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Public Act 095-0208 |
HB1257 Enrolled |
LRB095 07696 DRJ 27850 b |
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AN ACT concerning aging.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Senior Citizens and Disabled Persons |
Property Tax Relief and
Pharmaceutical Assistance Act is |
amended by changing Section 4 as follows:
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(320 ILCS 25/4) (from Ch. 67 1/2, par. 404)
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Sec. 4. Amount of Grant.
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(a) In general. Any individual 65 years or older or any |
individual who will
become 65 years old during the calendar |
year in which a claim is filed, and any
surviving spouse of |
such a claimant, who at the time of death received or was
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entitled to receive a grant pursuant to this Section, which |
surviving spouse
will become 65 years of age within the 24 |
months immediately following the
death of such claimant and |
which surviving spouse but for his or her age is
otherwise |
qualified to receive a grant pursuant to this Section, and any
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disabled person whose annual household income is less than |
$14,000 for grant
years before the 1998 grant year, less than |
$16,000 for the 1998 and 1999
grant years, and less than (i) |
$21,218 for a household containing one person,
(ii) $28,480 for |
a household containing 2 persons, or (iii) $35,740 for a
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household containing 3 or more persons for the 2000 grant year |
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and thereafter
and whose household is liable for payment of |
property taxes accrued or has
paid rent constituting property |
taxes accrued and is domiciled in this State
at the time he or |
she files his or her claim is entitled to claim a
grant under |
this Act.
With respect to claims filed by individuals who will |
become 65 years old
during the calendar year in which a claim |
is filed, the amount of any grant
to which that household is |
entitled shall be an amount equal to 1/12 of the
amount to |
which the claimant would otherwise be entitled as provided in
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this Section, multiplied by the number of months in which the |
claimant was
65 in the calendar year in which the claim is |
filed.
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(b) Limitation. Except as otherwise provided in |
subsections (a) and (f)
of this Section, the maximum amount of |
grant which a claimant is
entitled to claim is the amount by |
which the property taxes accrued which
were paid or payable |
during the last preceding tax year or rent
constituting |
property taxes accrued upon the claimant's residence for the
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last preceding taxable year exceeds 3 1/2% of the claimant's |
household
income for that year but in no event is the grant to |
exceed (i) $700 less
4.5% of household income for that year for |
those with a household income of
$14,000 or less or (ii) $70 if |
household income for that year is more than
$14,000.
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(c) Public aid recipients. If household income in one or |
more
months during a year includes cash assistance in excess of |
$55 per month
from the Department of Healthcare and Family |
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Services or the Department of Human Services (acting
as |
successor to the Department of Public Aid under the Department |
of Human
Services Act) which was determined under regulations |
of
that Department on a measure of need that included an |
allowance for actual
rent or property taxes paid by the |
recipient of that assistance, the amount
of grant to which that |
household is entitled, except as otherwise provided in
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subsection (a), shall be the product of (1) the maximum amount |
computed as
specified in subsection (b) of this Section and (2) |
the ratio of the number of
months in which household income did |
not include such cash assistance over $55
to the number twelve. |
If household income did not include such cash assistance
over |
$55 for any months during the year, the amount of the grant to |
which the
household is entitled shall be the maximum amount |
computed as specified in
subsection (b) of this Section. For |
purposes of this paragraph (c), "cash
assistance" does not |
include any amount received under the federal Supplemental
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Security Income (SSI) program.
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(d) Joint ownership. If title to the residence is held |
jointly by
the claimant with a person who is not a member of |
his or her household,
the amount of property taxes accrued used |
in computing the amount of grant
to which he or she is entitled |
shall be the same percentage of property
taxes accrued as is |
the percentage of ownership held by the claimant in the
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residence.
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(e) More than one residence. If a claimant has occupied |
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more than
one residence in the taxable year, he or she may |
claim only one residence
for any part of a month. In the case |
of property taxes accrued, he or she
shall prorate 1/12 of the |
total property taxes accrued on
his or her residence to each |
month that he or she owned and occupied
that residence; and, in |
the case of rent constituting property taxes accrued,
shall |
prorate each month's rent payments to the residence
actually |
occupied during that month.
