Sen. Emil Jones Jr.
Filed: 10/25/2005
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1 | AMENDMENT TO HOUSE BILL 806
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2 | AMENDMENT NO. ______. Amend House Bill 806 by replacing | ||||||
3 | everything after the enacting clause with the following:
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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 |
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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.
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10 | "Child" means a person under the age of 19.
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11 | "Department" means the Department of Healthcare and Family | ||||||
12 | Services.
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13 | "Medical assistance" means health care benefits provided | ||||||
14 | under Article V of the Illinois Public Aid Code.
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15 | "Program" means the Covering ALL KIDS Health Insurance | ||||||
16 | Program.
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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.
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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. |
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1 | Section 20. Eligibility. | ||||||
2 | (a) To be eligible for the Program, a person must be a | ||||||
3 | child:
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4 | (1) who is a resident of the State of Illinois; and
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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
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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 |
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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.
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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 |
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1 | (2) the child is an inmate of a public institution or | ||||||
2 | an institution for mental diseases.
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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 |
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1 | Health Insurance Program Act, except for non-emergency | ||||||
2 | transportation.
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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.
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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.
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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.
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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.
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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:
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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 |
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1 | cost-sharing.
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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.
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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.
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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 |
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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 |
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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:
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15 | (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
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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
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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 |
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1 | action. Any definition of "employable"
adopted by the | ||||||
2 | Department shall apply only to persons above the age of
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3 | compulsory school attendance.
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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.
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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 .
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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
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30 | of the service of the notice.
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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 |
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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
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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:
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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
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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;
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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;
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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 |
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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;
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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;
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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;
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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.
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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.
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31 | The court may reduce and apportion the Illinois
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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, |
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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
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10 | State of Illinois with the exception of the attorney's lien | ||||||
11 | under said statute.
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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.
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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.
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25 | (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
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26 | (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
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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
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32 | subrogated
to any right of
recovery such recipient may have | ||||||
33 | under the terms of any private or public
health care coverage |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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).
|
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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.)
|
| |||||||
| |||||||
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.".
|