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1 | AN ACT concerning military service.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The State Finance Act is amended by changing | |||||||||||||||||||||||||||||||||||||
5 | Section 6z-52 as follows:
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6 | (30 ILCS 105/6z-52)
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7 | Sec. 6z-52. Drug Rebate Fund.
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8 | (a) There is created in the State Treasury a special fund | |||||||||||||||||||||||||||||||||||||
9 | to be known as
the Drug Rebate Fund.
| |||||||||||||||||||||||||||||||||||||
10 | (b) The Fund is created for the purpose of receiving and | |||||||||||||||||||||||||||||||||||||
11 | disbursing moneys
in accordance with this Section. | |||||||||||||||||||||||||||||||||||||
12 | Disbursements from the Fund shall be made,
subject to | |||||||||||||||||||||||||||||||||||||
13 | appropriation, only as follows:
| |||||||||||||||||||||||||||||||||||||
14 | (1) For payments for reimbursement or coverage for | |||||||||||||||||||||||||||||||||||||
15 | prescription drugs and other pharmacy products
provided to | |||||||||||||||||||||||||||||||||||||
16 | a recipient of medical assistance under the Illinois Public | |||||||||||||||||||||||||||||||||||||
17 | Aid Code, the Children's Health Insurance Program Act, the | |||||||||||||||||||||||||||||||||||||
18 | Covering ALL KIDS Health Insurance Act, and the Veterans' | |||||||||||||||||||||||||||||||||||||
19 | Supplemental Health Insurance Program Act of 2008.
| |||||||||||||||||||||||||||||||||||||
20 | (2) For reimbursement of moneys collected by the | |||||||||||||||||||||||||||||||||||||
21 | Department of Healthcare and Family Services (formerly
| |||||||||||||||||||||||||||||||||||||
22 | Illinois Department of
Public Aid) through error or | |||||||||||||||||||||||||||||||||||||
23 | mistake.
|
| |||||||
| |||||||
1 | (3) For payments of any amounts that are reimbursable | ||||||
2 | to the federal
government resulting from a payment into | ||||||
3 | this Fund.
| ||||||
4 | (4) For payments of operational and administrative | ||||||
5 | expenses related to providing and managing coverage for | ||||||
6 | prescription drugs and other pharmacy products provided to | ||||||
7 | a recipient of medical assistance under the Illinois Public | ||||||
8 | Aid Code, the Children's Health Insurance Program Act, the | ||||||
9 | Covering ALL KIDS Health Insurance Act, the Veterans' | ||||||
10 | Supplemental Health Insurance Program Act of 2008, and the | ||||||
11 | Senior Citizens and Disabled Persons Property Tax Relief | ||||||
12 | and Pharmaceutical Assistance Act. | ||||||
13 | (c) The Fund shall consist of the following:
| ||||||
14 | (1) Upon notification from the Director of Healthcare | ||||||
15 | and Family Services, the Comptroller
shall direct and the | ||||||
16 | Treasurer shall transfer the net State share (disregarding | ||||||
17 | the reduction in net State share attributable to the | ||||||
18 | American Recovery and Reinvestment Act of 2009 or any other | ||||||
19 | federal economic stimulus program) of all moneys
received | ||||||
20 | by the Department of Healthcare and Family Services | ||||||
21 | (formerly Illinois Department of Public Aid) from drug | ||||||
22 | rebate agreements
with pharmaceutical manufacturers | ||||||
23 | pursuant to Title XIX of the federal Social
Security Act, | ||||||
24 | including any portion of the balance in the Public Aid | ||||||
25 | Recoveries
Trust Fund on July 1, 2001 that is attributable | ||||||
26 | to such receipts.
|
| |||||||
| |||||||
1 | (2) All federal matching funds received by the Illinois | ||||||
2 | Department as a
result of expenditures made by the | ||||||
3 | Department that are attributable to moneys
deposited in the | ||||||
4 | Fund.
| ||||||
5 | (3) Any premium collected by the Illinois Department | ||||||
6 | from participants
under a waiver approved by the federal | ||||||
7 | government relating to provision of
pharmaceutical | ||||||
8 | services.
| ||||||
9 | (4) All other moneys received for the Fund from any | ||||||
10 | other source,
including interest earned thereon.
| ||||||
11 | (Source: P.A. 96-8, eff. 4-28-09; 96-1100, eff. 1-1-11; 97-689, | ||||||
12 | eff. 7-1-12.)
