CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND COMMISSION

M.G.L. pt. Part I, tit. Title XVI, ch. c. 111K

in effect

M.G.L. c. 111K, § 1 Definitions

c. 111K, § 1. Definitions Section 1. As used in this chapter the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Catastrophic illness'', pediatric cancer, or any illness or condition treated at a pediatric specialty hospital, including ambulatory care and services provided by or ordered through such a hospital, the medical and related expenses of which are not covered by any other state or federal program, including the uncompensated care pool, or any insurance contract and which exceed 10 per cent of the first $100,000 of annual income of a family and 15 per cent of any family income in excess of $100,000. ''Child'', a person 21 years of age or under. ''Commission'', the catastrophic illness in children relief fund commission. ''Department'', the department of public health. ''Family'', a child and the child's parent, parents or legal guardian, as the case may be, who is legally responsible for the child's medical expenses. ''Fund'', the Catastrophic Illness in Children Relief Fund established pursuant to section 2ZZ of chapter 29. ''Income'', all income, from whatever source derived, actually received by a family, excluding payments received from the fund. ''Resident'', a resident of the commonwealth.

M.G.L. c. 111K, § 2 Catastrophic illness in children relief fund commission; establishment; members

c. 111K, § 2. Catastrophic illness in children relief fund commission; establishment; members Section 2. (a) There is hereby established a catastrophic illness in children relief fund commission within the department of public health. The commission shall consist of the secretary of health and human services, the commissioner of public health, the commissioner of insurance and the state treasurer, who shall be members ex officio, and seven public members who shall be residents of the commonwealth, three of whom shall be appointed by the governor, one of whom shall be a representative of the AFL–CIO and four of whom shall be appointed upon the recommendation of the attorney general, including two of whom shall be providers of health care services to children in the commonwealth. The public members shall serve terms of five years, but the three public members first appointed by the governor shall serve for terms of two, three and four years, respectively. (b) Each public member shall hold office for the term of his appointment and until his successor has been appointed and qualified. A member of the commission is eligible for reappointment. (c) Each ex officio member of the commission may designate an employee of his department to represent him at meetings of the commission, and each designee may lawfully vote and otherwise act on behalf of the ex officio member for whom he constitutes the designee. Any designation shall be in writing delivered to the commission and filed with the secretary of state. The designation shall continue in effect until revoked or amended in the same manner as provided for in the initial designation.

M.G.L. c. 111K, § 3 Membership of commission; removal from office for cause

c. 111K, § 3. Membership of commission; removal from office for cause Section 3. (a) Each public member of the commission may be removed from the office by the governor for cause, after a public hearing, and may be suspended by the governor pending the completion of the hearing. Before entering upon their duties, members of the commission shall take and subscribe an oath to perform the duties of the office faithfully, impartially and to the best of their ability. A record of oaths shall be filed with the secretary of state. (b) Any vacancies in the membership of the commission occurring other than by expiration of a term shall be filled in the same manner as the original appointment, but for the unexpired term only.

M.G.L. c. 111K, § 4 Election of chairperson and chief executive officer by members; quorum

c. 111K, § 4. Election of chairperson and chief executive officer by members; quorum Section 4. (a) The members shall elect a chairperson and chief executive officer of the commission who shall be one of the public members of the commission. The commission shall by rule determine the term of office of the chairperson and chief executive officer. The members shall elect a secretary and a treasurer who need not be members of the commission and the same person may be elected to serve as both secretary and treasurer. (b) The powers of the commission shall be vested in its members in office from time to time and seven members of the commission shall constitute a quorum at any meeting. Actions may be taken and motions and resolutions adopted by the commission at any meeting by the affirmative vote of at least seven members of the commission. A vacancy in the membership of the commission shall not impair the right of a quorum to exercise all the powers and perform all the duties of the commission. (c) The members of the commission shall serve without compensation, but the commission shall reimburse its members for the reasonable expenses incurred in the performance of their duties based upon the monies available in the fund. (d) The commission shall be appointed not later than November 1, 2000 and shall organize as soon as may be practicable after the appointment of its members.

