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Public Act 094-0693 |
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AN ACT concerning State government.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. Short title. This Act may be cited as the | ||||
Covering ALL KIDS Health Insurance Act. | ||||
Section 5. Legislative intent. The General Assembly finds | ||||
that, for the economic and social benefit of all residents of | ||||
the State, it is important to enable all children of this State | ||||
to access affordable health insurance that offers | ||||
comprehensive coverage and emphasizes preventive healthcare. | ||||
Many children in working families, including many families | ||||
whose family income ranges between $40,000 and $80,000, are | ||||
uninsured. Numerous studies, including the Institute of | ||||
Medicine's report, "Health Insurance Matters", demonstrate | ||||
that lack of insurance negatively affects health status. The | ||||
General Assembly further finds that access to healthcare is a | ||||
key component for children's healthy development and | ||||
successful education. The effects of lack of insurance also | ||||
negatively impact those who are insured because the cost of | ||||
paying for care to the uninsured is often shifted to those who | ||||
have insurance in the form of higher health insurance premiums. | ||||
A Families USA 2005 report indicates that family premiums in | ||||
Illinois are increased by $1,059 due to cost-shifting from the | ||||
uninsured. It is, therefore, the intent of this legislation to | ||||
provide access to affordable health insurance to all uninsured | ||||
children in Illinois. | ||||
Section 10. Definitions. In this Act: | ||||
"Application agent" means an organization or individual, | ||||
such as a licensed health care provider, school, youth service | ||||
agency, employer, labor union, local chamber of commerce, | ||||
community-based organization, or other organization, approved |
by the Department to assist in enrolling children in the | ||
Program.
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"Child" means a person under the age of 19.
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"Department" means the Department of Healthcare and Family | ||
Services.
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"Medical assistance" means health care benefits provided | ||
under Article V of the Illinois Public Aid Code.
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"Program" means the Covering ALL KIDS Health Insurance | ||
Program.
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"Resident" means an individual (i) who is in the State for | ||
other than a temporary or transitory purpose during the taxable | ||
year or (ii) who is domiciled in this State but is absent from | ||
the State for a temporary or transitory purpose during the | ||
taxable year.
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Section 15. Operation of Program. The Covering ALL KIDS | ||
Health Insurance Program is created. The Program shall be | ||
administered by the Department of Healthcare and Family | ||
Services. The Department shall have the same powers and | ||
authority to administer the Program as are provided to the | ||
Department in connection with the Department's administration | ||
of the Illinois Public Aid Code and the Children's Health | ||
Insurance Program Act. The Department shall coordinate the | ||
Program with the existing children's health programs operated | ||
by the Department and other State agencies. | ||
Section 20. Eligibility. | ||
(a) To be eligible for the Program, a person must be a | ||
child:
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(1) who is a resident of the State of Illinois; and
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(2) who is ineligible for medical assistance under the | ||
Illinois Public Aid Code or benefits under the Children's | ||
Health Insurance Program Act; and
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(3) either (i) who has been without health insurance | ||
coverage for a period set forth by the Department in rules, | ||
but not less than 6 months during the first month of |
operation of the Program, 7 months during the second month | ||
of operation, 8 months during the third month of operation, | ||
9 months during the fourth month of operation, 10 months | ||
during the fifth month of operation, 11 months during the | ||
sixth month of operation, and 12 months thereafter, (ii) | ||
whose parent has lost employment that made available | ||
affordable dependent health insurance coverage, until such | ||
time as affordable employer-sponsored dependent health | ||
insurance coverage is again available for the child as set | ||
forth by the Department in rules, (iii) who is a newborn | ||
whose responsible relative does not have available | ||
affordable private or employer-sponsored health insurance, | ||
or (iv) who, within one year of applying for coverage under | ||
this Act, lost medical benefits under the Illinois Public | ||
Aid Code or the Children's Health Insurance Program Act. | ||
An entity that provides health insurance coverage (as | ||
defined in Section 2 of the Comprehensive Health Insurance Plan | ||
Act) to Illinois residents shall provide health insurance data | ||
match to the Department of Healthcare and Family Services for | ||
the purpose of determining eligibility for the Program under | ||
this Act. | ||
The Department of Healthcare and Family Services, in | ||
collaboration with the Department of Financial and | ||
Professional Regulation, Division of Insurance, shall adopt | ||
rules governing the exchange of information under this Section. | ||
The rules shall be consistent with all laws relating to the | ||
confidentiality or privacy of personal information or medical | ||
records, including provisions under the Federal Health | ||
Insurance Portability and Accountability Act (HIPAA). | ||
(b) The Department shall monitor the availability and | ||
retention of employer-sponsored dependent health insurance | ||
coverage and shall modify the period described in subdivision | ||
(a)(3) if necessary to promote retention of private or | ||
employer-sponsored health insurance and timely access to | ||
healthcare services, but at no time shall the period described | ||
in subdivision (a)(3) be less than 6 months.
