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S1472aa,aa...........................................by JUDICIARY AND RULES
MEDICAL ASSISTANCE - Amends existing law relating to medical assistance to
require disclosure of a claim for medical expenses against a third party or
entity; to provide the Department of Health and Welfare's entitlement to
such reimbursement when medical assistance has been paid; and to provide
reference to material omissions.
02/25 Senate intro - 1st rdg - to printing
02/26 Rpt prt - to Health/Wel
03/01 Rpt out - to 14th Ord
03/04 Rpt out amen - to engros
03/05 Rpt engros - 1st rdg - to 2nd rdg as amen
03/06 2nd rdg - to 3rd rdg as amen
03/07 To 14th Ord
03/11 Rpt out amen - to engros
03/12 Rpt engros - 1st rdg - to 2nd rdg as amen
Rls susp - PASSED - 34-0-1
AYES -- Andreason, Boatright, Branch(Bartlett), Brandt, Bunderson,
Burtenshaw, Cameron, Darrington, Davis, Deide, Dunklin, Frasure,
Geddes, Goedde, Hawkins, Hill, Ingram, Ipsen, Keough, Little, Lodge,
Marley, Noh, Richardson, Risch, Sandy, Schroeder, Sims, Sorensen,
Stegner, Stennett, Thorne, Wheeler, Williams
NAYS -- None
Absent and excused -- King-Barrutia
Floor Sponsor - Ipsen
Title apvd - to House
03/13 House intro - 1st rdg - to Health/Wel
03/15 Rpt out - rec d/p - to 2nd rdg
Rls susp - PASSED - 64-0-6
AYES -- Barraclough, Barrett, Bedke, Bell, Bieter, Black, Block, Boe,
Bolz, Bruneel, Callister, Campbell, Clark, Collins, Crow, Cuddy,
Deal, Denney, Ellis, Ellsworth, Eskridge, Field(13), Field(20),
Gagner, Gould, Hadley, Hammond, Harwood, Henbest, Higgins, Hornbeck,
Jaquet, Jones, Kellogg, Kendell, Kunz, Lake, Langford, Loertscher,
Mader, Martinez, Meyer, Montgomery, Moyle, Pearce, Pischner, Pomeroy,
Raybould, Ridinger, Roberts, Robison, Sali, Schaefer, Sellman,
Shepherd, Smith(33), Smith(23), Smylie, Stevenson, Stone, Trail,
Wood, Young, Mr. Speaker
NAYS -- None
Absent and excused -- Aikele, Bradford, McKague, Mortensen, Tilman,
Wheeler
Floor Sponsors - Ellis & Sali
Title apvd - to Senate
03/15 To enrol
03/18 Rpt enrol - Pres signed - Sp signed
03/18 To Governor
03/27 Governor signed
Session Law Chapter 369
Effective: 07/01/02
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
IN THE SENATE
SENATE BILL NO. 1472
BY JUDICIARY AND RULES COMMITTEE
1 AN ACT
2 RELATING TO MEDICAL ASSISTANCE; AMENDING SECTION 56-209b, IDAHO CODE, TO
3 REQUIRE DISCLOSURE OF A CLAIM AGAINST A THIRD PARTY OR ENTITY AND TO PRO-
4 VIDE THE DEPARTMENT OF HEALTH AND WELFARE'S ENTITLEMENT TO SUCH REIMBURSE-
5 MENT AND TO MAKE TECHNICAL CORRECTIONS; AND AMENDING SECTION 56-227, IDAHO
6 CODE, TO PROVIDE PENALTIES AND TO MAKE A TECHNICAL CORRECTION.
7 Be It Enacted by the Legislature of the State of Idaho:
8 SECTION 1. That Section 56-209b, Idaho Code, be, and the same is hereby
9 amended to read as follows:
10 56-209b. MEDICAL ASSISTANCE -- MEDICAL ASSISTANCE ACCOUNT. (1) Medical
11 assistance shall be awarded to persons as mandated by federal law; and medical
12 assistance may be awarded to such other persons not required to be awarded
13 medical assistance as mandated by federal law when such award is to the fiscal
14 advantage of the state of Idaho.
15 (2) There is hereby created in the dedicated fund the medical assistance
16 account. The medical assistance account shall be an entity primarily designed
17 to receive moneys from the families and relatives of patients receiving medi-
18 cal assistance under the state plan for medicaid, and to provide a source of
19 moneys to pay for the state's share of medical assistance expenses. Moneys in
20 the medical assistance account may not be commingled with moneys in the coop-
21 erative welfare account. Moneys in the medical assistance account must be
22 appropriated in order to be expended to pay for the state's share of medical
23 assistance expenses.