| ||||||
13 | Section 10. The Illinois Public Aid Code is amended by | ||||||
14 | changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
| ||||||
15 | (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
| ||||||
16 | Sec. 11-22. Charge upon claims and causes of action for | ||||||
17 | injuries. The Illinois Department shall have a charge upon all | ||||||
18 | claims, demands and
causes of action for injuries to an | ||||||
19 | applicant for or recipient of (i)
financial aid under Articles | ||||||
20 | III, IV, and V, (ii) health care benefits provided under the | ||||||
21 | Covering ALL KIDS Health Insurance Act, or (iii) health care | ||||||
22 | benefits provided under the Veterans' Health Insurance Program | ||||||
23 | Act or the Veterans' Supplemental Health Insurance Program Act | ||||||
24 | of 2008 for the total
amount of
medical assistance provided the |
| |||||||
| |||||||
1 | recipient from the time of injury to the
date of recovery upon | ||||||
2 | such claim, demand or cause of action. In addition, if
the | ||||||
3 | applicant or recipient was employable, as defined by the | ||||||
4 | Department, at
the time of the injury, the Department shall | ||||||
5 | also have a charge upon any
such claims, demands and causes of | ||||||
6 | action for the total amount of aid
provided to the recipient | ||||||
7 | and his
dependents, including all cash assistance and medical | ||||||
8 | assistance
only to the extent includable in the claimant's | ||||||
9 | action, from the
time of injury to the date of recovery upon | ||||||
10 | such
claim, demand or cause of action. Any definition of | ||||||
11 | "employable"
adopted by the Department shall apply only to | ||||||
12 | persons above the age of
compulsory school attendance.
| ||||||
13 | If the injured person was employable at the time of the | ||||||
14 | injury and is
provided aid under Articles III, IV, or V and any | ||||||
15 | dependent or
member of his family is provided aid under Article | ||||||
16 | VI, or vice versa,
both the Illinois Department and the local | ||||||
17 | governmental unit shall have
a charge upon such claims, demands | ||||||
18 | and causes of action for the aid
provided to the injured person | ||||||
19 | and any
dependent member of his family, including all cash | ||||||
20 | assistance, medical
assistance and food stamps, from the time | ||||||
21 | of the injury to the date
of recovery.
| ||||||
22 | "Recipient", as used herein, means (i) in the case of | ||||||
23 | financial aid provided under this Code, the grantee of record | ||||||
24 | and any
persons whose needs are included in the financial aid | ||||||
25 | provided to the
grantee of record or otherwise met by grants | ||||||
26 | under the appropriate
Article of this Code for which such |
| |||||||
| |||||||
1 | person is eligible, (ii) in the case of health care benefits | ||||||
2 | provided under the Covering ALL KIDS Health Insurance Act, the | ||||||
3 | child to whom those benefits are provided, and (iii) in the | ||||||
4 | case of health care benefits provided under the Veterans' | ||||||
5 | Health Insurance Program Act or the Veterans' Supplemental | ||||||
6 | Health Insurance Program Act of 2008, the veteran to whom | ||||||
7 | benefits are provided.
| ||||||
8 | In each case, the notice shall be served by certified mail | ||||||
9 | or
registered mail, or by facsimile or electronic messaging | ||||||
10 | when requested by the party or parties against whom the | ||||||
11 | applicant or recipient has a claim, demand, or cause of action, | ||||||
12 | upon the party or parties against whom the applicant or
| ||||||
13 | recipient has a claim, demand or cause of action. The notice | ||||||
14 | shall
claim the charge and describe the interest the Illinois | ||||||
15 | Department, the
local governmental unit, or the county, has in | ||||||
16 | the claim, demand, or
cause of action. The charge shall attach | ||||||
17 | to any verdict or judgment
entered and to any money or property | ||||||
18 | which may be recovered on account
of such claim, demand, cause | ||||||
19 | of action or suit from and after the time
of the service of the | ||||||
20 | notice.
| ||||||
21 | On petition filed by the Illinois Department, or by the | ||||||
22 | local
governmental unit or county if either is claiming a | ||||||
23 | charge, or by the
recipient, or by the defendant, the court, on | ||||||
24 | written notice to all
interested parties, may adjudicate the | ||||||
25 | rights of the parties and enforce
the charge. The court may | ||||||
26 | approve the settlement of any claim, demand
or cause of action |
| |||||||
| |||||||
1 | either before or after a verdict, and nothing in this
Section | ||||||
2 | shall be construed as requiring the actual trial or final
| ||||||
3 | adjudication of any claim, demand or cause of action upon which | ||||||
4 | the
Illinois Department, the local governmental unit or county | ||||||
5 | has charge.
The court may determine what portion of the | ||||||
6 | recovery shall be paid to
the injured person and what portion | ||||||
7 | shall be paid to the Illinois
Department, the local | ||||||
8 | governmental unit or county having a charge
against the | ||||||
9 | recovery.