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(c) The Department, at its discretion, may take into | ||
account the affordability of dependent health insurance when | ||
determining whether employer-sponsored dependent health | ||
insurance coverage is available upon reemployment of a child's | ||
parent as provided in subdivision (a)(3). | ||
(d) A child who is determined to be eligible for the | ||
Program shall remain eligible for 12 months, provided that the | ||
child maintains his or her residence in this State, has not yet | ||
attained 19 years of age, and is not excluded under subsection | ||
(e). | ||
(e) A child is not eligible for coverage under the Program | ||
if: | ||
(1) the premium required under Section 40 has not been | ||
timely paid; if the required premiums are not paid, the | ||
liability of the Program shall be limited to benefits | ||
incurred under the Program for the time period for which | ||
premiums have been paid; if the required monthly premium is | ||
not paid, the child is ineligible for re-enrollment for a | ||
minimum period of 3 months; re-enrollment shall be | ||
completed before the next covered medical visit, and the | ||
first month's required premium shall be paid in advance of | ||
the next covered medical visit; or | ||
(2) the child is an inmate of a public institution or | ||
an institution for mental diseases.
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(f) The Department shall adopt eligibility rules, | ||
including, but not limited to: rules regarding annual renewals | ||
of eligibility for the Program; rules providing for | ||
re-enrollment, grace periods, notice requirements, and hearing | ||
procedures under subdivision (e)(1) of this Section; and rules | ||
regarding what constitutes availability and affordability of | ||
private or employer-sponsored health insurance, with | ||
consideration of such factors as the percentage of income | ||
needed to purchase children or family health insurance, the | ||
availability of employer subsidies, and other relevant | ||
factors. |
Section 25. Enrollment in Program. The Department shall | ||
develop procedures to allow application agents to assist in | ||
enrolling children in the Program or other children's health | ||
programs operated by the Department. At the Department's | ||
discretion, technical assistance payments may be made | ||
available for approved applications facilitated by an | ||
application agent. | ||
Section 30. Program outreach and marketing. The Department | ||
may provide grants to application agents and other | ||
community-based organizations to educate the public about the | ||
availability of the Program. The Department shall adopt rules | ||
regarding performance standards and outcomes measures expected | ||
of organizations that are awarded grants under this Section, | ||
including penalties for nonperformance of contract standards. | ||
Section 35. Health care benefits for children. | ||
(a) The Department shall purchase or provide health care | ||
benefits for eligible children that are identical to the | ||
benefits provided for children under the Illinois Children's | ||
Health Insurance Program Act, except for non-emergency | ||
transportation.
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(b) As an alternative to the benefits set forth in | ||
subsection (a), and when cost-effective, the Department may | ||
offer families subsidies toward the cost of privately sponsored | ||
health insurance, including employer-sponsored health | ||
insurance.
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(c) Notwithstanding clause (i) of subdivision (a)(3) of | ||
Section 20, the Department may consider offering, as an | ||
alternative to the benefits set forth in subsection (a), | ||
partial coverage to children who are enrolled in a | ||
high-deductible private health insurance plan.