24 (3) In all cases where the department of health and welfare through the
25 medical assistance program has or will be required to pay medical expenses for
26 a recipient and that recipient is entitled to recover any or all such medical
27 expenses from any third party or entity, the department of health and welfare
28 will be subrogated to the rights of the recipient to the extent of the amount
29 of medical assistance benefits paid by the department as the result of the
30 occurrence giving rise to the claim against the third party or entity.
31 (4) If a recipient of medical assistance pursues a claim against a third
32 party or entity through litigation or a settlement, the recipient will so
33 notify the department. If a recipient fails to notify the department of such
34 claim, the department may recover the amount of any public assistance obtained
35 by the recipient while the recipient pursued such claim. In addition, iIf the
36 recipient recovers funds, either by settlement or judgment, from such a third
37 party or entity, the recipient shall reimburse the department to the extent of
38 the funds received in settlement minus attorney's fees and costs, the amount
39 of the medical assistance benefits paid by the department on his behalf as a
40 result of the occurrence giving rise to the need for medical assistance. The
41 department shall be entitled to all the legal rights and powers of a creditor
42 against a debtor in enforcing the recipient's reimbursement obligation.
43 (5) The department shall have priority to any amount received from a
2
1 third party or entity which can reasonably be construed to compensate the
2 recipient for the occurrence giving rise to the need for medical assistance,
3 whether the settlement or judgment is obtained through the subrogation right
4 of the department or through recovery by the recipient, and whether or not the
5 recipient is made whole by the amount recovered. The department will be enti-
6 tled to reimbursement of medical assistance benefits paid on behalf of the
7 recipient arising from the incident or occurrence prior to any amount being
8 distributed to the recipient. The department may notify such third party or
9 entity of the department's entitlement to receive the reimbursement prior to
10 any amount being distributed to the recipient. Furthermore, the department may
11 instruct the third party or entity to make such payment directly to the
12 department prior to any amount being distributed to the recipient. Any third
13 party or entity who distributed funds in violation of such a notice shall be
14 liable to the department for the amount of the reimbursement.
15 (6) In the event a recipient of assistance through the medical assistance
16 program incurs the obligation to pay attorney's fees and costs for the purpose
17 of enforcing a monetary claim to which the department has a right under this
18 section, the amount which the department is entitled to recover, or any lesser
19 amount which the department may agree to accept in compromise of its claim,
20 shall be reduced by an amount which bears the same relation to the total
21 amount of attorney's fees and costs actually paid by the recipient as the
22 amount actually recovered for medical expenses paid by the department, exclu-
23 sive of the reduction for attorney's fees and costs, bears to the total amount
24 paid by the third party or entity to the recipient. If a settlement or judg-
25 ment is received by the recipient without delineating what portion of the set-
26 tlement or judgment is in payment of medical expenses, it will be presumed
27 that the settlement or judgment applies first to the medical expenses incurred
28 by the recipient in an amount equal to the expenditure for medical assistance
29 benefits paid by the department as a result of the occurrence giving rise to
30 the payment or payments to the recipient.
31 SECTION 2. That Section 56-227, Idaho Code, be, and the same is hereby
32 amended to read as follows:
33 56-227. FRAUDULENT ACTS -- PENALTY. (a) Whoever knowingly and willfully
34 makes a false statement or material omission, or conceals or fails to report
35 his income or resources as required by section 56-209b(4), 56-215 or 56-224,
36 Idaho Code, or otherwise employs fraudulent devices to obtains, or attempts to
37 obtain, or aids or abets any person in obtaining, by means of a wilfully will-
38 fully false statement or representation, or other fraudulent devices, public
39 assistance, relief or federal-aid assistance to which he is not entitled, or
40 in an amount greater than that to which he is justly entitled, shall be pun-
41 ished in the same manner and to the same extent as for larceny or theft of the
42 money or value of the public assistance so obtained or attempted to be so
43 obtained.
44 (b) Whoever sells, conveys, mortgages or otherwise disposes of his prop-
45 erty, real or personal, or conceals or fails to report his income or resources
46 as required by section 56-209b(4), 56-215 or 56-224, Idaho Code, for the pur-
47 pose of rendering him eligible for any form of assistance, theretofore or
48 thereafter applied for, to which he would not otherwise be entitled, shall be
49 punished in the same manner and to the same extent as for larceny or theft of
50 the money or value of the assistance so obtained or so attempted to be
51 obtained.
52 (c) Every person who knowingly aids or abets any person in selling, con-
53 veying, mortgaging or otherwise disposing of his property, real or personal,
3
1 or in concealing or failing to report his income or resources as required by
2 section 56-209b(4), 56-215 or 56-224, Idaho Code, for the purpose of rendering
3 him eligible for any form of public assistance or relief, theretofore or
4 thereafter applied for and received, to which he would not otherwise be enti-
5 tled, shall be punished in the same manner and to the same extent as for lar-
6 ceny or theft of the money or value of the public assistance or relief so
7 obtained or attempted to be obtained.
