|
|
|
96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010 HB4219
Introduced 2/27/2009, by Rep. Ron Stephens - Mike Bost - Harry R. Ramey, Jr. - Jerry L. Mitchell SYNOPSIS AS INTRODUCED: |
|
New Act |
|
305 ILCS 5/11-22 |
from Ch. 23, par. 11-22 |
305 ILCS 5/11-22a |
from Ch. 23, par. 11-22a |
305 ILCS 5/11-22b |
from Ch. 23, par. 11-22b |
305 ILCS 5/11-22c |
from Ch. 23, par. 11-22c |
330 ILCS 126/Act rep. |
|
|
Creates the Military Emergency Direct Insurance Contingency Act. Creates the Military Emergency Direct Insurance Contingency Program under the Act. Provides for administration of the program by the Department of Healthcare and Family Services. Sets forth eligibility requirements for veterans. Requires the Department to purchase or provide health care benefits for eligible veterans that are identical to the benefits provided to adults under the State's Medicaid program, except for nursing facility services and non-emergency transportation. Includes provisions for co-payments and monthly premiums for health care services. Gives the Department a charge upon claims and causes of action and a right of subrogation, and gives the Department the right to recover the reasonable value of benefits provided. Requires an annual report to the General Assembly by January 1 of each year beginning in 2010. Amends the Illinois Public Aid Code to add cross-references to the Military Emergency Direct Insurance Contingency Act. Repeals the Veterans' Health Insurance Program Act of 2008. Repeals the Military Emergency Direct Insurance Contingency Act on January 1, 2013. Effective immediately. |
| |
|
|
| FISCAL NOTE ACT MAY APPLY | |
|
|
A BILL FOR
|
|
|
|
|
HB4219 |
|
LRB096 08777 DRJ 18909 b |
|
|
1 |
| AN ACT concerning State government.
|
2 |
| Be it enacted by the People of the State of Illinois, |
3 |
| represented in the General Assembly:
|
4 |
| Section 1. Short title. This Act may be cited as the |
5 |
| Military Emergency Direct Insurance Contingency Act. |
6 |
| Section 3. Legislative intent. The General Assembly finds |
7 |
| that those who have served their country honorably in military |
8 |
| service and who are residing in this State deserve access to |
9 |
| affordable, comprehensive health insurance. Many veterans are |
10 |
| uninsured and unable to afford healthcare. This lack of |
11 |
| healthcare, including preventative care, often exacerbates |
12 |
| health conditions. The effects of lack of insurance negatively |
13 |
| impact those residents of the State who are insured because the |
14 |
| cost of paying for care to the uninsured is often shifted to |
15 |
| those who have insurance in the form of higher health insurance |
16 |
| premiums. It is, therefore, the intent of this legislation to |
17 |
| provide access to affordable health insurance for veterans |
18 |
| residing in Illinois who are unable to afford such coverage. |
19 |
| However, the State has only a limited amount of resources, and |
20 |
| the General Assembly therefore declares that while it intends |
21 |
| to cover as many such veterans as possible, the State may not |
22 |
| be able to cover every eligible person who qualifies for this |
23 |
| Program as a matter of entitlement due to limited funding. |
|
|
|
HB4219 |
- 2 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| Section 5. Definitions. The following words have the |
2 |
| following meanings: |
3 |
| "Department" means the Department of Healthcare and Family |
4 |
| Services, or any successor agency. |
5 |
| "Director" means the Director of Healthcare and Family |
6 |
| Services, or any successor agency. |
7 |
| "Medical assistance" means health care benefits provided |
8 |
| under Article V of the Illinois Public Aid Code. |
9 |
| "Program" means the Military Emergency Direct Insurance |
10 |
| Contingency Program. |
11 |
| "Resident" means an individual who has an Illinois |
12 |
| residence, as provided in Section 5-3 of the Illinois Public |
13 |
| Aid Code. |
14 |
| "Veteran" means any person who has served in a branch of |
15 |
| the United States military for greater than 180 consecutive |
16 |
| days after initial training. |
17 |
| "Veterans Affairs" or "VA" means the United States |
18 |
| Department of Veterans Affairs. |
19 |
| Section 10. Operation of the Program. |
20 |
| (a) The Military Emergency Direct Insurance Contingency |
21 |
| Program is created. This Program is not an entitlement. |
22 |
| Enrollment is based on the availability of funds, and |
23 |
| enrollment may be capped based on funds appropriated for the |
24 |
| Program. As soon as practical after the effective date of this |
|
|
|
HB4219 |
