be | 20 | | available to veterans under the federal Patient Protection and | 21 | | Affordable Care Act. | 22 | | Section 15. Eligibility. | 23 | | (a) To be eligible for the Program, a person must: | 24 | | (1) be a veteran who is not on active duty and who has | 25 | | not been dishonorably discharged from service; |
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| 1 | | (2) be a resident of the State of Illinois; | 2 | | (3) be at least 17 years of age; and | 3 | | (4) have a household income no greater than an amount | 4 | | equal to 138% of the federal poverty level. | 5 | | (b) A veteran who is determined eligible for the Program | 6 | | shall remain eligible for 12 months, provided the veteran | 7 | | remains a resident of the State and is not excluded under | 8 | | subsection (c) of this Section and provided the Department has | 9 | | not limited the enrollment period as set forth in subsection | 10 | | (b) of Section 10. | 11 | | (c) A veteran is not eligible for coverage under the | 12 | | Program if the veteran is a resident of a nursing facility or | 13 | | an inmate of a public institution, as defined by 42 CFR | 14 | | 435.1009. | 15 | | (d) The Department shall adopt rules for the Program, | 16 | | including, but not limited to, rules relating to eligibility, | 17 | | re-enrollment, grace periods, notice requirements, hearing | 18 | | procedures, covered services, and provider requirements.
| 19 | | (e) A veteran with private dental insurance is eligible for | 20 | | the Program, however, if a veteran has private dental | 21 | | insurance, then the State is the payer of last resort for | 22 | | preventative dental service claims. | 23 | | (f) Enrollment in the Program shall not affect an | 24 | | individual's eligibility for any other State medical | 25 | | assistance program. |
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| 1 | | Section 20. Notice of decisions to terminate eligibility. | 2 | | Whenever the Department decides to either deny or terminate | 3 | | eligibility under this Act, the veteran shall have a right to | 4 | | notice and a hearing, as provided by the Department by rule. | 5 | | Section 25. Illinois Department of Veterans' Affairs. The | 6 | | Department shall coordinate with the Illinois Department of | 7 | | Veterans' Affairs and the Veterans Assistance Commissions to | 8 | | allow State Veterans' Affairs service officers and the Veterans | 9 | | Assistance Commissions to assist veterans to apply for the | 10 | | Program. All applicants must be reviewed for Veterans Health | 11 | | Administration eligibility or other existing health benefits | 12 | | prior to consideration for the Program. | 13 | | Section 30. Preventative dental service benefits. | 14 | | (a) Veterans that are eligible for and enrolled in the | 15 | | Program shall receive preventative dental service benefits. | 16 | | (b) On and after July 1, 2018, targeted dental services, as | 17 | | set
forth in Exhibit D of the Consent Decree entered by the | 18 | | United
States District Court for the Northern District of | 19 | | Illinois,
Eastern Division, in the matter of Memisovski v. | 20 | | Maram, Case
No. 92 C 1982, that are provided to veterans under | 21 | | the Program shall be reimbursed at the rates set forth
in the | 22 | | "New Rate" column in Exhibit D of the Consent Decree for
| 23 | | targeted dental services that are provided to persons under the
| 24 | | age of 18 under the medical assistance program under Article V |
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| 1 | | of the Illinois Public Aid Code. | 2 | | Section 35. Charge upon claims and causes of action; right | 3 | | of subrogation; recoveries. Sections 11-22, 11-22a, 11-22b, | 4 | | and 11-22c of the Illinois Public Aid Code apply to | 5 | | preventative dental service benefits provided to veterans | 6 | | under this Act, as provided in those Sections. | 7 | | Section 40. Reporting. | 8 | | (a) The Department shall prepare an annual report for | 9 | | submission to the General Assembly. The report shall be due to | 10 | | the General Assembly by January 1 of each year beginning in | 11 | | 2019. This report shall include information regarding | 12 | | implementation of the Program, including the number of veterans | 13 | | enrolled and any available information regarding other | 14 | | benefits derived from the Program, including screening for and | 15 | | acquisition of other veterans' benefits through the Veterans' | 16 | | Service Officers and the Veterans' Assistance Commissions. | 17 | | This report may also include recommendations regarding | 18 | | improvements that may be made to the Program. | 19 | | (b) The Department shall also arrange for the conducting of | 20 | | an evaluation regarding the availability of and access to | 21 | | preventative dental services for veterans who are residents of | 22 | | Illinois, taking into consideration the program established by | 23 | | this Act, programs and services provided by the U.S. Department | 24 | | of Veterans Affairs, and programs and services otherwise |
