PRINTER'S NO. 119
No. 122 Session of 1991
INTRODUCED BY KENNEY, COHEN, J. TAYLOR, THOMAS, KOSINSKI, WOGAN,
O'BRIEN, FARMER, D. R. WRIGHT, COY, GEORGE, DeLUCA, HAGARTY,
TRELLO, COLAFELLA, TIGUE, NAHILL, HECKLER, HALUSKA, STEELMAN,
HARPER, CORNELL AND BUNT, JANUARY 29, 1991
REFERRED TO COMMITTEE ON AGING AND YOUTH, JANUARY 29, 1991
AN ACT
1 Establishing the Catastrophic Illness in Children Relief Fund;
2 creating 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 for the program.
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 Fund 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.
18 An illness resulting in this potentially devastating
19 financial consequence is referred to as a catastrophic
1 illness.
2 (2) Catastrophic illnesses often threaten to push some
3 families into bankruptcy and others toward seeking inferior
4 medical care and present a major problem for this nation's
5 health care system in that catastrophic illnesses account for
6 over 20% of this nation's health expenditures.
7 (3) The impact of catastrophic illnesses on the family
8 is especially acute in that children have the highest average
9 medical costs among the population as a whole.
10 (4) It is the public policy of this Commonwealth that
11 each child should have access to quality health care and
12 adequate protection against the extraordinarily high costs of
13 health care services which are determined to be catastrophic
14 and severely impact upon a child and his family.
15 (5) To this end, it is incumbent upon the Commonwealth
16 to provide assistance to children and their families whose
17 medical expenses extend beyond the families' available
18 resources.
19 Section 3. Definitions.
20 The following words and phrases when used in this act shall
21 have the meanings given to them in this section unless the
22 context clearly indicates otherwise:
23 "Catastrophic illness." An illness or condition, the medical
24 expenses of which are not covered by any other Federal or State
25 program or any insurance contract and which exceed 30% of the
26 income of a family whose income is $100,000 or less per year or
27 40% of the income of a family whose income is over $100,000 per
28 year.
29 "Child." A person 17 years of age or younger.
30 "Commission." The Catastrophic Illness in Children Relief
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1 Fund Commission.
2 "Family." A child and the child's parent, parents or legal
3 guardian, as the case may be, who is legally responsible for the
4 child's medical expenses.
5 "Fund." The Catastrophic Illness in Children Relief Fund.
6 "Income." All income, from whatever source derived, actually
7 received by a family.
8 "Resident." A person legally domiciled within this
9 Commonwealth for a period of six months immediately preceding
10 the date of application for inclusion in the program. Mere
11 seasonal or temporary residence within this Commonwealth, of
12 whatever duration, does not constitute domicile. Absence from
13 this Commonwealth for a period of 12 months or more is prima
14 facie evidence of abandonment of domicile. The burden of
15 establishing legal domicile within this Commonwealth is upon the
16 parent or legal guardian of a child.
17 Section 4. Catastrophic Illness in Children Relief Fund.
18 (a) Establishment.--The Catastrophic Illness in Children
19 Relief Fund is hereby established as a nonlapsing, revolving
20 fund. The fund shall be administered by the commission and shall
21 be credited with moneys received under section 9.
22 (b) Disbursements.--The State Treasurer shall be the
23 custodian of the fund, and all disbursements from the fund shall
24 be made by the treasurer upon vouchers signed by the chairman of
25 the commission. The moneys in the fund shall be invested and
26 reinvested by the State Treasurer as are other trust funds in
27 the custody of the State Treasurer in the manner provided by
28 law. Interest received on the moneys in the fund shall be
29 credited to the fund.
30 Section 5. Catastrophic Illness in Children Relief Fund
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1 Commission.
2 (a) Establishment.--There is hereby established within the
3 Department of Health the Catastrophic Illness in Children Relief
4 Fund Commission.
5 (b) Members.--The commission shall consist of the Secretary
6 of Health, the Secretary of Public Welfare, the Insurance
7 Commissioner and the State Treasurer, who shall be members ex
8 officio, and five public members who are residents of this
9 Commonwealth, appointed by the Governor with the advice and
10 consent of the Senate for terms of five years. Of the public
11 members, one shall be appointed upon the recommendation of the
12 President pro tempore of the Senate and shall be a provider of
13 health care services to children in this Commonwealth and one
14 shall be appointed upon the recommendation of the Speaker of the
15 House of Representatives and shall be a provider of health care
16 services to children in this Commonwealth. The five public
17 members first appointed by the Governor shall serve for terms of
18 one, two, three, four and five years, respectively.
19 (c) Term of office.--Each member shall hold office for the
20 term of his appointment and until his successor has been
21 appointed and qualified. A member of the commission is eligible
22 for reappointment.
23 (d) Appointment of designees.--Each ex officio member of the
24 commission may designate an officer or employee of his
25 department to represent him at meetings of the commission, and
26 each designee may lawfully vote and otherwise act on behalf of
27 the member for whom he constitutes the designee. Any designation
28 shall be in writing, shall be delivered to the commission, shall
29 be filed with the office of the Secretary of the Commonwealth
30 and shall continue in effect until revoked or amended in the
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1 same manner as provided for designation.