- 3 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| Act, coverage for this Program shall begin. The Program shall |
2 |
| be administered by the Department of Healthcare and Family |
3 |
| Services in collaboration with the Department of Veterans' |
4 |
| Affairs. The Department shall have the same powers and |
5 |
| authority to administer the Program as are provided to the |
6 |
| Department in connection with the Department's administration |
7 |
| of the Illinois Public Aid Code. The Department shall |
8 |
| coordinate the Program with other health programs operated by |
9 |
| the Department and other State and federal agencies. |
10 |
| (b) The Department shall operate the Program in a manner so |
11 |
| that the estimated cost of the Program during the fiscal year |
12 |
| will not exceed the total appropriation for the Program. The |
13 |
| Department may take any appropriate action to limit spending or |
14 |
| enrollment into the Program, including, but not limited to, |
15 |
| ceasing to accept or process applications, reviewing |
16 |
| eligibility more frequently than annually, adjusting |
17 |
| cost-sharing, or reducing the income threshold for eligibility |
18 |
| as necessary to control expenditures for the Program. |
19 |
| Section 15. Eligibility. |
20 |
| (a) To be eligible for the Program, a person must: |
21 |
| (1) be a veteran who is not on active duty and who has |
22 |
| not been dishonorably discharged from service; |
23 |
| (2) be a resident of the State of Illinois; |
24 |
| (3) be at least 19 years of age and no older than 64 |
25 |
| years of age; |
|
|
|
HB4219 |
- 4 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| (4) be uninsured, as defined by the Department by rule, |
2 |
| for a period of time established by the Department by rule, |
3 |
| which shall be no less than 6 months; |
4 |
| (5) not be eligible for medical assistance under the |
5 |
| Illinois Public Aid Code; |
6 |
| (6) not be eligible for medical benefits through the |
7 |
| Veterans Health Administration; except that if he or she is |
8 |
| eligible for services provided at a VA facility but resides |
9 |
| 60 miles or more from such a facility, he or she is |
10 |
| eligible for the Program; and |
11 |
| (7) have a household income no greater than the sum of |
12 |
| (i) an amount equal to 25% of the federal poverty level |
13 |
| plus (ii) an amount equal to the Veterans Administration |
14 |
| means test income threshold at the initiation of the |
15 |
| Program; depending on the availability of funds, this level |
16 |
| may be increased to an amount equal to the sum of (iii) an |
17 |
| amount equal to 50% of the federal poverty level plus (iv) |
18 |
| an amount equal to the Veterans Administration means test |
19 |
| income threshold. This means test income threshold is |
20 |
| subject to alteration by the Department as set forth in |
21 |
| subsection (b) of Section 10. |
22 |
| (b) A veteran who is determined eligible for the Program |
23 |
| shall remain eligible for 12 months, provided the veteran |
24 |
| remains a resident of the State and is not excluded under |
25 |
| subsection (c) of this Section and provided the Department has |
26 |
| not limited the enrollment period as set forth in subsection |
|
|
|
HB4219 |
- 5 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| (b) of Section 10. |
2 |
| (b-5) If a veteran was enrolled in the program operated |
3 |
| under the Veterans' Health Insurance Program Act of 2008 on the |
4 |
| effective date of this Act, he or she shall be enrolled in the |
5 |
| Program operated under this Act on that date, notwithstanding |
6 |
| any other provision of this Act. |
7 |
| (c) A veteran is not eligible for coverage under the |
8 |
| Program if: |
9 |
| (1) the premium required under Section 35 of this Act |
10 |
| has not been timely paid; if the required premiums are not |
11 |
| paid, the liability of the Program shall be limited to |
12 |
| benefits incurred under the Program for the time period for |
13 |
| which premiums have been paid and for grace periods as |
14 |
| established under subsection (d); if the required monthly |
15 |
| premium is not paid, the veteran is ineligible for |
16 |
| re-enrollment for a minimum period of 3 months; or |
17 |
| (2) the veteran is a resident of a nursing facility or |
18 |
| an inmate of a public institution, as defined by 42 CFR |
19 |
| 435.1009. |
20 |
| (d) The Department shall adopt rules for the Program, |
21 |
| including, but not limited to, rules relating to eligibility, |
22 |
| re-enrollment, grace periods, notice requirements, hearing |
23 |
| procedures, cost-sharing, covered services, and provider |
24 |
| requirements.