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| 1 | | provided by and available through other public and private | 2 | | entities. The evaluation shall determine whether there are | 3 | | limitations or barriers to care, gaps in service, or other | 4 | | deficits that should be overcome to ensure that veterans are | 5 | | provided appropriate and high-quality care. The Department | 6 | | shall report on the results of this evaluation to the Governor | 7 | | and the General Assembly by March 1, 2020. | 8 | | (c) The reports to the General Assembly under subsections | 9 | | (a) and (b) shall be filed with the Clerk of the House of | 10 | | Representatives and the Secretary of the Senate in electronic | 11 | | form only, in the manner that the Clerk and the Secretary shall | 12 | | direct. The report to the Governor under subsection (b) shall | 13 | | be filed with the Office of the Governor in electronic form | 14 | | only, in the manner that the Office of the Governor shall | 15 | | direct. | 16 | | Section 45. Emergency rulemaking. The Department may adopt | 17 | | rules necessary to establish and implement this Act through the | 18 | | use of emergency rulemaking in accordance with Section 5-45 of | 19 | | the Illinois Administrative Procedure Act. For the purposes of | 20 | | that Act, the General Assembly finds that the adoption of rules | 21 | | to implement this Act is deemed an emergency and necessary for | 22 | | the public interest, safety, and welfare. | 23 | | Section 80. The Illinois Public Aid Code is amended by | 24 | | changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
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| 1 | | (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
| 2 | | Sec. 11-22. Charge upon claims and causes of action for | 3 | | injuries. The Illinois Department shall have a charge upon all | 4 | | claims, demands and
causes of action for injuries to an | 5 | | applicant for or recipient of (i)
financial aid under Articles | 6 | | III, IV, and V, (ii) health care benefits provided under the | 7 | | Covering ALL KIDS Health Insurance Act, or (iii) health care | 8 | | benefits provided under the Veterans' Health Insurance Program | 9 | | Act or the Veterans' Health Insurance Program Act of 2008 ; or | 10 | | (iv) preventative dental service benefits provided under the | 11 | | Veterans' Care Preventative Dental Program Act for the total
| 12 | | amount of
medical assistance provided the recipient from the | 13 | | time of injury to the
date of recovery upon such claim, demand | 14 | | or cause of action. In addition, if
the applicant or recipient | 15 | | was employable, as defined by the Department, at
the time of | 16 | | the injury, the Department shall also have a charge upon any
| 17 | | such claims, demands and causes of action for the total amount | 18 | | of aid
provided to the recipient and his
dependents, including | 19 | | all cash assistance and medical assistance
only to the extent | 20 | | includable in the claimant's action, from the
time of injury to | 21 | | the date of recovery upon such
claim, demand or cause of | 22 | | action. Any definition of "employable"
adopted by the | 23 | | Department shall apply only to persons above the age of
| 24 | | compulsory school attendance.
| 25 | | If the injured person was employable at the time of the |
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| 1 | | injury and is
provided aid under Articles III, IV, or V and any | 2 | | dependent or
member of his family is provided aid under Article | 3 | | VI, or vice versa,
both the Illinois Department and the local | 4 | | governmental unit shall have
a charge upon such claims, demands | 5 | | and causes of action for the aid
provided to the injured person | 6 | | and any
dependent member of his family, including all cash | 7 | | assistance, medical
assistance and food stamps, from the time | 8 | | of the injury to the date
of recovery.
| 9 | | "Recipient", as used herein, means (i) in the case of | 10 | | financial aid provided under this Code, the grantee of record | 11 | | and any
persons whose needs are included in the financial aid | 12 | | provided to the
grantee of record or otherwise met by grants | 13 | | under the appropriate
Article of this Code for which such | 14 | | person is eligible, (ii) in the case of health care benefits | 15 | | provided under the Covering ALL KIDS Health Insurance Act, the | 16 | | child to whom those benefits are provided, and (iii) in the | 17 | | case of health care benefits provided under the Veterans' | 18 | | Health Insurance Program Act or the Veterans' Health Insurance | 19 | | Program Act of 2008, or preventative dental service benefits | 20 | | provided under the Veterans' Care Preventative Dental Program | 21 | | Act, the veteran to whom benefits are provided.