8 (d) For the purpose of this section federal-aid assistance shall include
9 the specific categories of assistance for which provision is made in any fed-
10 eral law existing or hereafter enacted by the congress of the United States by
11 which payments are made from the federal government to the state in aid or in
12 respect to payment by the state for welfare purposes to any category of needy
13 person and any other program of assistance for which provision for federal
14 funds for aid may from time to time be made.
15 (e) The state department of health and welfare shall establish and oper-
16 ate a fraud control program as permitted by section 416 of the social security
17 act as now or hereafter amended.
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
Moved by Ipsen
Seconded by Lodge
IN THE SENATE
SENATE AMENDMENT TO S.B. NO. 1472, As Amended
1 AMENDMENTS TO SECTION 2
2 On page 2 of the engrossed bill, in line 33, delete "and willfully" and
3 delete lines 34, 35 and 36, and insert: "obtains, or attempts to"; in line 37,
4 delete "aids or abets" and insert: "aids or abets"; in line 45, delete "or
5 fails to report"; and in line 46, delete "as required by section 56-209b(4),
6 56-215 or 56-224, Idaho Code"; on page 3, in line 1, delete "or failing to
7 report" and also in line 1, delete "as required by"; and in line 2, delete
8 "section 56-209b(4), 56-215 or 56-224, Idaho Code,".
9 CORRECTION TO TITLE
10 On page 1, in line 6, delete "PENALTIES" and insert: "REFERENCE TO MATE-
11 RIAL OMISSIONS".
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
IN THE SENATE
SENATE BILL NO. 1472, As Amended, As Amended
BY JUDICIARY AND RULES COMMITTEE
1 AN ACT
2 RELATING TO MEDICAL ASSISTANCE; AMENDING SECTION 56-209b, IDAHO CODE, TO
3 REQUIRE DISCLOSURE OF A CLAIM AGAINST A THIRD PARTY OR ENTITY AND TO PRO-
4 VIDE THE DEPARTMENT OF HEALTH AND WELFARE'S ENTITLEMENT TO SUCH REIMBURSE-
5 MENT AND TO MAKE TECHNICAL CORRECTIONS; AND AMENDING SECTION 56-227, IDAHO
6 CODE, TO PROVIDE REFERENCE TO MATERIAL OMISSIONS AND TO MAKE A TECHNICAL
7 CORRECTION.
8 Be It Enacted by the Legislature of the State of Idaho:
9 SECTION 1. That Section 56-209b, Idaho Code, be, and the same is hereby
10 amended to read as follows:
11 56-209b. MEDICAL ASSISTANCE -- MEDICAL ASSISTANCE ACCOUNT. (1) Medical
12 assistance shall be awarded to persons as mandated by federal law; and medical
13 assistance may be awarded to such other persons not required to be awarded
14 medical assistance as mandated by federal law when such award is to the fiscal
15 advantage of the state of Idaho.
16 (2) There is hereby created in the dedicated fund the medical assistance
17 account. The medical assistance account shall be an entity primarily designed
18 to receive moneys from the families and relatives of patients receiving medi-
19 cal assistance under the state plan for medicaid, and to provide a source of
20 moneys to pay for the state's share of medical assistance expenses. Moneys in
21 the medical assistance account may not be commingled with moneys in the coop-
22 erative welfare account. Moneys in the medical assistance account must be
23 appropriated in order to be expended to pay for the state's share of medical
24 assistance expenses.
25 (3) In all cases where the department of health and welfare through the
26 medical assistance program has or will be required to pay medical expenses for
27 a recipient and that recipient is entitled to recover any or all such medical
28 expenses from any third party or entity, the department of health and welfare
29 will be subrogated to the rights of the recipient to the extent of the amount
30 of medical assistance benefits paid by the department as the result of the
31 occurrence giving rise to the claim against the third party or entity.
32 (4) If a recipient of medical assistance pursues a claim against a third
33 party or entity through litigation or a settlement, the recipient will so
34 notify the department. If a recipient fails to notify the department of such
35 claim, the department may recover the amount of any public assistance obtained
36 by the recipient while the recipient pursued such claim. In addition, iIf the
37 recipient recovers funds, either by settlement or judgment, from such a third
38 party or entity, the recipient shall reimburse the department to the extent of
39 the funds received in settlement minus attorney's fees and costs, the amount
40 of the medical assistance benefits paid by the department on his behalf as a
41 result of the occurrence giving rise to the need for medical assistance. The
42 department shall be entitled to all the legal rights and powers of a creditor
43 against a debtor in enforcing the recipient's reimbursement obligation.