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(d) Notwithstanding clause (i) of subdivision (a)(3) of | ||
Section 20, the Department may consider offering, as an | ||
alternative to the benefits set forth in subsection (a), a | ||
limited package of benefits to children in families who have |
private or employer-sponsored health insurance that does not | ||
cover certain benefits such as dental or vision benefits.
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(e) The content and availability of benefits described in | ||
subsections (b), (c), and (d), and the terms of eligibility for | ||
those benefits, shall be at the Department's discretion and the | ||
Department's determination of efficacy and cost-effectiveness | ||
as a means of promoting retention of private or | ||
employer-sponsored health insurance.
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Section 40. Cost-sharing. | ||
(a) Children enrolled in the Program under subsection (a) | ||
of Section 35 are subject to the following cost-sharing | ||
requirements:
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(1) The Department, by rule, shall set forth | ||
requirements concerning co-payments and coinsurance for | ||
health care services and monthly premiums. This | ||
cost-sharing shall be on a sliding scale based on family | ||
income. The Department may periodically modify such | ||
cost-sharing.
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(2) Notwithstanding paragraph (1), there shall be no | ||
co-payment required for well-baby or well-child health | ||
care, including, but not limited to, age-appropriate | ||
immunizations as required under State or federal law.
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(b) Children enrolled in a privately sponsored health | ||
insurance plan under subsection (b) of Section 35 are subject | ||
to the cost-sharing provisions stated in the privately | ||
sponsored health insurance plan.
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(c) Notwithstanding any other provision of law, rates paid | ||
by the Department shall not be used in any way to determine the | ||
usual and customary or reasonable charge, which is the charge | ||
for health care that is consistent with the average rate or | ||
charge for similar services furnished by similar providers in a | ||
certain geographic area. | ||
Section 45. Study. | ||
(a) The Department shall conduct a study that includes, but |
is not limited to, the following: | ||
(1) Establishing estimates, broken down by regions of | ||
the State, of the number of children with and without | ||
health insurance coverage; the number of children who are | ||
eligible for Medicaid or the Children's Health Insurance | ||
Program, and, of that number, the number who are enrolled | ||
in Medicaid or the Children's Health Insurance Program; and | ||
the number of children with access to dependent coverage | ||
through an employer, and, of that number, the number who | ||
are enrolled in dependent coverage through an employer. | ||
(2) Surveying those families whose children have | ||
access to employer-sponsored dependent coverage but who | ||
decline such coverage as to the reasons for declining | ||
coverage. | ||
(3) Ascertaining, for the population of children | ||
accessing employer-sponsored dependent coverage or who | ||
have access to such coverage, the comprehensiveness of | ||
dependent coverage available, the amount of cost-sharing | ||
currently paid by the employees, and the cost-sharing | ||
associated with such coverage. | ||
(4) Measuring the health outcomes or other benefits for | ||
children utilizing the Covering ALL KIDS Health Insurance | ||
Program and analyzing the effects on utilization of | ||
healthcare services for children after enrollment in the | ||
Program compared to the preceding period of uninsured | ||
status. | ||
(b) The studies described in subsection (a) shall be | ||
conducted in a manner that compares a time period preceding or | ||
at the initiation of the program with a later period. | ||
(c) The Department shall submit the preliminary results of | ||
the study to the Governor and the General Assembly no later | ||
than July 1, 2008 and shall submit the final results to the | ||
Governor and the General Assembly no later than July 1, 2010. | ||
Section 50. Consultation with stakeholders. The Department | ||
shall present details regarding implementation of the Program |
to the Medicaid Advisory Committee, and the Committee shall | ||
serve as the forum for healthcare providers, advocates, | ||
consumers, and other interested parties to advise the | ||
Department with respect to the Program. | ||
Section 55. Charge upon claims and causes of action; right | ||
of subrogation; recoveries. Sections 11-22, 11-22a, 11-22b, | ||
and 11-22c of the Illinois Public Aid Code apply to health care | ||
benefits provided to children under this Act, as provided in | ||
those Sections. | ||
Section 60. Federal financial participation. The | ||
Department shall request any necessary state plan amendments or | ||