| 22 | | In each case, the notice shall be served by certified mail | 23 | | or
registered mail, or by facsimile or electronic messaging | 24 | | when requested by the party or parties against whom the | 25 | | applicant or recipient has a claim, demand, or cause of action, | 26 | | upon the party or parties against whom the applicant or
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| 1 | | recipient has a claim, demand or cause of action. The notice | 2 | | shall
claim the charge and describe the interest the Illinois | 3 | | Department, the
local governmental unit, or the county, has in | 4 | | the claim, demand, or
cause of action. The charge shall attach | 5 | | to any verdict or judgment
entered and to any money or property | 6 | | which may be recovered on account
of such claim, demand, cause | 7 | | of action or suit from and after the time
of the service of the | 8 | | notice.
| 9 | | On petition filed by the Illinois Department, or by the | 10 | | local
governmental unit or county if either is claiming a | 11 | | charge, or by the
recipient, or by the defendant, the court, on | 12 | | written notice to all
interested parties, may adjudicate the | 13 | | rights of the parties and enforce
the charge. The court may | 14 | | approve the settlement of any claim, demand
or cause of action | 15 | | either before or after a verdict, and nothing in this
Section | 16 | | shall be construed as requiring the actual trial or final
| 17 | | adjudication of any claim, demand or cause of action upon which | 18 | | the
Illinois Department, the local governmental unit or county | 19 | | has charge.
The court may determine what portion of the | 20 | | recovery shall be paid to
the injured person and what portion | 21 | | shall be paid to the Illinois
Department, the local | 22 | | governmental unit or county having a charge
against the | 23 | | recovery.
In making this determination, the court shall conduct | 24 | | an evidentiary hearing
and shall consider competent evidence | 25 | | pertaining
to the following matters:
| 26 | | (1) the amount of the charge sought to be enforced |
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| 1 | | against the recovery
when expressed as a percentage of the | 2 | | gross amount of the recovery; the
amount of the charge | 3 | | sought to be enforced against the recovery when expressed
| 4 | | as a percentage of the amount obtained by subtracting from | 5 | | the gross amount
of the recovery the total attorney's fees | 6 | | and other costs incurred by the
recipient incident to the | 7 | | recovery; and whether the Department, unit of
local | 8 | | government or county seeking to enforce the charge against | 9 | | the recovery
should as a matter of fairness and equity bear | 10 | | its proportionate share of
the fees and costs incurred to | 11 | | generate the recovery from which the charge
is sought to be | 12 | | satisfied;
| 13 | | (2) the amount, if any, of the attorney's fees and | 14 | | other costs incurred
by the recipient incident to the | 15 | | recovery and paid by the recipient up to the
time of | 16 | | recovery, and the amount of such fees and costs remaining | 17 | | unpaid
at the time of recovery;
| 18 | | (3) the total hospital, doctor and other medical | 19 | | expenses incurred for
care and treatment of the injury to | 20 | | the date of recovery therefor, the portion
of such expenses | 21 | | theretofore paid by the recipient, by insurance provided
by | 22 | | the recipient, and by the Department, unit of local | 23 | | government and county
seeking to enforce a charge against | 24 | | the recovery, and the amount of such
previously incurred | 25 | | expenses which remain unpaid at the time of recovery
and by | 26 | | whom such incurred, unpaid expenses are to be paid;
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| 1 | | (4) whether the recovery represents less than | 2 | | substantially full
recompense
for the injury and the | 3 | | hospital, doctor and other medical expenses incurred
to the | 4 | | date of recovery for the care and treatment of the injury, | 5 | | so that
reduction of the charge sought to be enforced | 6 | | against the recovery would
not likely result in a double | 7 | | recovery or unjust enrichment to the recipient;
| 8 | | (5) the age of the recipient and of persons dependent | 9 | | for support upon
the recipient, the nature and permanency | 10 | | of the recipient's injuries as
they affect not only the | 11 | | future employability and education of the recipient
but | 12 | | also the reasonably necessary and foreseeable future | 13 | | material, maintenance,
medical, rehabilitative and | 14 | | training needs of the recipient, the cost of
such | 15 | | reasonably necessary and foreseeable future needs, and the | 16 | | resources
available to meet such needs and pay such costs;
| 17 | | (6) the realistic ability of the recipient to repay in | 18 | | whole or in part
the charge sought to be enforced against | 19 | | the recovery when judged in light
of the factors enumerated | 20 | | above.
| 21 | | The burden of producing evidence sufficient to support the | 22 | | exercise by
the court of its discretion to reduce the amount of | 23 | | a proven charge sought
to be enforced against the recovery | 24 | | shall rest with the party seeking such reduction.
| 25 | | The court may reduce and apportion the Illinois
| 26 | | Department's lien proportionate to the recovery of the |
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| 1 | | claimant. The court may
consider the nature and extent of the | 2 | | injury, economic and noneconomic
loss, settlement offers, | 3 | | comparative negligence as it applies to the case
at hand, | 4 | | hospital costs, physician costs, and all other appropriate | 5 | | costs.
