Senate File 249 - Enrolled PAG LIN 1 1 SENATE FILE 249 1 2 1 3 AN ACT 1 4 RELATING TO THE CONFERENCE OF ELIGIBILITY ON AND CONDITIONS 1 5 OF ELIGIBILITY FOR INDIVIDUALS FOR CERTAIN PROGRAMS 1 6 UNDER THE PURVIEW OF THE DEPARTMENT OF HUMAN SERVICES. 1 7 1 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 1 9 1 10 Section 1. Section 249A.3, subsection 2, paragraph a, Code 1 11 Supplement 2007, is amended to read as follows: 1 12 a. As allowed under 42 U.S.C. } 1396a(a)(10)(A)(ii)(XIII), 1 13 individuals with disabilities, who are less than sixty=five 1 14 years of age, who are members of families whose income is less 1 15 than two hundred fifty percent of the most recently revised 1 16 official poverty guidelines published by the United States 1 17 department of health and human services for the family, who 1 18 have earned income and who are eligible for medical assistance 1 19 or additional medical assistance under this section if 1 20 earnings are disregarded. As allowed by 42 U.S.C. } 1 21 1396a(r)(2), unearned income shall also be disregarded in 1 22 determining whether an individual is eligible for assistance 1 23 under this paragraph. For the purposes of determining the 1 24 amount of an individual's resources under this paragraph and 1 25 as allowed by 42 U.S.C. } 1396a(r)(2), a maximum of ten 1 26 thousand dollars of available resources shall be disregarded, 1 27 and any additional resources held in a retirement account, in 1 28 a medical savings account, or in any other account approved 1 29 under rules adopted by the department shall also be 1 30 disregarded. Individuals eligible for assistance under this 1 31 paragraph, whose individual income exceeds one hundred fifty 1 32 percent of the official poverty guidelines published by the 1 33 United States department of health and human services for an 1 34 individual, shall pay a premium. The amount of the premium 1 35 shall be based on a sliding fee schedule adopted by rule of 2 1 the department and shall be based on a percentage of the 2 2 individual's income. The maximum premium payable by an 2 3 individual whose income exceeds one hundred fifty percent of 2 4 the official poverty guidelines shall be commensurate with the 2 5 cost of state employees' group health insurance in this state. 2 6 The payment to and acceptance by an automated case management 2 7 system or the department of the premium required under this 2 8 paragraph shall not automatically confer initial or continuing 2 9 program eligibility on an individual. A premium paid to and 2 10 accepted by the department's premium payment process that is 2 11 subsequently determined to be untimely or to have been paid on 2 12 behalf of an individual ineligible for the program shall be 2 13 refunded to the remitter in accordance with rules adopted by 2 14 the department. 2 15 Sec. 2. Section 249A.6, Code 2007, is amended to read as 2 16 follows: 2 17 249A.6 ASSIGNMENT == LIEN. 2 18 1. a. As a condition of eligibility for medical 2 19 assistance, a recipient who has the legal capacity to execute 2 20 an assignment shall do all of the following: 2 21 (1) Assign to the department any rights to payments of 2 22 medical care from any third party. 2 23 (2) Cooperate with the department in obtaining payments 2 24 described in paragraph "a". 2 25 (3) Cooperate with the department in identifying and 2 26 providing information to assist the department in pursuing any 2 27 third party who may be liable to pay for medical care and 2 28 services available under the medical assistance program. 2 29 b. Any amount collected by the department through an 2 30 assignment shall be retained by the department as 2 31 reimbursement for medical assistance payments. 2 32 c. An assignment under this subsection is in addition to 2 33 an assignment of medical support payments under any other law, 2 34 including section 252E.11. 