|
25 |
| Section 20. Notice of decisions to terminate eligibility. |
|
|
|
HB4219 |
- 6 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| Whenever the Department decides to either deny or terminate |
2 |
| eligibility under this Act, the veteran shall have a right to |
3 |
| notice and a hearing, as provided by the Department by rule. |
4 |
| Section 25. Illinois Department of Veterans' Affairs. The |
5 |
| Department shall coordinate with the Illinois Department of |
6 |
| Veterans' Affairs and the Veterans Assistance Commissions to |
7 |
| allow State Veterans' Affairs service officers and the Veterans |
8 |
| Assistance Commissions to assist veterans to apply for the |
9 |
| Program. All applicants must be reviewed for Veterans Health |
10 |
| Administration eligibility or other existing health benefits |
11 |
| prior to consideration for the Program. |
12 |
| Section 30. Health care benefits. |
13 |
| (a) For veterans eligible and enrolled, the Department |
14 |
| shall purchase or provide health care benefits for eligible |
15 |
| veterans that are identical to the benefits provided to adults |
16 |
| under the State's approved plan under Title XIX of the Social |
17 |
| Security Act, except for nursing facility services and |
18 |
| non-emergency transportation. |
19 |
| (b) Providers shall be subject to approval by the |
20 |
| Department to provide health care under the Illinois Public Aid |
21 |
| Code and shall be reimbursed at the same rates as providers |
22 |
| reimbursed under the State's approved plan under Title XIX of |
23 |
| the Social Security Act. |
24 |
| (c) As an alternative to the benefits set forth in |
|
|
|
HB4219 |
- 7 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| subsection (a) of this Section, and when cost-effective, the |
2 |
| Department may offer veterans subsidies toward the cost of |
3 |
| privately sponsored health insurance, including |
4 |
| employer-sponsored health insurance.
|
5 |
| Section 35. Cost-sharing. The Department, by rule, shall |
6 |
| set forth requirements concerning co-payments and monthly |
7 |
| premiums for health care services. This cost-sharing shall be |
8 |
| based on household income, as defined by the Department by |
9 |
| rule, and is subject to alteration by the Department as set |
10 |
| forth in subsection (b) of Section 10. |
11 |
| Section 40. Charge upon claims and causes of action; right |
12 |
| of subrogation; recoveries. Sections 11-22, 11-22a, 11-22b, |
13 |
| and 11-22c of the Illinois Public Aid Code apply to health |
14 |
| benefits provided to veterans under this Act, as provided in |
15 |
| those Sections. |
16 |
| Section 45. Reporting. The Department shall prepare an |
17 |
| annual report for submission to the General Assembly. The |
18 |
| report shall be due to the General Assembly by January 1 of |
19 |
| each year beginning in 2010. This report shall include |
20 |
| information regarding implementation of the Program, including |
21 |
| the number of veterans enrolled and any available information |
22 |
| regarding other benefits derived from the Program, including |
23 |
| screening for and acquisition of other veterans' benefits |
|
|
|
HB4219 |
- 8 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| through the Veterans' Service Officers and the Veterans' |
2 |
| Assistance Commissions. This report may also include |
3 |
| recommendations regarding improvements that may be made to the |
4 |
| Program and regarding the extension of the repeal date set |
5 |
| forth in Section 85 of this Act. |
6 |
| Section 50. Emergency rulemaking. The Department may adopt |
7 |
| rules necessary to establish and implement this Act through the |
8 |
| use of emergency rulemaking in accordance with Section 5-45 of |
9 |
| the Illinois Administrative Procedure Act. For the purposes of |
10 |
| that Act, the General Assembly finds that the adoption of rules |
11 |
| to implement this Act is deemed an emergency and necessary for |
12 |
| the public interest, safety, and welfare. |
13 |
| Section 85. Repeal. This Act is repealed on January 1, |
14 |
| 2013. |
15 |
| Section 90. The Illinois Public Aid Code is amended by |
16 |
| changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
|
17 |
| (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
|
18 |
| Sec. 11-22. Charge upon claims and causes of action for |
19 |
| injuries. The Illinois Department shall have a charge upon all |
20 |
| claims, demands and
causes of action for injuries to an |
21 |
| applicant for or recipient of (i)
financial aid under Articles |
22 |
| III, IV, and V, (ii) health care benefits provided under the |
|
|
|
HB4219 |
- 9 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| Covering ALL KIDS Health Insurance Act, or (iii) health care |
2 |
| benefits provided under the Veterans' Health Insurance Program |
3 |
| Act , or the Veterans' Health Insurance Program Act of 2008 , or |
4 |
| the Military Emergency Direct Insurance Contingency Act for the |
5 |
| total
amount of
medical assistance provided the recipient from |
6 |
| the time of injury to the
date of recovery upon such claim, |
7 |
| demand or cause of action. In addition, if
the applicant or |
8 |
| recipient was employable, as defined by the Department, at
the |
9 |
| time of the injury, the Department shall also have a charge |
10 |
| upon any
such claims, demands and causes of action for the |
11 |
| total amount of aid
provided to the recipient and his
|
12 |
| dependents, including all cash assistance and medical |
13 |
| assistance
only to the extent includable in the claimant's |
14 |
| action, from the
time of injury to the date of recovery upon |
15 |
| such
claim, demand or cause of action. Any definition of |
16 |
| "employable"
adopted by the Department shall apply only to |
17 |
| persons above the age of
compulsory school attendance.