The Illinois Department shall pay its pro rata share of | 6 | | the attorney fees
based on the Illinois Department's lien as it | 7 | | compares to the total
settlement agreed upon. This Section | 8 | | shall not affect the priority of an
attorney's lien under the | 9 | | Attorneys Lien Act. The charges of
the Illinois Department | 10 | | described in this Section, however, shall take
priority over | 11 | | all other liens and charges existing under the laws of the
| 12 | | State of Illinois with the exception of the attorney's lien | 13 | | under said statute.
| 14 | | Whenever the Department or any unit of local government
has | 15 | | a statutory charge under this Section against a recovery for | 16 | | damages
incurred by a recipient because of its advancement of | 17 | | any assistance, such
charge shall not be satisfied out of any | 18 | | recovery until the attorney's claim
for fees is satisfied, | 19 | | irrespective of whether or not an action based on
recipient's | 20 | | claim has been filed in court.
| 21 | | This Section shall be inapplicable to any claim, demand or | 22 | | cause of
action arising under (a) the Workers' Compensation Act | 23 | | or the predecessor
Workers' Compensation Act
of
June 28, 1913, | 24 | | (b) the Workers' Occupational Diseases Act or the predecessor
| 25 | | Workers' Occupational
Diseases Act of March 16, 1936; and (c) | 26 | | the Wrongful Death Act.
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| 1 | | (Source: P.A. 98-73, eff. 7-15-13.)
| 2 | | (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
| 3 | | Sec. 11-22a. Right of Subrogation. To the extent of the | 4 | | amount of (i) medical
assistance provided by the Department to | 5 | | or on behalf of a recipient under
Article V or VI, (ii) health | 6 | | care benefits provided for a child under the Covering ALL KIDS | 7 | | Health Insurance Act, or (iii) health care benefits provided to | 8 | | a veteran under the Veterans' Health Insurance Program Act or | 9 | | the Veterans' Health Insurance Program Act of 2008, or (iv) | 10 | | preventative dental service benefits provided to a veteran | 11 | | under the Veterans' Care Preventative Dental Program Act, the | 12 | | Department shall be
subrogated
to any right of
recovery such | 13 | | recipient may have under the terms of any private or public
| 14 | | health care coverage or casualty coverage, including coverage | 15 | | under the
"Workers' Compensation Act", approved July 9, 1951, | 16 | | as amended, or the
"Workers' Occupational Diseases Act", | 17 | | approved July 9, 1951, as amended,
without the necessity of | 18 | | assignment of claim or other authorization to secure
the right | 19 | | of recovery to the Department. To enforce its subrogation | 20 | | right, the
Department may (i) intervene or join in an action or | 21 | | proceeding brought by the
recipient, his or her guardian, | 22 | | personal representative, estate, dependents, or
survivors | 23 | | against any person or public or private entity that may be | 24 | | liable;
(ii) institute and prosecute legal proceedings against | 25 | | any person or public or
private entity that may be liable for |
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| 1 | | the cost of such services; or (iii)
institute and prosecute | 2 | | legal proceedings, to the extent necessary to reimburse
the | 3 | | Illinois Department for its costs, against any noncustodial | 4 | | parent who (A)
is required by court or administrative order to | 5 | | provide insurance or other
coverage of the cost of health care | 6 | | services for a child eligible for medical
assistance under this | 7 | | Code and (B) has received payment from a third party for
the | 8 | | costs of those services but has not used the payments to | 9 | | reimburse either
the other parent or the guardian of the child | 10 | | or the provider of the services.
| 11 | | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | 12 | | 95-755, eff. 7-25-08.)
| 13 | | (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
| 14 | | Sec. 11-22b. Recoveries.