In making this determination, the court shall conduct | ||||||
10 | an evidentiary hearing
and shall consider competent evidence | ||||||
11 | pertaining
to the following matters:
| ||||||
12 | (1) the amount of the charge sought to be enforced | ||||||
13 | against the recovery
when expressed as a percentage of the | ||||||
14 | gross amount of the recovery; the
amount of the charge | ||||||
15 | sought to be enforced against the recovery when expressed
| ||||||
16 | as a percentage of the amount obtained by subtracting from | ||||||
17 | the gross amount
of the recovery the total attorney's fees | ||||||
18 | and other costs incurred by the
recipient incident to the | ||||||
19 | recovery; and whether the Department, unit of
local | ||||||
20 | government or county seeking to enforce the charge against | ||||||
21 | the recovery
should as a matter of fairness and equity bear | ||||||
22 | its proportionate share of
the fees and costs incurred to | ||||||
23 | generate the recovery from which the charge
is sought to be | ||||||
24 | satisfied;
| ||||||
25 | (2) the amount, if any, of the attorney's fees and | ||||||
26 | other costs incurred
by the recipient incident to the |
| |||||||
| |||||||
1 | recovery and paid by the recipient up to the
time of | ||||||
2 | recovery, and the amount of such fees and costs remaining | ||||||
3 | unpaid
at the time of recovery;
| ||||||
4 | (3) the total hospital, doctor and other medical | ||||||
5 | expenses incurred for
care and treatment of the injury to | ||||||
6 | the date of recovery therefor, the portion
of such expenses | ||||||
7 | theretofore paid by the recipient, by insurance provided
by | ||||||
8 | the recipient, and by the Department, unit of local | ||||||
9 | government and county
seeking to enforce a charge against | ||||||
10 | the recovery, and the amount of such
previously incurred | ||||||
11 | expenses which remain unpaid at the time of recovery
and by | ||||||
12 | whom such incurred, unpaid expenses are to be paid;
| ||||||
13 | (4) whether the recovery represents less than | ||||||
14 | substantially full
recompense
for the injury and the | ||||||
15 | hospital, doctor and other medical expenses incurred
to the | ||||||
16 | date of recovery for the care and treatment of the injury, | ||||||
17 | so that
reduction of the charge sought to be enforced | ||||||
18 | against the recovery would
not likely result in a double | ||||||
19 | recovery or unjust enrichment to the recipient;
| ||||||
20 | (5) the age of the recipient and of persons dependent | ||||||
21 | for support upon
the recipient, the nature and permanency | ||||||
22 | of the recipient's injuries as
they affect not only the | ||||||
23 | future employability and education of the recipient
but | ||||||
24 | also the reasonably necessary and foreseeable future | ||||||
25 | material, maintenance,
medical, rehabilitative and | ||||||
26 | training needs of the recipient, the cost of
such |
| |||||||
| |||||||
1 | reasonably necessary and foreseeable future needs, and the | ||||||
2 | resources
available to meet such needs and pay such costs;
| ||||||
3 | (6) the realistic ability of the recipient to repay in | ||||||
4 | whole or in part
the charge sought to be enforced against | ||||||
5 | the recovery when judged in light
of the factors enumerated | ||||||
6 | above.
| ||||||
7 | The burden of producing evidence sufficient to support the | ||||||
8 | exercise by
the court of its discretion to reduce the amount of | ||||||
9 | a proven charge sought
to be enforced against the recovery | ||||||
10 | shall rest with the party seeking such reduction.
| ||||||
11 | The court may reduce and apportion the Illinois
| ||||||
12 | Department's lien proportionate to the recovery of the | ||||||
13 | claimant. The court may
consider the nature and extent of the | ||||||
14 | injury, economic and noneconomic
loss, settlement offers, | ||||||
15 | comparative negligence as it applies to the case
at hand, | ||||||
16 | hospital costs, physician costs, and all other appropriate | ||||||
17 | costs.
The Illinois Department shall pay its pro rata share of | ||||||
18 | the attorney fees
based on the Illinois Department's lien as it | ||||||
19 | compares to the total
settlement agreed upon. This Section | ||||||
20 | shall not affect the priority of an
attorney's lien under the | ||||||
21 | Attorneys Lien Act. The charges of
the Illinois Department | ||||||
22 | described in this Section, however, shall take
priority over | ||||||
23 | all other liens and charges existing under the laws of the
| ||||||
24 | State of Illinois with the exception of the attorney's lien | ||||||
25 | under said statute.
| ||||||
26 | Whenever the Department or any unit of local government
has |
| |||||||
| |||||||
1 | a statutory charge under this Section against a recovery for | ||||||
2 | damages
incurred by a recipient because of its advancement of | ||||||
3 | any assistance, such
charge shall not be satisfied out of any | ||||||
4 | recovery until the attorney's claim
for fees is satisfied, | ||||||
5 | irrespective of whether or not an action based on
recipient's | ||||||
6 | claim has been filed in court.
| ||||||
7 | This Section shall be inapplicable to any claim, demand or | ||||||
8 | cause of
action arising under (a) the Workers' Compensation Act | ||||||
9 | or the predecessor
Workers' Compensation Act
of
June 28, 1913, | ||||||
10 | (b) the Workers' Occupational Diseases Act or the predecessor
| ||||||
11 | Workers' Occupational
Diseases Act of March 16, 1936; and (c) | ||||||
12 | the Wrongful Death Act.
| ||||||
13 | (Source: P.A. 98-73, eff. 7-15-13.)