|
18 |
| If the injured person was employable at the time of the |
19 |
| injury and is
provided aid under Articles III, IV, or V and any |
20 |
| dependent or
member of his family is provided aid under Article |
21 |
| VI, or vice versa,
both the Illinois Department and the local |
22 |
| governmental unit shall have
a charge upon such claims, demands |
23 |
| and causes of action for the aid
provided to the injured person |
24 |
| and any
dependent member of his family, including all cash |
25 |
| assistance, medical
assistance and food stamps, from the time |
26 |
| of the injury to the date
of recovery.
|
|
|
|
HB4219 |
- 10 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| "Recipient", as used herein, means (i) in the case of |
2 |
| financial aid provided under this Code, the grantee of record |
3 |
| and any
persons whose needs are included in the financial aid |
4 |
| provided to the
grantee of record or otherwise met by grants |
5 |
| under the appropriate
Article of this Code for which such |
6 |
| person is eligible, (ii) in the case of health care benefits |
7 |
| provided under the Covering ALL KIDS Health Insurance Act, the |
8 |
| child to whom those benefits are provided, and (iii) in the |
9 |
| case of health care benefits provided under the Veterans' |
10 |
| Health Insurance Program Act , or the Veterans' Health Insurance |
11 |
| Program Act of 2008 , or the Military Emergency Direct Insurance |
12 |
| Contingency Act , the veteran to whom benefits are provided.
|
13 |
| In each case, the notice shall be served by certified mail |
14 |
| or
registered mail, upon the party or parties against whom the |
15 |
| applicant or
recipient has a claim, demand or cause of action. |
16 |
| The notice shall
claim the charge and describe the interest the |
17 |
| Illinois Department, the
local governmental unit, or the |
18 |
| county, has in the claim, demand, or
cause of action. The |
19 |
| charge shall attach to any verdict or judgment
entered and to |
20 |
| any money or property which may be recovered on account
of such |
21 |
| claim, demand, cause of action or suit from and after the time
|
22 |
| of the service of the notice.
|
23 |
| On petition filed by the Illinois Department, or by the |
24 |
| local
governmental unit or county if either is claiming a |
25 |
| charge, or by the
recipient, or by the defendant, the court, on |
26 |
| written notice to all
interested parties, may adjudicate the |
|
|
|
HB4219 |
- 11 - |
LRB096 08777 DRJ 18909 b |
|
|
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;
|
|
|
|
HB4219 |
- 12 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| (2) the amount, if any, of the attorney's fees and |
2 |
| other costs incurred
by the recipient incident to the |
3 |
| recovery and paid by the recipient up to the
time of |
4 |
| recovery, and the amount of such fees and costs remaining |
5 |
| unpaid
at the time of recovery;
|
6 |
| (3) the total hospital, doctor and other medical |
7 |
| expenses incurred for
care and treatment of the injury to |
8 |
| the date of recovery therefor, the portion
of such expenses |
9 |
| theretofore paid by the recipient, by insurance provided
by |
10 |
| the recipient, and by the Department, unit of local |
11 |
| government and county
seeking to enforce a charge against |
12 |
| the recovery, and the amount of such
previously incurred |
13 |
| expenses which remain unpaid at the time of recovery
and by |
14 |
| whom such incurred, unpaid expenses are to be paid;
|
15 |
| (4) whether the recovery represents less than |
16 |
| substantially full
recompense
for the injury and the |
17 |
| hospital, doctor and other medical expenses incurred
to the |
18 |
| date of recovery for the care and treatment of the injury, |
19 |
| so that
reduction of the charge sought to be enforced |
20 |
| against the recovery would
not likely result in a double |
21 |
| recovery or unjust enrichment to the recipient;
|
22 |
| (5) the age of the recipient and of persons dependent |
23 |
| for support upon
the recipient, the nature and permanency |
24 |
| of the recipient's injuries as
they affect not only the |
25 |
| future employability and education of the recipient
but |
26 |
| also the reasonably necessary and foreseeable future |
|
|
|
HB4219 |
- 13 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| material, maintenance,
medical, rehabilitative and |
2 |
| training needs of the recipient, the cost of
such |
3 |
| reasonably necessary and foreseeable future needs, and the |
4 |
| resources
available to meet such needs and pay such costs;
|
5 |
| (6) the realistic ability of the recipient to repay in |
6 |
| whole or in part
the charge sought to be enforced against |
7 |
| the recovery when judged in light
of the factors enumerated |
8 |
| above.