| 15 | | (a) As used in this Section:
| 16 | | (1) "Carrier" means any insurer, including any private | 17 | | company,
corporation, mutual association, trust fund, | 18 | | reciprocal or interinsurance
exchange authorized under the | 19 | | laws of this State to insure persons against
liability or | 20 | | injuries caused to another and any insurer providing
| 21 | | benefits under a policy of bodily injury liability | 22 | | insurance covering
liability arising out of the ownership, | 23 | | maintenance or use of a motor
vehicle which provides | 24 | | uninsured motorist endorsement or coverage.
| 25 | | (2) "Beneficiary" means any person or their dependents |
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| 1 | | who has received
benefits or will be provided benefits | 2 | | under this Code, under the Covering ALL KIDS Health | 3 | | Insurance Act, or under the Veterans' Health Insurance | 4 | | Program Act , under or the Veterans' Health Insurance | 5 | | Program Act of 2008 , or under the Veterans' Care | 6 | | Preventative Dental Program Act
because of an injury for
| 7 | | which another person may be liable. It includes such | 8 | | beneficiary's guardian,
conservator or other personal | 9 | | representative, his estate or survivors.
| 10 | | (b)(1) When benefits are provided or will be provided to a | 11 | | beneficiary
under this Code, under the Covering ALL KIDS Health | 12 | | Insurance Act, or under the Veterans' Health Insurance Program | 13 | | Act , under or the Veterans' Health Insurance Program Act of | 14 | | 2008 , or under the Veterans' Care Preventative Dental Program | 15 | | Act because of an injury for which another person is liable, or
| 16 | | for which a carrier is liable in accordance with the provisions | 17 | | of any
policy of insurance issued pursuant to the Illinois | 18 | | Insurance Code, the
Illinois Department shall have a right to | 19 | | recover from such person or carrier
the reasonable value of | 20 | | benefits so provided. The Attorney General may, to
enforce such | 21 | | right, institute and prosecute legal proceedings against the
| 22 | | third person or carrier who may be liable for the injury in an | 23 | | appropriate
court, either in the name of the Illinois | 24 | | Department or in the name of the
injured person, his guardian, | 25 | | personal representative, estate, or survivors.
| 26 | | (2) The Department may:
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| 1 | | (A) compromise or settle and release any such claim for | 2 | | benefits
provided under this Code, or
| 3 | | (B) waive any such claims for benefits provided under | 4 | | this Code, in
whole or in part, for the convenience of the | 5 | | Department or if the Department
determines that collection | 6 | | would result in undue hardship upon the person who
suffered | 7 | | the injury or, in a wrongful death action, upon the heirs | 8 | | of the
deceased.
| 9 | | (3) No action taken on behalf of the Department pursuant to | 10 | | this Section
or any judgment rendered in such action shall be a | 11 | | bar to any action upon
the claim or cause of action of the | 12 | | beneficiary, his guardian, conservator,
personal | 13 | | representative, estate, dependents or survivors against the | 14 | | third
person who may be liable for the injury, or shall operate | 15 | | to deny to the
beneficiary the recovery for that portion of any | 16 | | damages not covered hereunder.
| 17 | | (c)(1) When an action is brought by the Department pursuant | 18 | | to
subsection (b), it shall be commenced within the period | 19 | | prescribed by
Article XIII of the Code of Civil Procedure.
| 20 | | However, the Department may not commence the action prior | 21 | | to 5 months
before the end of the applicable period prescribed | 22 | | by Article XIII of the
Code of Civil Procedure. Thirty days | 23 | | prior to commencing an action, the
Department shall notify the | 24 | | beneficiary of the Department's intent to
commence such an | 25 | | action.
| 26 | | (2) The death of the beneficiary does not abate any right |
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| 1 | | of action
established by subsection (b).
| 2 | | (3) When an action or claim is brought by persons entitled | 3 | | to bring such
actions or assert such claims against a third | 4 | | person who may be liable for
causing the death of a | 5 | | beneficiary, any settlement, judgment or award
obtained is | 6 | | subject to the Department's claim for reimbursement of the
| 7 | | benefits provided to the beneficiary under this Code, under the | 8 | | Covering ALL KIDS Health Insurance Act, or under the Veterans' | 9 | | Health Insurance Program Act , under or the Veterans' Health | 10 | | Insurance Program Act of 2008 , or under the Veterans' Care | 11 | | Preventative Dental Program Act .