| ||||||
14 | (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
| ||||||
15 | Sec. 11-22a. Right of Subrogation. To the extent of the | ||||||
16 | amount of (i) medical
assistance provided by the Department to | ||||||
17 | or on behalf of a recipient under
Article V or VI, (ii) health | ||||||
18 | care benefits provided for a child under the Covering ALL KIDS | ||||||
19 | Health Insurance Act, or (iii) health care benefits provided to | ||||||
20 | a veteran under the Veterans' Health Insurance Program Act or | ||||||
21 | the Veterans' Supplemental Health Insurance Program Act of | ||||||
22 | 2008, the Department shall be
subrogated
to any right of
| ||||||
23 | recovery such recipient may have under the terms of any private | ||||||
24 | or public
health care coverage or casualty coverage, including | ||||||
25 | coverage under the
"Workers' Compensation Act", approved July |
| |||||||
| |||||||
1 | 9, 1951, as amended, or the
"Workers' Occupational Diseases | ||||||
2 | Act", approved July 9, 1951, as amended,
without the necessity | ||||||
3 | of assignment of claim or other authorization to secure
the | ||||||
4 | right of recovery to the Department. To enforce its subrogation | ||||||
5 | right, the
Department may (i) intervene or join in an action or | ||||||
6 | proceeding brought by the
recipient, his or her guardian, | ||||||
7 | personal representative, estate, dependents, or
survivors | ||||||
8 | against any person or public or private entity that may be | ||||||
9 | liable;
(ii) institute and prosecute legal proceedings against | ||||||
10 | any person or public or
private entity that may be liable for | ||||||
11 | the cost of such services; or (iii)
institute and prosecute | ||||||
12 | legal proceedings, to the extent necessary to reimburse
the | ||||||
13 | Illinois Department for its costs, against any noncustodial | ||||||
14 | parent who (A)
is required by court or administrative order to | ||||||
15 | provide insurance or other
coverage of the cost of health care | ||||||
16 | services for a child eligible for medical
assistance under this | ||||||
17 | Code and (B) has received payment from a third party for
the | ||||||
18 | costs of those services but has not used the payments to | ||||||
19 | reimburse either
the other parent or the guardian of the child | ||||||
20 | or the provider of the services.
| ||||||
21 | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | ||||||
22 | 95-755, eff. 7-25-08.)
| ||||||
23 | (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
| ||||||
24 | Sec. 11-22b. Recoveries.
| ||||||
25 | (a) As used in this Section:
|
| |||||||
| |||||||
1 | (1) "Carrier" means any insurer, including any private | ||||||
2 | company,
corporation, mutual association, trust fund, | ||||||
3 | reciprocal or interinsurance
exchange authorized under the | ||||||
4 | laws of this State to insure persons against
liability or | ||||||
5 | injuries caused to another and any insurer providing
| ||||||
6 | benefits under a policy of bodily injury liability | ||||||
7 | insurance covering
liability arising out of the ownership, | ||||||
8 | maintenance or use of a motor
vehicle which provides | ||||||
9 | uninsured motorist endorsement or coverage.
| ||||||
10 | (2) "Beneficiary" means any person or their dependents | ||||||
11 | who has received
benefits or will be provided benefits | ||||||
12 | under this Code, under the Covering ALL KIDS Health | ||||||
13 | Insurance Act, or under the Veterans' Health Insurance | ||||||
14 | Program Act or the Veterans' Supplemental Health Insurance | ||||||
15 | Program Act of 2008
because of an injury for
which another | ||||||
16 | person may be liable. It includes such beneficiary's | ||||||
17 | guardian,
conservator or other personal representative, | ||||||
18 | his estate or survivors.
| ||||||
19 | (b)(1) When benefits are provided or will be provided to a | ||||||
20 | beneficiary
under this Code, under the Covering ALL KIDS Health | ||||||
21 | Insurance Act, or under the Veterans' Health Insurance Program | ||||||
22 | Act or the Veterans' Supplemental Health Insurance Program Act | ||||||
23 | of 2008 because of an injury for which another person is | ||||||
24 | liable, or
for which a carrier is liable in accordance with the | ||||||
25 | provisions of any
policy of insurance issued pursuant to the | ||||||
26 | Illinois Insurance Code, the
Illinois Department shall have a |
| |||||||
| |||||||
1 | right to recover from such person or carrier
the reasonable | ||||||
2 | value of benefits so provided. The Attorney General may, to
| ||||||
3 | enforce such right, institute and prosecute legal proceedings | ||||||
4 | against the
third person or carrier who may be liable for the | ||||||
5 | injury in an appropriate
court, either in the name of the | ||||||
6 | Illinois Department or in the name of the
injured person, his | ||||||
7 | guardian, personal representative, estate, or survivors.
| ||||||
8 | (2) The Department may:
| ||||||
9 | (A) compromise or settle and release any such claim for | ||||||
10 | benefits
provided under this Code, or
| ||||||
11 | (B) waive any such claims for benefits provided under | ||||||
12 | this Code, in
whole or in part, for the convenience of the | ||||||
13 | Department or if the Department
determines that collection | ||||||
14 | would result in undue hardship upon the person who
suffered | ||||||
15 | the injury or, in a wrongful death action, upon the heirs | ||||||
16 | of the
deceased.
