PRINTER'S NO. 2006
No. 1641 Session of 1999
INTRODUCED BY KENNEY, ADOLPH, ORIE, E. Z. TAYLOR, WOGAN,
SEYFERT, RUBLEY, ARGALL, BARRAR, BELFANTI, BOYES, CAWLEY,
CIVERA, CLYMER, DeLUCA, DERMODY, FARGO, GANNON, HARHAI,
HENNESSEY, HORSEY, JAMES, LAUGHLIN, MAHER, McCALL, McGILL,
MELIO, NAILOR, PESCI, RAYMOND, ROSS, SAYLOR, SEMMEL,
STEELMAN, STURLA, TIGUE, TRELLO, WASHINGTON, WILT AND
YOUNGBLOOD, JUNE 14, 1999
REFERRED TO COMMITTEE ON AGING AND YOUTH, JUNE 14, 1999
AN ACT
1 Establishing the Catastrophic Illness in Children Relief Fund
2 and the Catastrophic Illness in Children Relief Fund
3 Commission; providing for the powers and duties of the
4 commission; establishing a program for the payment of medical
5 expenses of children in cases of catastrophic illness; and
6 providing for funding.
7 The General Assembly of the Commonwealth of Pennsylvania
8 hereby enacts as follows:
9 Section 1. Short title.
10 This act shall be known and may be cited as the Catastrophic
11 Illness in Children Relief Act.
12 Section 2. Legislative findings and declarations.
13 The General Assembly finds and declares as follows:
14 (1) Although the majority of Americans are covered by
15 some form of health insurance, families nevertheless lack
16 protection against the high cost of chronic or single
17 episodes of serious illness that may destroy their resources.
1 An illness resulting in this potentially devastating
2 financial consequence is referred to as a catastrophic
3 illness.
4 (2) Catastrophic illnesses often threaten to push some
5 families into bankruptcy and others toward seeking inferior
6 medical care and present a major problem for this nation's
7 health care system because catastrophic illnesses account for
8 over 20% of this nation's health expenditures.
9 (3) The impact of catastrophic illnesses on the family
10 is especially acute because children have the highest average
11 medical costs among the population as a whole.
12 (4) It is the public policy of this Commonwealth that
13 each child have access to quality health care and adequate
14 protection against the extraordinarily high costs of health
15 care services which are determined to be catastrophic and
16 that severely impact a child and his family.
17 (5) To this end, it is incumbent upon the Commonwealth
18 to provide assistance to children and their families whose
19 medical expenses extend beyond the families' available
20 resources.
21 Section 3. Definitions.
22 The following words and phrases when used in this act shall
23 have the meanings given to them in this section unless the
24 context clearly indicates otherwise:
25 "Catastrophic illness." An illness or condition, the medical
26 expenses of which are not covered by any other Federal or State
27 program or any insurance contract and which exceed 30% of the
28 income of a family whose income is $100,000 or less per year or
29 40% of the income of a family whose income is in excess of
30 $100,000 per year.
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1 "Child." A person 17 years of age or younger.
2 "Commission." The Catastrophic Illness in Children Relief
3 Fund Commission.
4 "Family." A child and the child's parent, parents or legal
5 guardian, as the case may be, who is legally responsible for the
6 child's medical expenses.
7 "Fund." The Catastrophic Illness in Children Relief Fund.
8 "Income." All income, from whatever source derived, actually
9 received by a family.
10 "Program." The program for paying medical expenses of
11 children in cases of catastrophic illness as set forth in this
12 act.
13 "Resident." A person legally domiciled within this
14 Commonwealth for a period of six months immediately preceding
15 the date of application for inclusion in the program. Mere
16 seasonal or temporary residence within this Commonwealth, of
17 whatever duration, shall not constitute domicile. Absence from
18 this Commonwealth for a period of 12 months or more shall be
19 prima facie evidence of abandonment of domicile. The burden of
20 establishing legal domicile within this Commonwealth shall be on
21 the parent or legal guardian of a child.
22 "Tobacco litigation master settlement agreement." The master
23 settlement agreement relating to tobacco litigation entered into
24 in 1998 by the Commonwealth and leading United States tobacco
25 product manufacturers.
26 Section 4. Catastrophic Illness in Children Relief Fund.
27 (a) Establishment.--The Catastrophic Illness in Children
28 Relief Fund is hereby established as a nonlapsing, revolving
29 fund. The fund shall be administered by the commission and shall
30 be credited with moneys received under section 9.
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1 (b) Disbursements.--The State Treasurer shall be the
2 custodian of the fund, and all disbursements from the fund shall
3 be made by the State Treasurer upon vouchers signed by the
4 chairperson of the commission. The moneys in the fund shall be
5 invested and reinvested by the State Treasurer as are other
6 trust funds in the custody of the State Treasurer in the manner
7 provided by law. Interest received on the moneys in the fund
8 shall be credited to the fund.
9 Section 5. Catastrophic Illness in Children Relief Fund
10 Commission.
11 (a) Establishment.--There is hereby established within the
12 Department of Health the Catastrophic Illness in Children Relief
13 Fund Commission.
14 (b) Members.--The commission shall consist of the Secretary
15 of Health, the Secretary of Public Welfare, the Insurance
16 Commissioner and the State Treasurer, who shall be members ex
17 officio, and five public members who are residents of this
18 Commonwealth, appointed by the Governor with the advice and
19 consent of the Senate for terms of five years. Of the public
20 members, one shall be appointed upon the recommendation of the
21 President pro tempore of the Senate and shall be a provider of
22 health care services to children in this Commonwealth and one
23 member shall be appointed upon the recommendation of the Speaker
24 of the House of Representatives and shall be a provider of
25 health care services to children in this Commonwealth. The five
26 public members first appointed by the Governor shall serve for
27 terms of one, two, three, four and five years, respectively.