| 12 | | (4) When the action or claim is brought by the beneficiary | 13 | | alone and
the beneficiary incurs a personal liability to pay | 14 | | attorney's fees and
costs of litigation, the Department's claim | 15 | | for reimbursement of the
benefits provided to the beneficiary | 16 | | shall be the full amount of benefits
paid on behalf of the | 17 | | beneficiary under this Code, under the Covering ALL KIDS Health | 18 | | Insurance Act, or under the Veterans' Health Insurance Program | 19 | | Act , under or the Veterans' Health Insurance Program Act of | 20 | | 2008 , or under the Veterans' Care Preventative Dental Program | 21 | | Act less a pro rata
share which represents the Department's | 22 | | reasonable share of attorney's fees
paid by the beneficiary and | 23 | | that portion of the cost of litigation expenses
determined by | 24 | | multiplying by the ratio of the full amount of the
expenditures | 25 | | of the full amount of the judgment, award or settlement.
| 26 | | (d)(1) If either the beneficiary or the Department brings |
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| 1 | | an action or
claim against such third party or carrier, the | 2 | | beneficiary or the
Department shall within 30 days of filing | 3 | | the action give to the other
written notice by personal service | 4 | | or registered mail of the action or
claim and of the name of | 5 | | the court in which the
action or claim is brought. Proof of | 6 | | such notice shall be filed in such
action or claim. If an | 7 | | action or claim is brought by either the Department
or the | 8 | | beneficiary, the other may, at any time before trial on the | 9 | | facts,
become a party to such action or claim or shall | 10 | | consolidate his action or
claim with the other if brought | 11 | | independently.
| 12 | | (2) If an action or claim is brought by the Department | 13 | | pursuant to
subsection (b)(1), written notice to the | 14 | | beneficiary, guardian, personal
representative, estate or | 15 | | survivor given pursuant to this Section shall
advise him of his | 16 | | right to intervene in the proceeding, his right to obtain
a | 17 | | private attorney of his choice and the Department's right to | 18 | | recover the
reasonable value of the benefits provided.
| 19 | | (e) In the event of judgment or award in a suit or claim | 20 | | against such
third person or carrier:
| 21 | | (1) If the action or claim is prosecuted by the | 22 | | beneficiary alone, the
court shall first order paid from | 23 | | any judgment or award the
reasonable litigation expenses | 24 | | incurred in preparation and prosecution of
such action or | 25 | | claim, together with reasonable attorney's fees, when an
| 26 | | attorney has been retained. After payment of such expenses |
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| 1 | | and attorney's
fees the court shall, on the application of | 2 | | the Department, allow
as a first lien against the amount of | 3 | | such judgment or award the amount of
the Department's | 4 | | expenditures for the benefit of the beneficiary under this
| 5 | | Code, under the Covering ALL KIDS Health Insurance Act, or | 6 | | under the Veterans' Health Insurance Program Act , under or | 7 | | the Veterans' Health Insurance Program Act of 2008 , or | 8 | | under the Veterans' Care Preventative Dental Program Act , | 9 | | as provided in subsection (c)(4).
| 10 | | (2) If the action or claim is prosecuted both by the | 11 | | beneficiary and the
Department, the court shall first order | 12 | | paid from any judgment or
award the reasonable litigation | 13 | | expenses incurred in preparation and
prosecution of such | 14 | | action or claim, together with reasonable attorney's
fees | 15 | | for plaintiffs attorneys based solely on the services | 16 | | rendered for the
benefit of the beneficiary. After payment | 17 | | of such expenses and attorney's
fees, the court shall apply | 18 | | out of the balance of such judgment or award an
amount | 19 | | sufficient to reimburse the Department the full amount of | 20 | | benefits
paid on behalf of the beneficiary under this Code, | 21 | | under the Covering ALL KIDS Health Insurance Act, or under | 22 | | the Veterans' Health Insurance Program Act , under or the | 23 | | Veterans' Health Insurance Program Act of 2008 , or under | 24 | | the Veterans' Care Preventative Dental Program Act .
| 25 | | (f) The court shall, upon further application at any time
| 26 | | before the judgment or award is satisfied, allow as a further |
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| 1 | | lien the
amount of any expenditures of the Department in | 2 | | payment of additional
benefits arising out of the same cause of | 3 | | action or claim provided on
behalf of the beneficiary under | 4 | | this Code, under the Covering ALL KIDS Health Insurance Act, or | 5 | | under the Veterans' Health Insurance Program Act , under or the | 6 | | Veterans' Health Insurance Program Act of 2008 , or under the | 7 | | Veterans' Care Preventative Dental Program Act , when such | 8 | | benefits were
provided or became payable subsequent to the | 9 | | original order.