| ||||||
17 | (3) No action taken on behalf of the Department pursuant to | ||||||
18 | this Section
or any judgment rendered in such action shall be a | ||||||
19 | bar to any action upon
the claim or cause of action of the | ||||||
20 | beneficiary, his guardian, conservator,
personal | ||||||
21 | representative, estate, dependents or survivors against the | ||||||
22 | third
person who may be liable for the injury, or shall operate | ||||||
23 | to deny to the
beneficiary the recovery for that portion of any | ||||||
24 | damages not covered hereunder.
| ||||||
25 | (c)(1) When an action is brought by the Department pursuant | ||||||
26 | to
subsection (b), it shall be commenced within the period |
| |||||||
| |||||||
1 | prescribed by
Article XIII of the Code of Civil Procedure.
| ||||||
2 | However, the Department may not commence the action prior | ||||||
3 | to 5 months
before the end of the applicable period prescribed | ||||||
4 | by Article XIII of the
Code of Civil Procedure. Thirty days | ||||||
5 | prior to commencing an action, the
Department shall notify the | ||||||
6 | beneficiary of the Department's intent to
commence such an | ||||||
7 | action.
| ||||||
8 | (2) The death of the beneficiary does not abate any right | ||||||
9 | of action
established by subsection (b).
| ||||||
10 | (3) When an action or claim is brought by persons entitled | ||||||
11 | to bring such
actions or assert such claims against a third | ||||||
12 | person who may be liable for
causing the death of a | ||||||
13 | beneficiary, any settlement, judgment or award
obtained is | ||||||
14 | subject to the Department's claim for reimbursement of the
| ||||||
15 | benefits provided to the beneficiary under this Code, under the | ||||||
16 | Covering ALL KIDS Health Insurance Act, or under the Veterans' | ||||||
17 | Health Insurance Program Act or the Veterans' Supplemental | ||||||
18 | Health Insurance Program Act of 2008.
| ||||||
19 | (4) When the action or claim is brought by the beneficiary | ||||||
20 | alone and
the beneficiary incurs a personal liability to pay | ||||||
21 | attorney's fees and
costs of litigation, the Department's claim | ||||||
22 | for reimbursement of the
benefits provided to the beneficiary | ||||||
23 | shall be the full amount of benefits
paid on behalf of the | ||||||
24 | beneficiary under this Code, under the Covering ALL KIDS Health | ||||||
25 | Insurance Act, or under the Veterans' Health Insurance Program | ||||||
26 | Act or the Veterans' Supplemental Health Insurance Program Act |
| |||||||
| |||||||
1 | of 2008 less a pro rata
share which represents the Department's | ||||||
2 | reasonable share of attorney's fees
paid by the beneficiary and | ||||||
3 | that portion of the cost of litigation expenses
determined by | ||||||
4 | multiplying by the ratio of the full amount of the
expenditures | ||||||
5 | of the full amount of the judgment, award or settlement.
| ||||||
6 | (d)(1) If either the beneficiary or the Department brings | ||||||
7 | an action or
claim against such third party or carrier, the | ||||||
8 | beneficiary or the
Department shall within 30 days of filing | ||||||
9 | the action give to the other
written notice by personal service | ||||||
10 | or registered mail of the action or
claim and of the name of | ||||||
11 | the court in which the
action or claim is brought. Proof of | ||||||
12 | such notice shall be filed in such
action or claim. If an | ||||||
13 | action or claim is brought by either the Department
or the | ||||||
14 | beneficiary, the other may, at any time before trial on the | ||||||
15 | facts,
become a party to such action or claim or shall | ||||||
16 | consolidate his action or
claim with the other if brought | ||||||
17 | independently.
| ||||||
18 | (2) If an action or claim is brought by the Department | ||||||
19 | pursuant to
subsection (b)(1), written notice to the | ||||||
20 | beneficiary, guardian, personal
representative, estate or | ||||||
21 | survivor given pursuant to this Section shall
advise him of his | ||||||
22 | right to intervene in the proceeding, his right to obtain
a | ||||||
23 | private attorney of his choice and the Department's right to | ||||||
24 | recover the
reasonable value of the benefits provided.
| ||||||
25 | (e) In the event of judgment or award in a suit or claim | ||||||
26 | against such
third person or carrier:
|
| |||||||
| |||||||
1 | (1) If the action or claim is prosecuted by the | ||||||
2 | beneficiary alone, the
court shall first order paid from | ||||||
3 | any judgment or award the
reasonable litigation expenses | ||||||
4 | incurred in preparation and prosecution of
such action or | ||||||
5 | claim, together with reasonable attorney's fees, when an
| ||||||
6 | attorney has been retained. After payment of such expenses | ||||||
7 | and attorney's
fees the court shall, on the application of | ||||||
8 | the Department, allow
as a first lien against the amount of | ||||||
9 | such judgment or award the amount of
the Department's | ||||||
10 | expenditures for the benefit of the beneficiary under this
| ||||||
11 | Code, under the Covering ALL KIDS Health Insurance Act, or | ||||||
12 | under the Veterans' Health Insurance Program Act or the | ||||||
13 | Veterans' Supplemental Health Insurance Program Act of | ||||||
14 | 2008, as provided in subsection (c)(4).