2 351.2. When payment is made by the department for medical 3 1 care or expenses through the medical assistance program on 3 2 behalf of a recipient, the department shall have a lien, to 3 3 the extent of those payments, upon all monetary claims which 3 4 the recipient may have against third parties. A lien under 3 5 this section is not effective unless the department files a 3 6 notice of lien with the clerk of the district court in the 3 7 county where the recipient resides and with the recipient's 3 8 attorney when the recipient's eligibility for medical 3 9 assistance is established. The notice of lien shall be filed 3 10 before the third party has concluded a final settlement with 3 11 the recipient, the recipient's attorney, or other 3 12 representative. The third party shall obtain a written 3 13 determination from the department concerning the amount of the 3 14 lien before a settlement is deemed final for purposes of this 3 15 section. A compromise, including but not limited to a 3 16 settlement, waiver or release, of a claim under this section 3 17 does not defeat the department's lien except pursuant to the 3 18 written agreement of the director or the director's designee. 3 19 A settlement, award, or judgment structured in any manner not 3 20 to include medical expenses or an action brought by a 3 21 recipient or on behalf of a recipient which fails to state a 3 22 claim for recovery of medical expenses does not defeat the 3 23 department's lien if there is any recovery on the recipient's 3 24 claim. 3 252.3. The department shall be given notice of monetary 3 26 claims against third parties as follows: 3 27 a. Applicants for medical assistance shall notify the 3 28 department of any possible claims against third parties upon 3 29 submitting the application. Recipients of medical assistance 3 30 shall notify the department of any possible claims when those 3 31 claims arise. 3 32 b. A person who provides health care services to a person 3 33 receiving assistance through the medical assistance program 3 34 shall notify the department whenever the person has reason to 3 35 believe that third parties may be liable for payment of the 4 1 costs of those health care services. 4 2 c. An attorney representing an applicant for or recipient 4 3 of assistance on a claim upon which the department has a lien 4 4 under this section shall notify the department of the claim of 4 5 which the attorney has actual knowledge, prior to filing a 4 6 claim, commencing an action or negotiating a settlement offer. 4 7 Actual knowledge under this section shall include the notice 4 8 to the attorney pursuant to subsection12. 4 9 The mailing and deposit in a United States post office or 4 10 public mailing box of the notice, addressed to the department 4 11 at its state or district office location, is adequate legal 4 12 notice of the claim. 4 133.4. The department's lien is valid and binding on an 4 14 attorney, insurer, or other third party only upon notice by 4 15 the department or unless the attorney, insurer, or third party 4 16 has actual notice that the recipient is receiving medical 4 17 assistance from the department and only to the extent to which 4 18 the attorney, insurer, or third party has not made payment to 4 19 the recipient or an assignee of the recipient prior to the 4 20 notice. Payment of benefits by an insurer or third party 4 21 pursuant to the rights of the lienholder in this section 4 22 discharges the attorney, insurer, or third party from 4 23 liability to the recipient or the recipient's assignee to the 4 24 extent of the payment to the department. 4 254.5. If a recipient of assistance through the medical 4 26 assistance program incurs the obligation to pay attorney fees 4 27 and court costs for the purpose of enforcing a monetary claim 4 28 upon which the department has a lien under this section, upon 4 29 the receipt of the judgment or settlement of the total claim, 4 30 of which the lien for medical assistance payments is a part, 4 31 the court costs and reasonable attorney fees shall first be 4 32 deducted from this total judgment or settlement. One=third of 4 33 the remaining balance shall then be deducted and paid to the 4 34 recipient. From the remaining balance, the lien of the 4 35 department shall be paid. Any amount remaining shall be paid 5 1 to the recipient. An attorney acting on behalf of a recipient 5 2 of medical assistance for the purpose of enforcing a claim 5 3 upon which the department has a lien shall not collect from 5 4 the recipient any amount as attorney fees which is in excess 5 5 of the amount which the attorney customarily would collect on 5 6 claims not subject to this section. 