| 10 | | (g) No judgment, award, or settlement in any action or | 11 | | claim by a
beneficiary to recover damages for injuries, when | 12 | | the Department has an
interest, shall be satisfied without | 13 | | first giving the Department notice and
a reasonable opportunity | 14 | | to perfect and satisfy its lien.
| 15 | | (h) When the Department has perfected a lien upon a | 16 | | judgment or award in
favor of a beneficiary against any third | 17 | | party for an injury for which the
beneficiary has received | 18 | | benefits under this Code, under the Covering ALL KIDS Health | 19 | | Insurance Act, or under the Veterans' Health Insurance Program | 20 | | Act , under or the Veterans' Health Insurance Program Act of | 21 | | 2008 , or under the Veterans' Care Preventative Dental Program | 22 | | Act , the Department shall be
entitled to a writ of execution as | 23 | | lien claimant to enforce payment of said
lien against such | 24 | | third party with interest and other accruing costs as in
the | 25 | | case of other executions. In the event the amount of such | 26 | | judgment or
award so recovered has been paid to the |
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| 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. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | 13 | | 95-755, eff. 7-25-08.)
| 14 | | (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
| 15 | | Sec. 11-22c. Recovery of back wages. | 16 | | (a) As used in this Section, "recipient" means any person
| 17 | | receiving financial assistance under Article IV or Article VI | 18 | | of this Code, receiving health care benefits under the Covering | 19 | | ALL KIDS Health Insurance Act, or receiving health care | 20 | | benefits under the Veterans' Health Insurance Program Act or | 21 | | the Veterans' Health Insurance Program Act of 2008 , or | 22 | | receiving preventative dental service benefits under the | 23 | | Veterans' Care Preventative Dental Program Act .
| 24 | | (b) If a recipient maintains any suit, charge or other | 25 | | court or
administrative action against an employer seeking back |
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| 1 | | pay for a period
during which the recipient received financial | 2 | | assistance under Article IV
or Article VI of this Code, health | 3 | | care benefits under the Covering ALL KIDS Health Insurance Act, | 4 | | or health care benefits under the Veterans' Health Insurance | 5 | | Program Act or the Veterans' Health Insurance Program Act of | 6 | | 2008, or preventative dental service benefits under the | 7 | | Veterans' Care Preventative Dental Program Act, the recipient | 8 | | shall report such fact to the
Department. To the extent of the | 9 | | amount of assistance provided to or on
behalf of the recipient | 10 | | under Article IV or Article VI, health care benefits provided | 11 | | under the Covering ALL KIDS Health Insurance Act, or health | 12 | | care benefits provided under the Veterans' Health Insurance | 13 | | Program Act or the Veterans' Health Insurance Program Act of | 14 | | 2008, or preventative dental service benefits provided under | 15 | | the Veterans' Care Preventative Dental Program Act, the | 16 | | Department may
by intervention or otherwise without the | 17 | | necessity of assignment of claim,
attach a lien on the recovery | 18 | | of back wages equal to the amount of
assistance provided by the | 19 | | Department to the recipient under Article IV or
Article VI, | 20 | | under the Covering ALL KIDS Health Insurance Act, or under the | 21 | | Veterans' Health Insurance Program Act , under or the Veterans' | 22 | | Health Insurance Program Act of 2008 , or under the Veterans' | 23 | | Care Preventative Dental Program Act .
| 24 | | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | 25 | | 95-755, eff. 7-25-08.)
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| 1 | | Section 85. The Veterans' Health Insurance Program Act of | 2 | | 2008 is amended by changing Sections 10 and 15, as follows: | 3 | | (330 ILCS 126/10)
| 4 | | Sec. 10. Operation of the Program. | 5 | | (a) The Veterans' Health Insurance Program is created. This | 6 | | Program is not an entitlement. Enrollment is based on the | 7 | | availability of funds, and enrollment may be capped based on | 8 | | funds appropriated for the Program. As soon as practical after | 9 | | the effective date of this Act, coverage for this Program shall | 10 | | begin. The Program shall be administered by the Department of | 11 | | Healthcare and Family Services in collaboration with the | 12 | | Department of Veterans' Affairs. The Department shall have the | 13 | | same powers and authority to administer the Program as are | 14 | | provided to the Department in connection with the Department's | 15 | | administration of the Illinois Public Aid Code. The Department | 16 | | shall coordinate the Program with other health programs | 17 | | operated by the Department and other State and federal | 18 | | agencies. | 19 | | (b) The Department shall operate the Program in a manner so | 20 | | that the estimated cost of the Program during the fiscal year | 21 | | will not exceed the total appropriation for the Program. The | 22 | | Department may take any appropriate action to limit spending or | 23 | | enrollment into the Program, including, but not limited to, | 24 | | ceasing to accept or process applications, reviewing | 25 | | eligibility more frequently than annually, adjusting |
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| 1 | | cost-sharing, or reducing the income threshold for eligibility | 2 | | as necessary to control expenditures for the Program. The | 3 | | Department may use moneys designated for the Veterans' Health | 4 | | Insurance Program to fund the Veterans' Care Preventative | 5 | | Dental Program established under the Veterans' Care | 6 | | Preventative Dental Program.