2 (e) Officers.--The Secretary of Health shall be chairman and
3 chief executive officer of the commission. The members of the
4 commission shall elect a secretary and a treasurer, who need not
5 be members of the commission, and the same person may be elected
6 to serve both as secretary and treasurer.
7 (f) Quorum.--The powers of the commission are vested in the
8 members in office from time to time, and six members of the
9 commission shall constitute a quorum at any meeting thereof.
10 Action may be taken and motions and resolutions may be adopted
11 by the commission at any meeting by the affirmative vote of at
12 least six members of the commission. A vacancy in the membership
13 of the commission shall not impair the right of a quorum to
14 exercise all the powers and perform all the duties of the
15 commission.
16 (g) Expenses.--The members of the commission shall serve
17 without compensation, but the commission shall reimburse its
18 members for the reasonable expenses incurred in the performance
19 of their duties based upon the moneys available in the fund.
20 (h) Removal of members.--Each member of the commission may
21 be removed from office by the Governor, for cause, after a
22 public hearing and may be suspended by the Governor pending the
23 completion of the hearing.
24 (i) Oath.--Each member of the commission, before entering
25 upon his duties, shall take and subscribe an oath to perform the
26 duties of his office faithfully, impartially and justly to the
27 best of his ability. A record of the oaths shall be filed in the
28 office of the Secretary of the Commonwealth.
29 (j) Vacancies.--Any vacancy in the membership of the
30 commission occurring other than by the expiration of a term
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1 shall be filled in the same manner as the original appointment,
2 but for the unexpired term only.
3 Section 6. Powers and duties of commission.
4 The commission shall:
5 (1) Establish, in conjunction with the Department of
6 Health, a program for reimbursement for payment in accordance
7 with the provisions of this act, administer the fund and
8 authorize the payment or reimbursement of medical expenses of
9 children with catastrophic illnesses.
10 (2) Establish procedures for:
11 (i) enrolling in the program;
12 (ii) determining eligibility for the payment or
13 reimbursement of medical expenses for each child;
14 (iii) processing claim disputes; and
15 (iv) providing for reimbursement to the fund by the
16 family for the amount of assistance received, or that
17 portion thereof covered by the amount of the damages less
18 the expense of recovery, in the case of an illness or
19 condition for which the family, after receiving
20 assistance under this act, recovers damages for the
21 child's medical expenses under a settlement or judgment
22 in a legal action.
23 (3) Establish the amount of reimbursement for the
24 medical expenses of each child using a sliding fee scale,
25 based on a family's ability to pay for medical expenses,
26 which takes into account family size, family income and
27 assets and family medical expenses, and adjust the financial
28 eligibility criteria established by the definition of
29 "catastrophic illness" based upon the moneys available in the
30 fund.
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1 (4) Disseminate information on the fund and the program
2 to the public.
3 (5) Adopt bylaws for the regulation of its affairs and
4 the conduct of its business, adopt an official seal and alter
5 the same at pleasure, maintain an office at the place within
6 this Commonwealth as it may designate, and sue and be sued in
7 its own name.
8 (6) Employ professional and clerical assistance
9 necessary to perform its duties and as may be within the
10 limits of funds appropriated or otherwise made available to
11 it for its purposes.
12 (7) Maintain confidential records on each child who
13 applies for assistance under the funds.
14 (8) Adopt rules and regulations to administer the
15 provisions of this act.
16 (9) Do all other acts and things necessary or convenient
17 to carry out the purposes of this act.
18 Section 7. Children eligible to enroll in program.
19 A child who is a resident of this Commonwealth is eligible,
20 through his parent or legal guardian, to enroll in the program
21 established in section 6.
22 Section 8. Financial assistance.
23 Whenever a child has a catastrophic illness and is enrolled
24 in the program, the child, through his parent or legal guardian,
25 is eligible for financial assistance from moneys in the fund,
26 subject to the rules and regulations established by the
27 commission and the availability of moneys in the fund. The
28 financial assistance shall include, but not be limited to,
29 payments or reimbursements for the cost of medical treatment,
30 hospital care, drugs, nursing care and physician services.
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1 Section 9. Source of funds.
2 The moneys to establish and maintain the fund shall be
3 derived from the additional contribution imposed upon employers
4 under section 301 of the act of December 5, 1936 (2nd Sp.Sess.,
5 1937 P.L.2897, No.1), known as the Unemployment Compensation
6 Law.
7 Section 10. Annual report.
8 The commission shall report annually to the Governor and the
9 General Assembly. The report shall include information about the
10 number of participants in the program, average expenditures per
11 participant, the nature and type of catastrophic illnesses for
12 which the fund provided financial assistance and the average
13 income and expenditures of families who received financial
14 assistance under the program. The commission also may make
15 recommendations for changes in the law governing the fund.
16 Section 11. Effective date.
17 This act shall take effect in 60 days.
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