|
9 |
| The burden of producing evidence sufficient to support the |
10 |
| exercise by
the court of its discretion to reduce the amount of |
11 |
| a proven charge sought
to be enforced against the recovery |
12 |
| shall rest with the party seeking such reduction.
|
13 |
| The court may reduce and apportion the Illinois
|
14 |
| Department's lien proportionate to the recovery of the |
15 |
| claimant. The court may
consider the nature and extent of the |
16 |
| injury, economic and noneconomic
loss, settlement offers, |
17 |
| comparative negligence as it applies to the case
at hand, |
18 |
| hospital costs, physician costs, and all other appropriate |
19 |
| costs.
The Illinois Department shall pay its pro rata share of |
20 |
| the attorney fees
based on the Illinois Department's lien as it |
21 |
| compares to the total
settlement agreed upon. This Section |
22 |
| shall not affect the priority of an
attorney's lien under the |
23 |
| Attorneys Lien Act. The charges of
the Illinois Department |
24 |
| described in this Section, however, shall take
priority over |
25 |
| all other liens and charges existing under the laws of the
|
26 |
| State of Illinois with the exception of the attorney's lien |
|
|
|
HB4219 |
- 14 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| under said statute.
|
2 |
| Whenever the Department or any unit of local government
has |
3 |
| a statutory charge under this Section against a recovery for |
4 |
| damages
incurred by a recipient because of its advancement of |
5 |
| any assistance, such
charge shall not be satisfied out of any |
6 |
| recovery until the attorney's claim
for fees is satisfied, |
7 |
| irrespective of whether or not an action based on
recipient's |
8 |
| claim has been filed in court.
|
9 |
| This Section shall be inapplicable to any claim, demand or |
10 |
| cause of
action arising under (a) the Workers' Compensation Act |
11 |
| or the predecessor
Workers' Compensation Act
of
June 28, 1913, |
12 |
| (b) the Workers' Occupational Diseases Act or the predecessor
|
13 |
| Workers' Occupational
Diseases Act of March 16, 1936; and (c) |
14 |
| the Wrongful Death Act.
|
15 |
| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; |
16 |
| 95-755, eff. 7-25-08.)
|
17 |
| (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
|
18 |
| Sec. 11-22a. Right of Subrogation. To the extent of the |
19 |
| amount of (i) medical
assistance provided by the Department to |
20 |
| or on behalf of a recipient under
Article V or VI, (ii) health |
21 |
| care benefits provided for a child under the Covering ALL KIDS |
22 |
| Health Insurance Act, or (iii) health care benefits provided to |
23 |
| a veteran under the Veterans' Health Insurance Program Act , or |
24 |
| the Veterans' Health Insurance Program Act of 2008 , or the |
25 |
| Military Emergency Direct Insurance Contingency Act , the |
|
|
|
HB4219 |
- 15 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| Department shall be
subrogated
to any right of
recovery such |
2 |
| recipient may have under the terms of any private or public
|
3 |
| health care coverage or casualty coverage, including coverage |
4 |
| under the
"Workers' Compensation Act", approved July 9, 1951, |
5 |
| as amended, or the
"Workers' Occupational Diseases Act", |
6 |
| approved July 9, 1951, as amended,
without the necessity of |
7 |
| assignment of claim or other authorization to secure
the right |
8 |
| of recovery to the Department. To enforce its subrogation |
9 |
| right, the
Department may (i) intervene or join in an action or |
10 |
| proceeding brought by the
recipient, his or her guardian, |
11 |
| personal representative, estate, dependents, or
survivors |
12 |
| against any person or public or private entity that may be |
13 |
| liable;
(ii) institute and prosecute legal proceedings against |
14 |
| any person or public or
private entity that may be liable for |
15 |
| the cost of such services; or (iii)
institute and prosecute |
16 |
| legal proceedings, to the extent necessary to reimburse
the |
17 |
| Illinois Department for its costs, against any noncustodial |
18 |
| parent who (A)
is required by court or administrative order to |
19 |
| provide insurance or other
coverage of the cost of health care |
20 |
| services for a child eligible for medical
assistance under this |
21 |
| Code and (B) has received payment from a third party for
the |
22 |
| costs of those services but has not used the payments to |
23 |
| reimburse either
the other parent or the guardian of the child |
24 |
| or the provider of the services.
|
25 |
| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; |
26 |
| 95-755, eff. 7-25-08.)
|
|
|
|
HB4219 |
- 16 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
|
2 |
| Sec. 11-22b. Recoveries.