| ||||||
15 | (2) If the action or claim is prosecuted both by the | ||||||
16 | beneficiary and the
Department, the court shall first order | ||||||
17 | paid from any judgment or
award the reasonable litigation | ||||||
18 | expenses incurred in preparation and
prosecution of such | ||||||
19 | action or claim, together with reasonable attorney's
fees | ||||||
20 | for plaintiffs attorneys based solely on the services | ||||||
21 | rendered for the
benefit of the beneficiary. After payment | ||||||
22 | of such expenses and attorney's
fees, the court shall apply | ||||||
23 | out of the balance of such judgment or award an
amount | ||||||
24 | sufficient to reimburse the Department the full amount of | ||||||
25 | benefits
paid on behalf of the beneficiary under this Code, | ||||||
26 | under the Covering ALL KIDS Health Insurance Act, or under |
| |||||||
| |||||||
1 | the Veterans' Health Insurance Program Act or the Veterans' | ||||||
2 | Supplemental Health Insurance Program Act of 2008.
| ||||||
3 | (f) The court shall, upon further application at any time
| ||||||
4 | before the judgment or award is satisfied, allow as a further | ||||||
5 | lien the
amount of any expenditures of the Department in | ||||||
6 | payment of additional
benefits arising out of the same cause of | ||||||
7 | action or claim provided on
behalf of the beneficiary under | ||||||
8 | this Code, under the Covering ALL KIDS Health Insurance Act, or | ||||||
9 | under the Veterans' Health Insurance Program Act or the | ||||||
10 | Veterans' Supplemental Health Insurance Program Act of 2008, | ||||||
11 | when such benefits were
provided or became payable subsequent | ||||||
12 | to the original order.
| ||||||
13 | (g) No judgment, award, or settlement in any action or | ||||||
14 | claim by a
beneficiary to recover damages for injuries, when | ||||||
15 | the Department has an
interest, shall be satisfied without | ||||||
16 | first giving the Department notice and
a reasonable opportunity | ||||||
17 | to perfect and satisfy its lien.
| ||||||
18 | (h) When the Department has perfected a lien upon a | ||||||
19 | judgment or award in
favor of a beneficiary against any third | ||||||
20 | party for an injury for which the
beneficiary has received | ||||||
21 | benefits under this Code, under the Covering ALL KIDS Health | ||||||
22 | Insurance Act, or under the Veterans' Health Insurance Program | ||||||
23 | Act or the Veterans' Supplemental Health Insurance Program Act | ||||||
24 | of 2008, the Department shall be
entitled to a writ of | ||||||
25 | execution as lien claimant to enforce payment of said
lien | ||||||
26 | against such third party with interest and other accruing costs |
| |||||||
| |||||||
1 | as in
the case of other executions. In the event the amount of | ||||||
2 | such judgment or
award so recovered has been paid to the | ||||||
3 | beneficiary, the Department shall
be entitled to a writ of | ||||||
4 | execution against such beneficiary to the extent of
the | ||||||
5 | Department's lien, with interest and other accruing costs as in | ||||||
6 | the case
of other executions.
| ||||||
7 | (i) Except as otherwise provided in this Section, | ||||||
8 | notwithstanding any
other provision of law, the entire amount | ||||||
9 | of any settlement of the injured
beneficiary's action or claim, | ||||||
10 | with or without suit, is subject to the
Department's claim for | ||||||
11 | reimbursement of the benefits provided and any lien
filed | ||||||
12 | pursuant thereto to the same extent and subject to the same
| ||||||
13 | limitations as in Section 11-22 of this Code.
| ||||||
14 | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | ||||||
15 | 95-755, eff. 7-25-08.)
| ||||||
16 | (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
| ||||||
17 | Sec. 11-22c. Recovery of back wages. | ||||||
18 | (a) As used in this Section, "recipient" means any person
| ||||||
19 | receiving financial assistance under Article IV or Article VI | ||||||
20 | of this Code, receiving health care benefits under the Covering | ||||||
21 | ALL KIDS Health Insurance Act, or receiving health care | ||||||
22 | benefits under the Veterans' Health Insurance Program Act or | ||||||
23 | the Veterans' Supplemental Health Insurance Program Act of | ||||||
24 | 2008.