waivers of federal requirements in order to allow receipt of | ||
federal funds for implementing any or all of the provisions of | ||
the Program. The failure of the responsible federal agency to | ||
approve a waiver or other State plan amendment shall not | ||
prevent the implementation of any provision of this Act. | ||
Section 65. Emergency rulemaking. The Department may adopt | ||
rules necessary to establish and implement this Act through the | ||
use of emergency rulemaking in accordance with Section 5-45 of | ||
the Illinois Administrative Procedure Act. For the purposes of | ||
that Act, the General Assembly finds that the adoption of rules | ||
to implement this Act is deemed an emergency and necessary for | ||
the public interest, safety, and welfare. This Section is | ||
repealed on July 1, 2008. | ||
Section 90. The Illinois Public Aid Code is amended by | ||
changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
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(305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
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Sec. 11-22. Charge upon claims and causes of action for | ||
injuries. The Illinois Department shall have a charge upon all | ||
claims, demands and
causes of action for injuries to an | ||
applicant for or recipient of (i)
financial aid under Articles |
III, IV, and V or (ii) health care benefits provided under the | ||
Covering ALL KIDS Health Insurance Act for the total
amount of
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medical assistance provided the recipient from the time of | ||
injury to the
date of recovery upon such claim, demand or cause | ||
of action. In addition, if
the applicant or recipient was | ||
employable, as defined by the Department, at
the time of the | ||
injury, the Department shall also have a charge upon any
such | ||
claims, demands and causes of action for the total amount of | ||
aid
provided to the recipient and his
dependents, including all | ||
cash assistance and medical assistance
only to the extent | ||
includable in the claimant's action, from the
time of injury to | ||
the date of recovery upon such
claim, demand or cause of | ||
action. Any definition of "employable"
adopted by the | ||
Department shall apply only to persons above the age of
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compulsory school attendance.
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If the injured person was employable at the time of the | ||
injury and is
provided aid under Articles III, IV, or V and any | ||
dependent or
member of his family is provided aid under Article | ||
VI, or vice versa,
both the Illinois Department and the local | ||
governmental unit shall have
a charge upon such claims, demands | ||
and causes of action for the aid
provided to the injured person | ||
and any
dependent member of his family, including all cash | ||
assistance, medical
assistance and food stamps, from the time | ||
of the injury to the date
of recovery.
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"Recipient", as used herein, means (i) in the case of | ||
financial aid provided under this Code, the grantee of record | ||
and any
persons whose needs are included in the financial aid | ||
provided to the
grantee of record or otherwise met by grants | ||
under the appropriate
Article of this Code for which such | ||
person is eligible and (ii) in the case of health care benefits | ||
provided under the Covering ALL KIDS Health Insurance Act, the | ||
child to whom those benefits are provided .
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In each case, the notice shall be served by certified mail | ||
or
registered mail, upon the party or parties against whom the | ||
applicant or
recipient has a claim, demand or cause of action. | ||
The notice shall
claim the charge and describe the interest the |
Illinois Department, the
local governmental unit, or the | ||
county, has in the claim, demand, or
cause of action. The | ||
charge shall attach to any verdict or judgment
entered and to | ||
any money or property which may be recovered on account
of such | ||
claim, demand, cause of action or suit from and after the time
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of the service of the notice.
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On petition filed by the Illinois Department, or by the | ||
local
governmental unit or county if either is claiming a | ||
charge, or by the
recipient, or by the defendant, the court, on | ||
written notice to all
interested parties, may adjudicate the | ||
rights of the parties and enforce
the charge. The court may | ||
approve the settlement of any claim, demand
or cause of action | ||
either before or after a verdict, and nothing in this
Section | ||
shall be construed as requiring the actual trial or final
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adjudication of any claim, demand or cause of action upon which | ||
the
Illinois Department, the local governmental unit or county | ||
has charge.