| 7 | | (c) Notwithstanding subsections (a) and (b) and with the | 8 | | mutual agreement of the Department of Veterans' Affairs and the | 9 | | Department of Healthcare and Family Services, the operation of | 10 | | the Program may be changed to simplify its administration and | 11 | | to take advantage of health insurance coverage that may be | 12 | | available to veterans under the Patient Protection and | 13 | | Affordable Care Act. | 14 | | (Source: P.A. 98-104, eff. 7-22-13.) | 15 | | (330 ILCS 126/15)
| 16 | | Sec. 15. Eligibility. | 17 | | (a) To be eligible for the Program, a person must: | 18 | | (1) be a veteran who is not on active duty and who has | 19 | | not been dishonorably discharged from service or the spouse | 20 | | of such a veteran; | 21 | | (2) be a resident of the State of Illinois; | 22 | | (3) be at least 19 years of age and no older than 64 | 23 | | years of age; | 24 | | (4) be uninsured, as defined by the Department by rule, | 25 | | for a period of time established by the Department by rule, |
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| 1 | | which shall be no less than 3 months; | 2 | | (5) not be eligible for medical assistance under the | 3 | | Illinois Public Aid Code or healthcare benefits under the | 4 | | Children's Health Insurance Program Act or the Covering ALL | 5 | | KIDS Health Insurance Act; | 6 | | (6) not be eligible for medical benefits through the | 7 | | Veterans Health Administration; and | 8 | | (7) have a household income no greater than the sum of | 9 | | (i) an amount equal to 25% of the federal poverty level | 10 | | plus (ii) an amount equal to the Veterans Administration | 11 | | means test income threshold at the initiation of the | 12 | | Program; depending on the availability of funds, this level | 13 | | may be increased to an amount equal to the sum of (iii) an | 14 | | amount equal to 50% of the federal poverty level plus (iv) | 15 | | an amount equal to the Veterans Administration means test | 16 | | income threshold. This means test income threshold is | 17 | | subject to alteration by the Department as set forth in | 18 | | subsection (b) of Section 10. | 19 | | (b) A veteran or spouse who is determined eligible for the | 20 | | Program shall remain eligible for 12 months, provided the | 21 | | veteran or spouse remains a resident of the State and is not | 22 | | excluded under subsection (c) of this Section and provided the | 23 | | Department has not limited the enrollment period as set forth | 24 | | in subsection (b) of Section 10. | 25 | | (c) A veteran or spouse is not eligible for coverage under | 26 | | the Program if: |
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| 1 | | (1) the premium required under Section 35 of this Act | 2 | | has not been timely paid; if the required premiums are not | 3 | | paid, the liability of the Program shall be limited to | 4 | | benefits incurred under the Program for the time period for | 5 | | which premiums have been paid and for grace periods as | 6 | | established under subsection (d); if the required monthly | 7 | | premium is not paid, the veteran or spouse is ineligible | 8 | | for re-enrollment for a minimum period of 3 months; or | 9 | | (2) the veteran or spouse is a resident of a nursing | 10 | | facility or an inmate of a public institution, as defined | 11 | | by 42 CFR 435.1009. | 12 | | (d) The Department shall adopt rules for the Program, | 13 | | including, but not limited to, rules relating to eligibility, | 14 | | re-enrollment, grace periods, notice requirements, hearing | 15 | | procedures, cost-sharing, covered services, and provider | 16 | | requirements.
As used in this subsection, "covered services" | 17 | | must include preventative dental services as defined under the | 18 | | Veterans' Care Preventative Dental Program Act.
| 19 | | (Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09 .)
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.".
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