| ||||||
25 | (b) If a recipient maintains any suit, charge or other |
| |||||||
| |||||||
1 | court or
administrative action against an employer seeking back | ||||||
2 | pay for a period
during which the recipient received financial | ||||||
3 | assistance under Article IV
or Article VI of this Code, health | ||||||
4 | care benefits under the Covering ALL KIDS Health Insurance Act, | ||||||
5 | or health care benefits under the Veterans' Health Insurance | ||||||
6 | Program Act or the Veterans' Supplemental Health Insurance | ||||||
7 | Program Act of 2008, the recipient shall report such fact to | ||||||
8 | the
Department. To the extent of the amount of assistance | ||||||
9 | provided to or on
behalf of the recipient under Article IV or | ||||||
10 | Article VI, health care benefits provided under the Covering | ||||||
11 | ALL KIDS Health Insurance Act, or health care benefits provided | ||||||
12 | under the Veterans' Health Insurance Program Act or the | ||||||
13 | Veterans' Supplemental Health Insurance Program Act of 2008, | ||||||
14 | the Department may
by intervention or otherwise without the | ||||||
15 | necessity of assignment of claim,
attach a lien on the recovery | ||||||
16 | of back wages equal to the amount of
assistance provided by the | ||||||
17 | Department to the recipient under Article IV or
Article VI, | ||||||
18 | under the Covering ALL KIDS Health Insurance Act, or under the | ||||||
19 | Veterans' Health Insurance Program Act or the Veterans' | ||||||
20 | Supplemental Health Insurance Program Act of 2008.
| ||||||
21 | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | ||||||
22 | 95-755, eff. 7-25-08.)
| ||||||
23 | Section 15. The Veterans' Health Insurance Program Act of | ||||||
24 | 2008 is amended by changing Sections 1, 3, 5, 10, and 15 as | ||||||
25 | follows: |
| |||||||
| |||||||
1 | (330 ILCS 126/1)
| ||||||
2 | Sec. 1. Short title. This Act may be cited as the Veterans' | ||||||
3 | Supplemental Health Insurance Program Act of 2008.
| ||||||
4 | (Source: P.A. 95-755, eff. 7-25-08 .) | ||||||
5 | (330 ILCS 126/3)
| ||||||
6 | Sec. 3. Legislative intent. The General Assembly finds that | ||||||
7 | 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 medical and dental preventative care, | ||||||
12 | often exacerbates health conditions. The effects of lack of | ||||||
13 | insurance negatively impact those residents of the State who | ||||||
14 | are insured because the cost of paying for care to the | ||||||
15 | uninsured is often shifted to those who have insurance in the | ||||||
16 | form of higher health insurance premiums. It is, therefore, the | ||||||
17 | intent of this legislation to provide access to affordable | ||||||
18 | health and dental insurance for veterans and their spouses | ||||||
19 | residing in Illinois who are unable to afford such coverage. | ||||||
20 | However, the State has only a limited amount of resources, and | ||||||
21 | the General Assembly therefore declares that while it intends | ||||||
22 | to cover as many such veterans and spouses as possible, the | ||||||
23 | State may not be able to cover every eligible person who | ||||||
24 | qualifies for this Program as a matter of entitlement due to |
| |||||||
| |||||||
1 | limited funding.
| ||||||
2 | (Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09 .) | ||||||
3 | (330 ILCS 126/5)
| ||||||
4 | Sec. 5. Definitions. The following words have the following | ||||||
5 | meanings: | ||||||
6 | "Department" means the Department of Healthcare and Family | ||||||
7 | Services, or any successor agency. | ||||||
8 | "Director" means the Director of Healthcare and Family | ||||||
9 | Services, or any successor agency. | ||||||
10 | "Medical assistance" means health care benefits provided | ||||||
11 | under Article V of the Illinois Public Aid Code. | ||||||
12 | "Program" means the Veterans' Supplemental Health | ||||||
13 | Insurance Program. | ||||||
14 | "Resident" means an individual who has an Illinois | ||||||
15 | residence, as provided in Section 5-3 of the Illinois Public | ||||||
16 | Aid Code. | ||||||
17 | "Spouse" means the person who is the person who, under the | ||||||
18 | laws of the State of Illinois, is married to an eligible | ||||||
19 | veteran at the time of application and subsequent | ||||||
20 | re-determinations for the Program and includes enrolled | ||||||
21 | spouses surviving the death of veteran spouses. | ||||||
22 | "Veteran" means any person who has served in a branch of | ||||||
23 | the United States military for greater than 180 days after | ||||||
24 | initial training. | ||||||
25 | "Veterans Affairs" or "VA" means the United States |
| |||||||
| |||||||
1 | Department of Veterans Affairs.