The court may determine what portion of the | ||
recovery shall be paid to
the injured person and what portion | ||
shall be paid to the Illinois
Department, the local | ||
governmental unit or county having a charge
against the | ||
recovery.
In making this determination, the court shall conduct | ||
an evidentiary hearing
and shall consider competent evidence | ||
pertaining
to the following matters:
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(1) the amount of the charge sought to be enforced | ||
against the recovery
when expressed as a percentage of the | ||
gross amount of the recovery; the
amount of the charge | ||
sought to be enforced against the recovery when expressed
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as a percentage of the amount obtained by subtracting from | ||
the gross amount
of the recovery the total attorney's fees | ||
and other costs incurred by the
recipient incident to the | ||
recovery; and whether the Department, unit of
local | ||
government or county seeking to enforce the charge against | ||
the recovery
should as a matter of fairness and equity bear | ||
its proportionate share of
the fees and costs incurred to | ||
generate the recovery from which the charge
is sought to be | ||
satisfied;
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(2) the amount, if any, of the attorney's fees and | ||
other costs incurred
by the recipient incident to the | ||
recovery and paid by the recipient up to the
time of | ||
recovery, and the amount of such fees and costs remaining | ||
unpaid
at the time of recovery;
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(3) the total hospital, doctor and other medical | ||
expenses incurred for
care and treatment of the injury to | ||
the date of recovery therefor, the portion
of such expenses | ||
theretofore paid by the recipient, by insurance provided
by | ||
the recipient, and by the Department, unit of local | ||
government and county
seeking to enforce a charge against | ||
the recovery, and the amount of such
previously incurred | ||
expenses which remain unpaid at the time of recovery
and by | ||
whom such incurred, unpaid expenses are to be paid;
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(4) whether the recovery represents less than | ||
substantially full
recompense
for the injury and the | ||
hospital, doctor and other medical expenses incurred
to the | ||
date of recovery for the care and treatment of the injury, | ||
so that
reduction of the charge sought to be enforced | ||
against the recovery would
not likely result in a double | ||
recovery or unjust enrichment to the recipient;
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(5) the age of the recipient and of persons dependent | ||
for support upon
the recipient, the nature and permanency | ||
of the recipient's injuries as
they affect not only the | ||
future employability and education of the recipient
but | ||
also the reasonably necessary and foreseeable future | ||
material, maintenance,
medical, rehabilitative and | ||
training needs of the recipient, the cost of
such | ||
reasonably necessary and foreseeable future needs, and the | ||
resources
available to meet such needs and pay such costs;
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(6) the realistic ability of the recipient to repay in | ||
whole or in part
the charge sought to be enforced against | ||
the recovery when judged in light
of the factors enumerated | ||
above.
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The burden of producing evidence sufficient to support the | ||
exercise by
the court of its discretion to reduce the amount of |
a proven charge sought
to be enforced against the recovery | ||
shall rest with the party seeking such reduction.
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The court may reduce and apportion the Illinois
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Department's lien proportionate to the recovery of the | ||
claimant. The court may
consider the nature and extent of the | ||
injury, economic and noneconomic
loss, settlement offers, | ||
comparative negligence as it applies to the case
at hand, | ||
hospital costs, physician costs, and all other appropriate | ||
costs.
The Illinois Department shall pay its pro rata share of | ||
the attorney fees
based on the Illinois Department's lien as it | ||
compares to the total
settlement agreed upon. This Section | ||
shall not affect the priority of an
attorney's lien under the | ||
Attorneys Lien Act. The charges of
the Illinois Department | ||
described in this Section, however, shall take
priority over | ||
all other liens and charges existing under the laws of the
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State of Illinois with the exception of the attorney's lien | ||
under said statute.
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Whenever the Department or any unit of local government
has | ||
a statutory charge under this Section against a recovery for | ||
damages
incurred by a recipient because of its advancement of | ||
any assistance, such
charge shall not be satisfied out of any | ||
recovery until the attorney's claim
for fees is satisfied, | ||
irrespective of whether or not an action based on
recipient's | ||
claim has been filed in court.