|
3 |
| (a) As used in this Section:
|
4 |
| (1) "Carrier" means any insurer, including any private |
5 |
| company,
corporation, mutual association, trust fund, |
6 |
| reciprocal or interinsurance
exchange authorized under the |
7 |
| laws of this State to insure persons against
liability or |
8 |
| injuries caused to another and any insurer providing
|
9 |
| benefits under a policy of bodily injury liability |
10 |
| insurance covering
liability arising out of the ownership, |
11 |
| maintenance or use of a motor
vehicle which provides |
12 |
| uninsured motorist endorsement or coverage.
|
13 |
| (2) "Beneficiary" means any person or their dependents |
14 |
| who has received
benefits or will be provided benefits |
15 |
| under this Code, under the Covering ALL KIDS Health |
16 |
| Insurance Act, or under the Veterans' Health Insurance |
17 |
| Program Act , or the Veterans' Health Insurance Program Act |
18 |
| of 2008 , or the Military Emergency Direct Insurance |
19 |
| Contingency Act
because of an injury for
which another |
20 |
| person may be liable. It includes such beneficiary's |
21 |
| guardian,
conservator or other personal representative, |
22 |
| his estate or survivors.
|
23 |
| (b)(1) When benefits are provided or will be provided to a |
24 |
| beneficiary
under this Code, under the Covering ALL KIDS Health |
25 |
| Insurance Act, or under the Veterans' Health Insurance Program |
|
|
|
HB4219 |
- 17 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| Act , or the Veterans' Health Insurance Program Act of 2008 , or |
2 |
| the Military Emergency Direct Insurance Contingency Act |
3 |
| because of an injury for which another person is liable, or
for |
4 |
| which a carrier is liable in accordance with the provisions of |
5 |
| any
policy of insurance issued pursuant to the Illinois |
6 |
| Insurance Code, the
Illinois Department shall have a right to |
7 |
| recover from such person or carrier
the reasonable value of |
8 |
| benefits so provided. The Attorney General may, to
enforce such |
9 |
| right, institute and prosecute legal proceedings against the
|
10 |
| third person or carrier who may be liable for the injury in an |
11 |
| appropriate
court, either in the name of the Illinois |
12 |
| Department or in the name of the
injured person, his guardian, |
13 |
| personal representative, estate, or survivors.
|
14 |
| (2) The Department may:
|
15 |
| (A) compromise or settle and release any such claim for |
16 |
| benefits
provided under this Code, or
|
17 |
| (B) waive any such claims for benefits provided under |
18 |
| this Code, in
whole or in part, for the convenience of the |
19 |
| Department or if the Department
determines that collection |
20 |
| would result in undue hardship upon the person who
suffered |
21 |
| the injury or, in a wrongful death action, upon the heirs |
22 |
| of the
deceased.
|
23 |
| (3) No action taken on behalf of the Department pursuant to |
24 |
| this Section
or any judgment rendered in such action shall be a |
25 |
| bar to any action upon
the claim or cause of action of the |
26 |
| beneficiary, his guardian, conservator,
personal |
|
|
|
HB4219 |
- 18 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| representative, estate, dependents or survivors against the |
2 |
| third
person who may be liable for the injury, or shall operate |
3 |
| to deny to the
beneficiary the recovery for that portion of any |
4 |
| damages not covered hereunder.
|
5 |
| (c)(1) When an action is brought by the Department pursuant |
6 |
| to
subsection (b), it shall be commenced within the period |
7 |
| prescribed by
Article XIII of the Code of Civil Procedure.
|
8 |
| However, the Department may not commence the action prior |
9 |
| to 5 months
before the end of the applicable period prescribed |
10 |
| by Article XIII of the
Code of Civil Procedure. Thirty days |
11 |
| prior to commencing an action, the
Department shall notify the |
12 |
| beneficiary of the Department's intent to
commence such an |
13 |
| action.
|
14 |
| (2) The death of the beneficiary does not abate any right |
15 |
| of action
established by subsection (b).
|
16 |
| (3) When an action or claim is brought by persons entitled |
17 |
| to bring such
actions or assert such claims against a third |
18 |
| person who may be liable for
causing the death of a |
19 |
| beneficiary, any settlement, judgment or award
obtained is |
20 |
| subject to the Department's claim for reimbursement of the
|
21 |
| benefits provided to the beneficiary under this Code, under the |
22 |
| Covering ALL KIDS Health Insurance Act, or under the Veterans' |
23 |
| Health Insurance Program Act , or the Veterans' Health Insurance |
24 |
| Program Act of 2008 , or the Military Emergency Direct Insurance |
25 |
| Contingency Act .