2
1 (5) The department shall have priority to any amount received from a
2 third party or entity which can reasonably be construed to compensate the
3 recipient for the occurrence giving rise to the need for medical assistance,
4 whether the settlement or judgment is obtained through the subrogation right
5 of the department or through recovery by the recipient, and whether or not the
6 recipient is made whole by the amount recovered. The department will be enti-
7 tled to reimbursement of medical assistance benefits paid on behalf of the
8 recipient arising from the incident or occurrence prior to any amount being
9 distributed to the recipient. The department may notify such third party or
10 entity of the department's entitlement to receive the reimbursement prior to
11 any amount being distributed to the recipient. Furthermore, the department may
12 instruct the third party or entity to make such payment directly to the
13 department prior to any amount being distributed to the recipient. Any third
14 party or entity who distributed funds in violation of such a notice shall be
15 liable to the department for the amount of the reimbursement.
16 (6) In the event a recipient of assistance through the medical assistance
17 program incurs the obligation to pay attorney's fees and costs for the purpose
18 of enforcing a monetary claim to which the department has a right under this
19 section, the amount which the department is entitled to recover, or any lesser
20 amount which the department may agree to accept in compromise of its claim,
21 shall be reduced by an amount which bears the same relation to the total
22 amount of attorney's fees and costs actually paid by the recipient as the
23 amount actually recovered for medical expenses paid by the department, exclu-
24 sive of the reduction for attorney's fees and costs, bears to the total amount
25 paid by the third party or entity to the recipient. If a settlement or judg-
26 ment is received by the recipient without delineating what portion of the set-
27 tlement or judgment is in payment of medical expenses, it will be presumed
28 that the settlement or judgment applies first to the medical expenses incurred
29 by the recipient in an amount equal to the expenditure for medical assistance
30 benefits paid by the department as a result of the occurrence giving rise to
31 the payment or payments to the recipient.
32 SECTION 2. That Section 56-227, Idaho Code, be, and the same is hereby
33 amended to read as follows:
34 56-227. FRAUDULENT ACTS -- PENALTY. (a) Whoever knowingly obtains, or
35 attempts to obtain, or aids or abets any person in obtaining, by means of a
36 wilfully willfully false statement or representation, material omission, or
37 other fraudulent devices, public assistance, relief or federal-aid assistance
38 to which he is not entitled, or in an amount greater than that to which he is
39 justly entitled, shall be punished in the same manner and to the same extent
40 as for larceny or theft of the money or value of the public assistance so
41 obtained or attempted to be so obtained.
42 (b) Whoever sells, conveys, mortgages or otherwise disposes of his prop-
43 erty, real or personal, or conceals his income or resources, for the purpose
44 of rendering him eligible for any form of assistance, theretofore or thereaf-
45 ter applied for, to which he would not otherwise be entitled, shall be pun-
46 ished in the same manner and to the same extent as for larceny or theft of the
47 money or value of the assistance so obtained or so attempted to be obtained.
48 (c) Every person who knowingly aids or abets any person in selling, con-
49 veying, mortgaging or otherwise disposing of his property, real or personal,
50 or in concealing his income or resources for the purpose of rendering him
51 eligible for any form of public assistance or relief, theretofore or thereaf-
52 ter applied for and received, to which he would not otherwise be entitled,
53 shall be punished in the same manner and to the same extent as for larceny or
3
1 theft of the money or value of the public assistance or relief so obtained or
2 attempted to be obtained.
3 (d) For the purpose of this section federal-aid assistance shall include
4 the specific categories of assistance for which provision is made in any fed-
5 eral law existing or hereafter enacted by the congress of the United States by
6 which payments are made from the federal government to the state in aid or in
7 respect to payment by the state for welfare purposes to any category of needy
8 person and any other program of assistance for which provision for federal
9 funds for aid may from time to time be made.
10 (e) The state department of health and welfare shall establish and oper-
11 ate a fraud control program as permitted by section 416 of the social security
12 act as now or hereafter amended.
STATEMENT OF PURPOSE
RS 12132
Passage of this legislation will require third parties to make
payment to the Department of Health and Welfare to reimburse the
state for any public assistance provided by the state prior to
litigation judgment or settlements payable to the recipient. Any
third party that fails to make this payment to the Department of
Health and Welfare shall be liable for the amount. It requires
Medicaid recipients to report income to the Department of Health
and Welfare and imposes a penalty for those who fail to do so.
Fiscal Impact
There are no costs connected with this proposed legislation.
Enactment of this provision will help the state to recover public
assistance payment and prevent relatively wealthy individuals from
remaining on the Medicaid program.
Contact
Name: Robert Vande Merwe,
Idaho Health Care Association
Phone: 343-9735
STATEMENT OF PURPOSE/FISCAL NOTE S 1472