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This Section shall be inapplicable to any claim, demand or | ||
cause of
action arising under (a) the Workers' Compensation Act | ||
or the predecessor
Workers' Compensation Act
of
June 28, 1913, | ||
(b) the Workers' Occupational Diseases Act or the predecessor
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Workers' Occupational
Diseases Act of March 16, 1936; and (c) | ||
the Wrongful Death Act.
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(Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
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(305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
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Sec. 11-22a. Right of Subrogation. To the extent of the | ||
amount of (i) medical
assistance provided by the Department to | ||
or on behalf of a recipient under
Article V or VI or (ii) |
health care benefits provided for a child under the Covering | ||
ALL KIDS Health Insurance Act , the Department shall be
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subrogated
to any right of
recovery such recipient may have | ||
under the terms of any private or public
health care coverage | ||
or casualty coverage, including coverage under the
"Workers' | ||
Compensation Act", approved July 9, 1951, as amended, or the
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"Workers' Occupational Diseases Act", approved July 9, 1951, as | ||
amended,
without the necessity of assignment of claim or other | ||
authorization to secure
the right of recovery to the | ||
Department. To enforce its subrogation right, the
Department | ||
may (i) intervene or join in an action or proceeding brought by | ||
the
recipient, his or her guardian, personal representative, | ||
estate, dependents, or
survivors against any person or public | ||
or private entity that may be liable;
(ii) institute and | ||
prosecute legal proceedings against any person or public or
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private entity that may be liable for the cost of such | ||
services; or (iii)
institute and prosecute legal proceedings, | ||
to the extent necessary to reimburse
the Illinois Department | ||
for its costs, against any noncustodial parent who (A)
is | ||
required by court or administrative order to provide insurance | ||
or other
coverage of the cost of health care services for a | ||
child eligible for medical
assistance under this Code and (B) | ||
has received payment from a third party for
the costs of those | ||
services but has not used the payments to reimburse either
the | ||
other parent or the guardian of the child or the provider of | ||
the services.
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(Source: P.A. 92-111, eff. 1-1-02.)
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(305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
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Sec. 11-22b. Recoveries.
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(a) As used in this Section:
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(1) "Carrier" means any insurer, including any private | ||
company,
corporation, mutual association, trust fund, | ||
reciprocal or interinsurance
exchange authorized under the | ||
laws of this State to insure persons against
liability or | ||
injuries caused to another and any insurer providing
benefits |
under a policy of bodily injury liability insurance covering
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liability arising out of the ownership, maintenance or use of a | ||
motor
vehicle which provides uninsured motorist endorsement or | ||
coverage.
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(2) "Beneficiary" means any person or their dependents who | ||
has received
benefits or will be provided benefits under this | ||
Code or under the Covering ALL KIDS Health Insurance Act
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because of an injury for
which another person may be liable. It | ||
includes such beneficiary's guardian,
conservator or other | ||
personal representative, his estate or survivors.
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(b) (1) When benefits are provided or will be provided to a | ||
beneficiary
under this Code or under the Covering ALL KIDS | ||
Health Insurance Act because of an injury for which another | ||
person is liable, or
for which a carrier is liable in | ||
accordance with the provisions of any
policy of insurance | ||
issued pursuant to the Illinois Insurance Code, the
Illinois | ||
Department shall have a right to recover from such person or | ||
carrier
the reasonable value of benefits so provided. The | ||
Attorney General may, to
enforce such right, institute and | ||
prosecute legal proceedings against the
third person or carrier | ||
who may be liable for the injury in an appropriate
court, | ||
either in the name of the Illinois Department or in the name of | ||
the
injured person, his guardian, personal representative, | ||
estate, or survivors.
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(2) The Department may:
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(A) compromise or settle and release any such claim for | ||
benefits
provided under this Code, or
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(B) waive any such claims for benefits provided under | ||
this Code, in
whole or in part, for the convenience of the | ||
Department or if the Department
determines that collection | ||
would result in undue hardship upon the person who
suffered | ||
the injury or, in a wrongful death action, upon the heirs | ||
of the
deceased.