|
26 |
| (4) When the action or claim is brought by the beneficiary |
|
|
|
HB4219 |
- 19 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| alone and
the beneficiary incurs a personal liability to pay |
2 |
| attorney's fees and
costs of litigation, the Department's claim |
3 |
| for reimbursement of the
benefits provided to the beneficiary |
4 |
| shall be the full amount of benefits
paid on behalf of the |
5 |
| beneficiary under this Code, under the Covering ALL KIDS Health |
6 |
| Insurance Act, or under the Veterans' Health Insurance Program |
7 |
| Act , or the Veterans' Health Insurance Program Act of 2008 , or |
8 |
| the Military Emergency Direct Insurance Contingency Act less a |
9 |
| pro rata
share which represents the Department's reasonable |
10 |
| share of attorney's fees
paid by the beneficiary and that |
11 |
| portion of the cost of litigation expenses
determined by |
12 |
| multiplying by the ratio of the full amount of the
expenditures |
13 |
| of the full amount of the judgment, award or settlement.
|
14 |
| (d)(1) If either the beneficiary or the Department brings |
15 |
| an action or
claim against such third party or carrier, the |
16 |
| beneficiary or the
Department shall within 30 days of filing |
17 |
| the action give to the other
written notice by personal service |
18 |
| or registered mail of the action or
claim and of the name of |
19 |
| the court in which the
action or claim is brought. Proof of |
20 |
| such notice shall be filed in such
action or claim. If an |
21 |
| action or claim is brought by either the Department
or the |
22 |
| beneficiary, the other may, at any time before trial on the |
23 |
| facts,
become a party to such action or claim or shall |
24 |
| consolidate his action or
claim with the other if brought |
25 |
| independently.
|
26 |
| (2) If an action or claim is brought by the Department |
|
|
|
HB4219 |
- 20 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| pursuant to
subsection (b)(1), written notice to the |
2 |
| beneficiary, guardian, personal
representative, estate or |
3 |
| survivor given pursuant to this Section shall
advise him of his |
4 |
| right to intervene in the proceeding, his right to obtain
a |
5 |
| private attorney of his choice and the Department's right to |
6 |
| recover the
reasonable value of the benefits provided.
|
7 |
| (e) In the event of judgment or award in a suit or claim |
8 |
| against such
third person or carrier:
|
9 |
| (1) If the action or claim is prosecuted by the |
10 |
| beneficiary alone, the
court shall first order paid from |
11 |
| any judgment or award the
reasonable litigation expenses |
12 |
| incurred in preparation and prosecution of
such action or |
13 |
| claim, together with reasonable attorney's fees, when an
|
14 |
| attorney has been retained. After payment of such expenses |
15 |
| and attorney's
fees the court shall, on the application of |
16 |
| the Department, allow
as a first lien against the amount of |
17 |
| such judgment or award the amount of
the Department's |
18 |
| expenditures for the benefit of the beneficiary under this
|
19 |
| Code, under the Covering ALL KIDS Health Insurance Act, or |
20 |
| under the Veterans' Health Insurance Program Act , or the |
21 |
| Veterans' Health Insurance Program Act of 2008 , or the |
22 |
| Military Emergency Direct Insurance Contingency Act , as |
23 |
| provided in subsection (c)(4).
|
24 |
| (2) If the action or claim is prosecuted both by the |
25 |
| beneficiary and the
Department, the court shall first order |
26 |
| paid from any judgment or
award the reasonable litigation |
|
|
|
HB4219 |
- 21 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| expenses incurred in preparation and
prosecution of such |
2 |
| action or claim, together with reasonable attorney's
fees |
3 |
| for plaintiffs attorneys based solely on the services |
4 |
| rendered for the
benefit of the beneficiary. After payment |
5 |
| of such expenses and attorney's
fees, the court shall apply |
6 |
| out of the balance of such judgment or award an
amount |
7 |
| sufficient to reimburse the Department the full amount of |
8 |
| benefits
paid on behalf of the beneficiary under this Code, |
9 |
| under the Covering ALL KIDS Health Insurance Act, or under |
10 |
| the Veterans' Health Insurance Program Act , or the |
11 |
| Veterans' Health Insurance Program Act of 2008 , or the |
12 |
| Military Emergency Direct Insurance Contingency 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, under the Covering ALL KIDS Health Insurance Act, or |
19 |
| under the Veterans' Health Insurance Program Act , or the |
20 |
| Veterans' Health Insurance Program Act of 2008 , or the Military |
21 |
| Emergency Direct Insurance Contingency Act , when such benefits |
22 |
| were
provided or became payable subsequent to the original |
23 |
| order.