28 (c) Term of office.--Each member shall hold office for the
29 term of that member's appointment and until that member's
30 successor has been appointed and qualified. A member of the
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1 commission may be eligible for reappointment.
2 (d) Appointment of designees.--Each ex officio member of the
3 commission may designate an officer or employee of that member's
4 department to represent the member at meetings of the
5 commission, and each designee may lawfully vote and otherwise
6 act on behalf of the member whom the designee represents. A
7 designation shall be in writing, shall be delivered to the
8 commission, shall be filed with the office of the Secretary of
9 the Commonwealth and shall continue in effect until revoked or
10 amended in the same manner as provided for designation.
11 (e) Officers.--The Secretary of Health shall be chairperson
12 and chief executive officer of the commission. The members of
13 the commission shall elect a secretary and a treasurer, who need
14 not be members of the commission and the same person may be
15 elected to serve both as secretary and treasurer.
16 (f) Quorum.--The powers of the commission shall be vested in
17 the members in office from time to time and six members of the
18 commission shall constitute a quorum at any meeting thereof.
19 Action may be taken and motions and resolutions may be adopted
20 by the commission at any meeting by the affirmative vote of at
21 least six members of the commission. No vacancy in the
22 membership of the commission shall impair the right of a quorum
23 to exercise all the powers and perform all the duties of the
24 commission.
25 (g) Expenses.--The members of the commission shall serve
26 without compensation, but the commission shall reimburse its
27 members for the reasonable expenses incurred in the performance
28 of their duties based upon the moneys available in the fund.
29 (h) Removal of members.--Each member of the commission may
30 be removed from membership of the commission by the Governor,
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1 for cause, after a public hearing and may be suspended by the
2 Governor pending the completion of the hearing. This subsection
3 shall not apply to the State Treasurer.
4 (i) Oath.--Each member of the commission, before entering
5 upon that member's duties, shall take and subscribe an oath to
6 perform the duties of that member's office faithfully,
7 impartially and justly to the best of that member's ability. A
8 record of the oaths shall be filed in the office of the
9 Secretary of the Commonwealth.
10 (j) Vacancies.--A vacancy in the membership of the
11 commission occurring other than by the expiration of a term
12 shall be filled in the same manner as the original appointment,
13 but for the unexpired term only.
14 Section 6. Powers and duties of commission.
15 The commission shall:
16 (1) Establish and administer, in conjunction with the
17 Department of Health, a program for the reimbursement of
18 medical expenses of children with catastrophic illnesses.
19 (2) Administer the fund.
20 (3) Establish procedures for:
21 (i) Enrolling in the program.
22 (ii) Determining eligibility for the payment or
23 reimbursement of medical expenses for each child.
24 (iii) Processing claim disputes.
25 (iv) Providing for reimbursement to the fund by the
26 family for the amount of assistance received, or that
27 portion thereof covered by the amount of the damages less
28 the expense of recovery, in the case of an illness or
29 condition for which the family, after receiving
30 assistance under this act, recovers damages for the
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1 child's medical expenses under a settlement or judgment
2 in a legal action.
3 (4) Establish the amount of reimbursement for the
4 medical expenses of each child using a sliding fee scale,
5 based on a family's ability to pay for medical expenses,
6 which takes into account family size, family income and
7 assets and family medical expenses.
8 (5) Adjust the financial eligibility criteria for a
9 catastrophic illness based upon the moneys available in the
10 fund.
11 (6) Disseminate information on the fund and the program
12 to the public.
13 (7) Adopt bylaws for the regulation of its affairs and
14 the conduct of its business, adopt an official seal and alter
15 the same at pleasure, maintain an office at the place within
16 this Commonwealth as it may designate, and sue and be sued in
17 its own name.
18 (8) Employ professional and clerical assistance
19 necessary to perform its duties and as may be within the
20 limits of funds appropriated or otherwise made available to
21 it for its purposes.
22 (9) Maintain confidential records on each child who
23 applies for assistance under the funds.
24 (10) Adopt rules and regulations to administer this act.
25 (11) Do all other acts and things necessary or
26 convenient to carry out the purposes of this act.
27 Section 7. Eligibility for program.
28 A child who is a resident of this Commonwealth is eligible,
29 through the child's parent or legal guardian, to enroll in the
30 program established in section 6.
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1 Section 8. Financial assistance from program.
2 Whenever a child has a catastrophic illness and is enrolled
3 in the program, the child, through his parent or legal guardian,
4 is eligible for financial assistance from moneys in the fund,
5 subject to the rules and regulations established by the
6 commission and the availability of moneys in the fund. The
7 financial assistance shall include, but not be limited to,
8 payments or reimbursements for the cost of medical treatment,
9 hospital care, drugs, nursing care and physical services.
10 Section 9. Source of funds.
11 The moneys to establish and maintain the fund shall be
12 derived from the tobacco litigation master settlement agreement.
13 Section 10. Annual report.
14 The commission shall report annually to the Governor and the
15 General Assembly. The report shall include information about:
16 (1) The number of participants in the program.
17 (2) Average expenditures per participant.
18 (3) The nature and type of catastrophic illnesses for
19 which the fund provided financial assistance.
20 (4) The average income and expenditures of families who
21 received financial assistance under the program.
22 In its report, the commission may make recommendations for
23 changes in the law governing the fund.
24 Section 11. Effective date.
25 This act shall take effect in 60 days.
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