M.G.L. c. 111K, § 5 Powers and duties of commission

c. 111K, § 5. Powers and duties of commission Section 5. The commission shall have the following powers and duties:— (a) to establish a program to administer the fund and authorize the payment or medical reimbursement of the medical and related expenses of children with catastrophic illnesses; (b) to establish procedures for applying to the fund, determining the eligibility for the payment or reimbursement of medical expenses for each child and processing claim disputes; (c) to establish procedures for reimbursement of the fund where a family, after receiving assistance from the fund, recovers the costs for a child's medical expenses from a catastrophic illness pursuant to a settlement or judgment in a legal action; (d) to establish the amount of reimbursement for the medical expenses of each child using a sliding fee scale based on a family's ability to pay for medical expenses, which takes into account family size, family income and assets and family medical expenses; (e) to adjust the financial eligibility criteria established pursuant to section 1 based upon the monies available in the fund; (f) to disseminate information on the fund and the program to the public; (g) to maintain confidential records on each child who applies for assistance under the fund; and (h) to authorize and make payment of all administrative costs, not to exceed 10 per cent of the monies transferred into the fund in a given fiscal year or 10 per cent of the carry forward balance for any fiscal year with reduced or no transfers into the fund, related to the management of the program including, but not limited to, costs for staff to manage the program and coordinate the work assigned by the commission and materials development, printing, postage and telephone expenses; provided, however, that administrative costs shall not include staff costs related to case management services, including the evaluation and processing of applications; and (i) to review and approve annual operating expenses.

M.G.L. c. 111K, § 6 Claims for reimbursement against families who have recovered damages in legal actions for expenses

c. 111K, § 6. Claims for reimbursement against families who have recovered damages in legal actions for expenses Section 6. The commission may negotiate or settle a claim that the fund maintains for reimbursement against a family who has received assistance for the medical expenses of a child with a catastrophic illness and who has recovered damages in a legal action for such expenses. A reimbursement shall be less the expense of any recovery by the family. Money recovered pursuant to this section shall be deposited in the fund.

M.G.L. c. 111K, § 7 Application process

c. 111K, § 7. Application process Section 7. A child who is a resident of the commonwealth shall be eligible, through his or her parent or guardian, to apply to the program. As part of the application process, the commission shall screen each applicant for other sources of coverage and for potential eligibility for government programs, and to document the results of such screening. If the commission determines that an applicant is potentially eligible for Medicaid or another government program, the commission shall assist the applicant in applying for benefits under such program.

M.G.L. c. 111K, § 8 Financial assistance for eligible children

c. 111K, § 8. Financial assistance for eligible children Section 8. Whenever a child has a catastrophic illness and is eligible for the program, the child, through his parent or guardian, may receive financial assistance from monies in the fund subject to the rules and regulations established by the commission and the availability of monies in the fund. The financial assistance shall include, but is not limited to, payments or reimbursements for the costs of medical treatment, hospital care, prescription drugs, nursing care and physician services.

M.G.L. c. 111K, § 9 Monies for relief fund

c. 111K, § 9. Monies for relief fund Section 9. To provide the monies necessary to establish and meet the purposes of the fund, the commission shall receive out of the employer medical assistance contribution under section 189 of chapter 149, $1 annually for each employee whose wages determine such employer's total employer medical assistance contribution under said section 189 of said chapter 149. Said contribution shall be collected by the director of unemployment assistance and paid over to the state treasurer for deposit in the fund annually as provided by the commission.

M.G.L. c. 111K, § 10 Federal financial participation

c. 111K, § 10. Federal financial participation Section 10. The department of public health, in consultation with the division of medical assistance, the center for health information and analysis and the department of mental health, shall take all necessary steps to maximize and coordinate the availability of federal financial participation under Title XIX of the Social Security Act for the program established by this chapter to the extent that expenditures under such program are considered expenses incurred for medical assistance within the meaning of 42 U.S.C. § 1396d(a).

M.G.L. c. 111K, § 11 Annual report

c. 111K, § 11. Annual report Section 11. The commission shall report annually to the governor and the senate and house committees on ways and means. The report shall include information about the number of participants in the program, average expenditures per participant, the nature and type of catastrophic illnesses for which the fund provided financial assistance and the average income and expenditures of families who receive financial assistance under the program. The commission shall also make recommendations for changes in the law and regulations governing the fund.

Source: Massachusetts General Court (malegislature.gov)URL: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111KFetched: 10/20/2026