| ||||||
2 | (Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09; | ||||||
3 | 96-1000, eff. 7-2-10 .) | ||||||
4 | (330 ILCS 126/10)
| ||||||
5 | Sec. 10. Operation of the Program. | ||||||
6 | (a) The Veterans' Supplemental Health Insurance Program is | ||||||
7 | created. This Program is not an entitlement. Enrollment is | ||||||
8 | limited to individuals at or below 200% of the federal poverty | ||||||
9 | level based on the availability of funds, and enrollment may be | ||||||
10 | capped based on funds appropriated for the Program . As soon as | ||||||
11 | practical after the effective date of this Act, coverage for | ||||||
12 | this Program shall begin. The Program shall be administered by | ||||||
13 | the Department of Healthcare and Family Services in | ||||||
14 | collaboration with the Department of Veterans' Affairs. The | ||||||
15 | Department shall have the same powers and authority to | ||||||
16 | administer the Program as are provided to the Department in | ||||||
17 | connection with the Department's administration of the | ||||||
18 | Illinois Public Aid Code. The Department shall coordinate the | ||||||
19 | Program with other health programs operated by the Department | ||||||
20 | and other State and federal agencies. | ||||||
21 | (b) The Department shall operate the Program in a manner so | ||||||
22 | that the estimated cost of the Program during the fiscal year | ||||||
23 | will not exceed the total appropriation for the Program. The | ||||||
24 | Department may take any appropriate action to limit spending or | ||||||
25 | enrollment into the Program, including, but not limited to, |
| |||||||
| |||||||
1 | ceasing to accept or process applications, reviewing | ||||||
2 | eligibility more frequently than annually, adjusting | ||||||
3 | cost-sharing, or reducing the income threshold for eligibility | ||||||
4 | as necessary to control expenditures for the Program.
| ||||||
5 | (c) Notwithstanding subsections (a) and (b) and with the | ||||||
6 | mutual agreement of the Department of Veterans' Affairs and the | ||||||
7 | Department of Healthcare and Family Services, the operation of | ||||||
8 | the Program may be changed to simplify its administration and | ||||||
9 | to take advantage of health insurance coverage that may be | ||||||
10 | available to veterans under the Patient Protection and | ||||||
11 | Affordable Care Act. | ||||||
12 | (Source: P.A. 98-104, eff. 7-22-13.) | ||||||
13 | (330 ILCS 126/15)
| ||||||
14 | Sec. 15. Eligibility. | ||||||
15 | (a) To be eligible for the Program, a person must: | ||||||
16 | (1) be a veteran who is not on active duty and who has | ||||||
17 | not been dishonorably discharged from service or the spouse | ||||||
18 | of such a veteran; | ||||||
19 | (2) be a resident of the State of Illinois; | ||||||
20 | (3) be at least 19 years of age and no older than 64 | ||||||
21 | years of age; | ||||||
22 | (4) be uninsured, as defined by the Department by rule, | ||||||
23 | for a period of time established by the Department by rule, | ||||||
24 | which shall be no less than 3 months; | ||||||
25 | (5) not be eligible for medical assistance under the |
| |||||||
| |||||||
1 | Illinois Public Aid Code or healthcare benefits under the | ||||||
2 | Children's Health Insurance Program Act or the Covering ALL | ||||||
3 | KIDS Health Insurance Act; | ||||||
4 | (6) not be eligible for medical benefits through the | ||||||
5 | Veterans Health Administration; and | ||||||
6 | (7) have a household income no greater than 200% the | ||||||
7 | sum of (i) an amount equal to 25% of the federal poverty | ||||||
8 | level plus (ii) an amount equal to the Veterans | ||||||
9 | Administration means test income threshold at the | ||||||
10 | initiation of the Program; depending on the availability of | ||||||
11 | funds, this level may be increased to an amount equal to | ||||||
12 | the sum of (iii) an amount equal to 50% of the federal | ||||||
13 | poverty level plus (iv) an amount equal to the Veterans | ||||||
14 | Administration means test income threshold. This means | ||||||
15 | test income threshold is subject to alteration by the | ||||||
16 | Department as set forth in subsection (b) of Section 10 . | ||||||
17 | (b) A veteran or spouse who is determined eligible for the | ||||||
18 | Program shall remain eligible for 12 months, provided the | ||||||
19 | veteran or spouse remains a resident of the State and is not | ||||||
20 | excluded under subsection (c) of this Section and provided the | ||||||
21 | Department has not limited the enrollment period as set forth | ||||||
22 | in subsection (b) of Section 10. | ||||||
23 | (c) A veteran or spouse is not eligible for coverage under | ||||||
24 | the Program if: | ||||||
25 | (1) the premium required under Section 35 of this Act | ||||||
26 | has not been timely paid; if the required premiums are not |
| |||||||
| |||||||
1 | paid, the liability of the Program shall be limited to | ||||||
2 | benefits incurred under the Program for the time period for | ||||||
3 | which premiums have been paid and for grace periods as | ||||||
4 | established under subsection (d); if the required monthly | ||||||
5 | premium is not paid, the veteran or spouse is ineligible | ||||||
6 | for re-enrollment for a minimum period of 3 months; or | ||||||
7 | (2) the veteran or spouse is a resident of a nursing | ||||||
8 | facility or an inmate of a public institution, as defined | ||||||
9 | by 42 CFR 435.1009. | ||||||
10 | (d) The Department shall adopt rules for the Program, | ||||||
11 | including, but not limited to, rules relating to eligibility, | ||||||
12 | re-enrollment, grace periods, notice requirements, hearing | ||||||
13 | procedures, cost-sharing, covered services, and provider | ||||||
14 | requirements.
For purposes of this Section, "covered services" | ||||||
15 | must include dental preventative and restorative services.
| ||||||
16 | (Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09 .)
|