5 75.6. For purposes of this section the term "third party" 5 8 includes an attorney, individual, institution, corporation, or 5 9 public or private agency which is or may be liable to pay part 5 10 or all of the medical costs incurred as a result of injury, 5 11 disease, or disability by or on behalf of an applicant for or 5 12 recipient of assistance under the medical assistance program. 5 136.7. The department may enforce its lien by a civil 5 14 action against any liable third party. 5 15 Sec. 3. Section 249J.8, subsection 1, Code Supplement 5 16 2007, is amended to read as follows: 5 17 1. Each expansion population member whose family income 5 18 exceeds one hundred percent of the federal poverty level as 5 19 defined by the most recently revised poverty income guidelines 5 20 published by the United States department of health and human 5 21 services shall pay a monthly premium not to exceed one=twelfth 5 22 of five percent of the member's annual family income. Each 5 23 expansion population member whose family income is equal to or 5 24 less than one hundred percent of the federal poverty level as 5 25 defined by the most recently revised poverty income guidelines 5 26 published by the United States department of health and human 5 27 services shall not be subject to payment of a monthly premium. 5 28 All premiums shall be paid on the last day of the month of 5 29 coverage. The department shall deduct the amount of any 5 30 monthly premiums paid by an expansion population member for 5 31 benefits under the healthy and well kids in Iowa program when 5 32 computing the amount of monthly premiums owed under this 5 33 subsection. An expansion population member shall pay the 5 34 monthly premium during the entire period of the member's 5 35 enrollment. Regardless of the length of enrollment, the 6 1 member is subject to payment of the premium for a minimum of 6 2 four consecutive months. However, an expansion population 6 3 member who complies with the requirement of payment of the 6 4 premium for a minimum of four consecutive months during a 6 5 consecutive twelve=month period of enrollment shall be deemed 6 6 to have complied with this requirement for the subsequent 6 7 consecutive twelve=month period of enrollment and shall only 6 8 be subject to payment of the monthly premium on a 6 9 month=by=month basis. Timely payment of premiums, including 6 10 any arrearages accrued from prior enrollment, is a condition 6 11 of receiving any expansion population services. The payment 6 12 to and acceptance by an automated case management system or 6 13 the department of the premium required under this subsection 6 14 shall not automatically confer initial or continuing program 6 15 eligibility on an individual. A premium paid to and accepted 6 16 by the department's premium payment process that is 6 17 subsequently determined to be untimely or to have been paid on 6 18 behalf of an individual ineligible for the program shall be 6 19 refunded to the remitter in accordance with rules adopted by 6 20 the department. Premiums collected under this subsection 6 21 shall be deposited in the premiums subaccount of the account 6 22 for health care transformation created pursuant to section 6 23 249J.23. An expansion population member shall also pay the 6 24 same copayments required of other adult recipients of medical 6 25 assistance. 6 26 Sec. 4. Section 514I.10, Code 2007, is amended by adding 6 27 the following new subsection: 6 28 NEW SUBSECTION. 3. The payment to and acceptance by an 6 29 automated case management system or the department of the 6 30 premium required under this section shall not automatically 6 31 confer initial or continuing program eligibility on an 6 32 individual. A premium paid to and accepted through the 6 33 department's premium payment process that is subsequently 6 34 determined to be untimely or to have been paid on behalf of an 6 35 individual ineligible for the program shall be refunded to the 7 1 remitter in accordance with rules adopted by the department. 7 2 7 3 7 4 7 5 JOHN P. KIBBIE 7 6 President of the Senate 7 7 7 8 7 9 7 10 PATRICK J. MURPHY 7 11 Speaker of the House 7 12 7 13 I hereby certify that this bill originated in the Senate and 7 14 is known as Senate File 249, Eighty=second General Assembly. 7 15 7 16 7 17 7 18 MICHAEL E. MARSHALL 7 19 Secretary of the Senate 7 20 Approved , 2008 7 21 7 22 7 23 7 24 CHESTER J. CULVER 7 25 Governor