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(3) No action taken on behalf of the Department pursuant to | ||
this Section
or any judgment rendered in such action shall be a | ||
bar to any action upon
the claim or cause of action of the |
beneficiary, his guardian, conservator,
personal | ||
representative, estate, dependents or survivors against the | ||
third
person who may be liable for the injury, or shall operate | ||
to deny to the
beneficiary the recovery for that portion of any | ||
damages not covered hereunder.
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(c) (1) When an action is brought by the Department | ||
pursuant to
subsection (b), it shall be commenced within the | ||
period prescribed by
Article XIII of the Code of Civil | ||
Procedure.
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However, the Department may not commence the action prior | ||
to 5 months
before the end of the applicable period prescribed | ||
by Article XIII of the
Code of Civil Procedure. Thirty days | ||
prior to commencing an action, the
Department shall notify the | ||
beneficiary of the Department's intent to
commence such an | ||
action.
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(2) The death of the beneficiary does not abate any right | ||
of action
established by subsection (b).
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(3) When an action or claim is brought by persons entitled | ||
to bring such
actions or assert such claims against a third | ||
person who may be liable for
causing the death of a | ||
beneficiary, any settlement, judgment or award
obtained is | ||
subject to the Department's claim for reimbursement of the
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benefits provided to the beneficiary under this Code or under | ||
the Covering ALL KIDS Health Insurance Act .
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(4) When the action or claim is brought by the beneficiary | ||
alone and
the beneficiary incurs a personal liability to pay | ||
attorney's fees and
costs of litigation, the Department's claim | ||
for reimbursement of the
benefits provided to the beneficiary | ||
shall be the full amount of benefits
paid on behalf of the | ||
beneficiary under this Code or under the Covering ALL KIDS | ||
Health Insurance Act less a pro rata
share which represents the | ||
Department's reasonable share of attorney's fees
paid by the | ||
beneficiary and that portion of the cost of litigation expenses
| ||
determined by multiplying by the ratio of the full amount of | ||
the
expenditures of the full amount of the judgment, award or | ||
settlement.
|
(d) (1) If either the beneficiary or the Department brings | ||
an action or
claim against such third party or carrier, the | ||
beneficiary or the
Department shall within 30 days of filing | ||
the action give to the other
written notice by personal service | ||
or registered mail of the action or
claim and of the name of | ||
the court in which the
action or claim is brought. Proof of | ||
such notice shall be filed in such
action or claim. If an | ||
action or claim is brought by either the Department
or the | ||
beneficiary, the other may, at any time before trial on the | ||
facts,
become a party to such action or claim or shall | ||
consolidate his action or
claim with the other if brought | ||
independently.
| ||
(2) If an action or claim is brought by the Department | ||
pursuant to
subsection (b)(1), written notice to the | ||
beneficiary, guardian, personal
representative, estate or | ||
survivor given pursuant to this Section shall
advise him of his | ||
right to intervene in the proceeding, his right to obtain
a | ||
private attorney of his choice and the Department's right to | ||
recover the
reasonable value of the benefits provided.
| ||
(e) In the event of judgment or award in a suit or claim | ||
against such
third person or carrier:
| ||
(1) If the action or claim is prosecuted by the beneficiary | ||
alone, the
court shall first order paid from any judgment or | ||
award the
reasonable litigation expenses incurred in | ||
preparation and prosecution of
such action or claim, together | ||
with reasonable attorney's fees, when an
attorney has been | ||
retained. After payment of such expenses and attorney's
fees | ||
the court shall, on the application of the Department, allow
as | ||
a first lien against the amount of such judgment or award the | ||
amount of
the Department's expenditures for the benefit of the | ||
beneficiary under this
Code or under the Covering ALL KIDS | ||
Health Insurance Act , as provided in subsection (c)(4).
