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S1345.................................................by HEALTH AND WELFARE MEDICAL ASSISTANCE - Amends existing law relating to medical assistance to provide for prior participation and express consent by the Department of Health and Welfare for certain claim settlements by a medical assistance recipient; and to provide that certain settlements or judgments give priority first to medical expenses incurred by the recipient in an amount equal to specified expenditures paid by the Department of Health and Welfare. 01/24 Senate intro - 1st rdg - to printing 01/25 Rpt prt - to Health/Wel
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]] Fifty-ninth Legislature Second Regular Session - 2008IN THE SENATE SENATE BILL NO. 1345 BY HEALTH AND WELFARE COMMITTEE 1 AN ACT 2 RELATING TO MEDICAL ASSISTANCE; AMENDING SECTION 56-209b, IDAHO CODE, TO PRO- 3 VIDE FOR PRIOR PARTICIPATION AND EXPRESS CONSENT BY THE DEPARTMENT OF 4 HEALTH AND WELFARE FOR CERTAIN CLAIM SETTLEMENTS BY A MEDICAL ASSISTANCE 5 RECIPIENT AND TO PROVIDE THAT CERTAIN SETTLEMENTS OR JUDGMENTS GIVE PRIOR- 6 ITY FIRST TO MEDICAL EXPENSES INCURRED BY THE RECIPIENT IN AN AMOUNT EQUAL 7 TO SPECIFIED EXPENDITURES PAID BY THE DEPARTMENT. 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. No settlement of any such claim by a recipient of medi- 35 cal assistance, which may affect the amount of reimbursement to the department 36 for medical assistance, including any agreement as to the allocation of set- 37 tlement proceeds to types or classes of damages, shall be made without the 38 prior participation and express consent of the department. If a recipient 39 fails to notify the department of such claim, the department may recover the 40 amount of any public assistance obtained by the recipient while the recipient 41 pursued such claim. In addition, if the recipient recovers funds, either by 42 settlement or judgment, from such a third party or entity, the recipient shall 43 reimburse the department to the extent of the funds received in settlement 2 1 minus attorney's fees and costs, the amount of the medical assistance benefits 2 paid by the department on his behalf as a result of the occurrence giving rise 3 to the need for medical assistance. The department shall be entitled to all 4 the legal rights and powers of a creditor against a debtor in enforcing the 5 recipient's reimbursement obligation. 6 (5) The department shall have priority to any amount received from a 7 third party or entity which can reasonably be construed to compensate the 8 recipient for the occurrence giving rise to the need for medical assistance, 9 whether the settlement or judgment is obtained through the subrogation right 10 of the department or through recovery by the recipient, and whether or not the 11 recipient is made whole by the amount recovered. The department will be enti- 12 tled to reimbursement of medical assistance benefits paid on behalf of the 13 recipient arising from the incident or occurrence prior to any amount being 14 distributed to the recipient. The department may notify such third party or 15 entity of the department's entitlement to receive the reimbursement prior to 16 any amount being distributed to the recipient. Furthermore, the department may 17 instruct the third party or entity to make such payment directly to the 18 department prior to any amount being distributed to the recipient. Any third 19 party or entity who distributed funds in violation of such a notice shall be 20 liable to the department for the amount of the reimbursement. 21 (6) In the event a recipient of assistance through the medical assistance 22 program incurs the obligation to pay attorney's fees and costs for the purpose 23 of enforcing a monetary claim to which the department has a right under this 24 section, the amount which the department is entitled to recover, or any lesser 25 amount which the department may agree to accept in compromise of its claim, 26 shall be reduced by an amount which bears the same relation to the total 27 amount of attorney's fees and costs actually paid by the recipient as the 28 amount actually recovered for medical expenses paid by the department, exclu- 29 sive of the reduction for attorney's fees and costs, bears to the total amount 30 paid by the third party or entity to the recipient. If a settlement or judg- 31 ment is received by the recipient without delineating what portion of the set- 32 tlement or judgment is in payment of medical expenses, it will be presumed 33 that the settlement or judgment applies first to the medical expenses incurred 34 by the recipient in an amount equal to the expenditure for medical assistance 35 benefits paid by the department as a result of the occurrence giving rise to 36 the payment or payments to the recipient. Any settlement or judgment which 37 delineates the types or classes of damages for which compensation is being 38 made shall give priority first to medical expenses incurred by the recipient 39 in an amount equal to the expenditure for medical assistance benefits paid by 40 the department as a result of the occurrence giving rise to the payment or 41 payments to the recipient.
STATEMENT OF PURPOSE
RS 17400
The purpose of this legislation is to require consent of the
Department of Health and Welfare in order to settle claims
against third parties which affect the recovery rights of the
Department. It also requires judgments and settlements against
third parties to give priority to recovery of medical assistance
payments. This is necessary following the United States Supreme
Court Decision in Ahlborn v. Arkansas Department of Human
Services.
FISCAL NOTE
It is difficult to accurately project the fiscal impact of this
legislation due to the fluctuating number and severity of
personal injury cases. However, it will have an estimated
positive fiscal impact of $500,000.00 in increased collections.
CONTACT
Name: Larry Tisdale
Agency: Health and Welfare
Phone: 208-287-1141
STATEMENT OF PURPOSE/FISCAL NOTE S 1345