|
24 |
| (g) No judgment, award, or settlement in any action or |
25 |
| claim by a
beneficiary to recover damages for injuries, when |
26 |
| the Department has an
interest, shall be satisfied without |
|
|
|
HB4219 |
- 22 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| first giving the Department notice and
a reasonable opportunity |
2 |
| to perfect and satisfy its lien.
|
3 |
| (h) When the Department has perfected a lien upon a |
4 |
| judgment or award in
favor of a beneficiary against any third |
5 |
| party for an injury for which the
beneficiary has received |
6 |
| benefits under this Code, under the Covering ALL KIDS Health |
7 |
| Insurance Act, or under the Veterans' Health Insurance Program |
8 |
| Act , or the Veterans' Health Insurance Program Act of 2008 , or |
9 |
| the Military Emergency Direct Insurance Contingency Act , the |
10 |
| Department shall be
entitled to a writ of execution as lien |
11 |
| claimant to enforce payment of said
lien against such third |
12 |
| party with interest and other accruing costs as in
the case of |
13 |
| other executions. In the event the amount of such judgment or
|
14 |
| award so recovered has been paid to the beneficiary, the |
15 |
| Department shall
be entitled to a writ of execution against |
16 |
| such beneficiary to the extent of
the Department's lien, with |
17 |
| interest and other accruing costs as in the case
of other |
18 |
| executions.
|
19 |
| (i) Except as otherwise provided in this Section, |
20 |
| notwithstanding any
other provision of law, the entire amount |
21 |
| of any settlement of the injured
beneficiary's action or claim, |
22 |
| with or without suit, is subject to the
Department's claim for |
23 |
| reimbursement of the benefits provided and any lien
filed |
24 |
| pursuant thereto to the same extent and subject to the same
|
25 |
| limitations as in Section 11-22 of this Code.
|
26 |
| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; |
|
|
|
HB4219 |
- 23 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| 95-755, eff. 7-25-08.)
|
2 |
| (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
|
3 |
| Sec. 11-22c. Recovery of back wages. |
4 |
| (a) As used in this Section, "recipient" means any person
|
5 |
| receiving financial assistance under Article IV or Article VI |
6 |
| of this Code, receiving health care benefits under the Covering |
7 |
| ALL KIDS Health Insurance Act, or receiving health care |
8 |
| benefits under the Veterans' Health Insurance Program Act , or |
9 |
| the Veterans' Health Insurance Program Act of 2008 , or the |
10 |
| Military Emergency Direct Insurance Contingency Act .
|
11 |
| (b) If a recipient maintains any suit, charge or other |
12 |
| court or
administrative action against an employer seeking back |
13 |
| pay for a period
during which the recipient received financial |
14 |
| assistance under Article IV
or Article VI of this Code, health |
15 |
| care benefits under the Covering ALL KIDS Health Insurance Act, |
16 |
| or health care benefits under the Veterans' Health Insurance |
17 |
| Program Act , or the Veterans' Health Insurance Program Act of |
18 |
| 2008 , or the Military Emergency Direct Insurance Contingency |
19 |
| Act , the recipient shall report such fact to the
Department. To |
20 |
| the extent of the amount of assistance provided to or on
behalf |
21 |
| of the recipient under Article IV or Article VI, health care |
22 |
| benefits provided under the Covering ALL KIDS Health Insurance |
23 |
| Act, or health care benefits provided under the Veterans' |
24 |
| Health Insurance Program Act , or the Veterans' Health Insurance |
25 |
| Program Act of 2008 , or the Military Emergency Direct Insurance |
|
|
|
HB4219 |
- 24 - |
LRB096 08777 DRJ 18909 b |
|
|
1 |
| Contingency Act , the Department may
by intervention or |
2 |
| otherwise without the necessity of assignment of claim,
attach |
3 |
| a lien on the recovery of back wages equal to the amount of
|
4 |
| assistance provided by the Department to the recipient under |
5 |
| Article IV or
Article VI, under the Covering ALL KIDS Health |
6 |
| Insurance Act, or under the Veterans' Health Insurance Program |
7 |
| Act , or the Veterans' Health Insurance Program Act of 2008 , or |
8 |
| the Military Emergency Direct Insurance Contingency Act .
|
9 |
| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; |
10 |
| 95-755, eff. 7-25-08.)
|
11 |
| (330 ILCS 126/Act rep.)
|
12 |
| Section 92. The Veterans' Health Insurance Program Act of |
13 |
| 2008 is repealed. |
14 |
| Section 97. Severability. The provisions of this Act are |
15 |
| severable under Section 1.31 of the Statute on Statutes.
|
16 |
| Section 99. Effective date. This Act takes effect upon |
17 |
| becoming law. |