| ||
(2) If the action or claim is prosecuted both by the | ||
beneficiary and the
Department, the court shall first order | ||
paid from any judgment or
award the reasonable litigation | ||
expenses incurred in preparation and
prosecution of such action |
or claim, together with reasonable attorney's
fees for | ||
plaintiffs attorneys based solely on the services rendered for | ||
the
benefit of the beneficiary. After payment of such expenses | ||
and attorney's
fees, the court shall apply out of the balance | ||
of such judgment or award an
amount sufficient to reimburse the | ||
Department the full amount of benefits
paid on behalf of the | ||
beneficiary under this Code or under the Covering ALL KIDS | ||
Health Insurance Act .
| ||
(f) The court shall, upon further application at any time
| ||
before the judgment or award is satisfied, allow as a further | ||
lien the
amount of any expenditures of the Department in | ||
payment of additional
benefits arising out of the same cause of | ||
action or claim provided on
behalf of the beneficiary under | ||
this Code or under the Covering ALL KIDS Health Insurance Act , | ||
when such benefits were
provided or became payable subsequent | ||
to the original order.
| ||
(g) No judgment, award, or settlement in any action or | ||
claim by a
beneficiary to recover damages for injuries, when | ||
the Department has an
interest, shall be satisfied without | ||
first giving the Department notice and
a reasonable opportunity | ||
to perfect and satisfy its lien.
| ||
(h) When the Department has perfected a lien upon a | ||
judgment or award in
favor of a beneficiary against any third | ||
party for an injury for which the
beneficiary has received | ||
benefits under this Code or under the Covering ALL KIDS Health | ||
Insurance Act , the Department shall be
entitled to a writ of | ||
execution as lien claimant to enforce payment of said
lien | ||
against such third party with interest and other accruing costs | ||
as in
the case of other executions. In the event the amount of | ||
such judgment or
award so recovered has been paid to the | ||
beneficiary, the Department shall
be entitled to a writ of | ||
execution against such beneficiary to the extent of
the | ||
Department's lien, with interest and other accruing costs as in | ||
the case
of other executions.
| ||
(i) Except as otherwise provided in this Section, | ||
notwithstanding any
other provision of law, the entire amount |
of any settlement of the injured
beneficiary's action or claim, | ||
with or without suit, is subject to the
Department's claim for | ||
reimbursement of the benefits provided and any lien
filed | ||
pursuant thereto to the same extent and subject to the same
| ||
limitations as in Section 11-22 of this Code.
| ||
(Source: P.A. 92-651, eff. 7-11-02.)
| ||
(305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
| ||
Sec. 11-22c. (a) As used in this Section, "recipient" means | ||
any person
receiving financial assistance under Article IV or | ||
Article VI of this Code or receiving health care benefits under | ||
the Covering ALL KIDS Health Insurance Act .
| ||
(b) If a recipient maintains any suit, charge or other | ||
court or
administrative action against an employer seeking back | ||
pay for a period
during which the recipient received financial | ||
assistance under Article IV
or Article VI of this Code or | ||
health care benefits under the Covering ALL KIDS Health | ||
Insurance Act , the recipient shall report such fact to the
| ||
Department. To the extent of the amount of assistance provided | ||
to or on
behalf of the recipient under Article IV or Article VI | ||
or health care benefits provided under the Covering ALL KIDS | ||
Health Insurance Act , the Department may
by intervention or | ||
otherwise without the necessity of assignment of claim,
attach | ||
a lien on the recovery of back wages equal to the amount of
| ||
assistance provided by the Department to the recipient under | ||
Article IV or
Article VI or under the Covering ALL KIDS Health | ||
Insurance Act .
| ||
(Source: P.A. 86-497.)
| ||
Section 97. Severability. If any provision of this Act or | ||
its application to any person or circumstance is held invalid, | ||
the invalidity of that provision or application does not affect | ||
other provisions or applications of this Act that can be given | ||
effect without the invalid provision or application, and to | ||
this end the provisions of this Act are severable. |
Section 98. Repealer. This Act is repealed on July 1, | ||
2011.
| ||
Section 99. Effective date. This Act takes effect July 1, | ||
2006. |