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(f) There is hereby established a program of pharmaceutical |
assistance
to the aged and disabled which shall be administered |
by the Department in
accordance with this Act, to consist of |
payments to authorized pharmacies, on
behalf of beneficiaries |
of the program, for the reasonable costs of covered
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prescription drugs. Each beneficiary who pays $5 for an |
identification card
shall pay no additional prescription |
costs. Each beneficiary who pays $25 for
an identification card |
shall pay $3 per prescription. In addition, after a
beneficiary |
receives $2,000 in benefits during a State fiscal year, that
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beneficiary shall also be charged 20% of the cost of each |
prescription for
which payments are made by the program during |
the remainder of the fiscal
year. To become a beneficiary under |
this program a person must: (1)
be (i) 65 years of age or |
older, or (ii) the surviving spouse of such
a claimant, who at |
the time of death received or was entitled to receive
benefits |
pursuant to this subsection, which surviving spouse will become |
65
years of age within the 24 months immediately following the |
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death of such
claimant and which surviving spouse but for his |
or her age is otherwise
qualified to receive benefits pursuant |
to this subsection, or (iii) disabled,
and (2) be domiciled in |
this State at the time he or she files
his or her claim, and (3) |
have a maximum household income of less
than $14,000 for grant |
years before the 1998 grant year, less than $16,000
for the |
1998 and 1999 grant years, and less than (i) $21,218 for a |
household
containing one person, (ii) $28,480 for a household |
containing 2 persons, or
(iii) $35,740 for a household |
containing 3 more persons for the 2000 grant
year
and |
thereafter. In addition, each eligible person must (1) obtain |
an
identification card from the Department, (2) at the time the |
card is obtained,
sign a statement assigning to the State of |
Illinois benefits which may be
otherwise claimed under any |
private insurance plans, and (3) present the
identification |
card to the dispensing pharmacist.
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The Department may adopt rules specifying
participation
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requirements for the pharmaceutical assistance program, |
including copayment
amounts,
identification card fees, |
expenditure limits, and the benefit threshold after
which a 20% |
charge is imposed on the cost of each prescription, to be in
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effect on and
after July 1, 2004.
Notwithstanding any other |
provision of this paragraph, however, the Department
may not
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increase the identification card fee above the amount in effect |
on May 1, 2003
without
the express consent of the General |
Assembly.
To the extent practicable, those requirements shall |
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be
commensurate
with the requirements provided in rules adopted |
by the Department of Healthcare and Family Services
to
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implement the pharmacy assistance program under Section |
5-5.12a of the Illinois
Public
Aid Code.
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Whenever a generic equivalent for a covered prescription |
drug is available,
the Department shall reimburse only for the |
reasonable costs of the generic
equivalent, less the co-pay |
established in this Section, unless (i) the covered
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prescription drug contains one or more ingredients defined as a |
narrow
therapeutic index drug at 21 CFR 320.33, (ii) the |
prescriber indicates on the
face of the prescription "brand |
medically necessary", and (iii) the prescriber
specifies that a |
substitution is not permitted. When issuing an oral
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prescription for covered prescription medication described in |
item (i) of this
paragraph, the prescriber shall stipulate |
"brand medically necessary" and
that a substitution is not |
permitted. If the covered prescription drug and its
authorizing |
prescription do not meet the criteria listed above, the |
beneficiary
may purchase the non-generic equivalent of the |
covered prescription drug by
paying the difference between the |
generic cost and the non-generic cost plus
the beneficiary |
co-pay.
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Any person otherwise eligible for pharmaceutical |
assistance under this
Act whose covered drugs are covered by |
any public program for assistance in
purchasing any covered |
prescription drugs shall be ineligible for assistance
under |
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this Act to the extent such costs are covered by such other |
plan.
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The fee to be charged by the Department for the |
identification card shall
be equal to $5 per coverage year for |
persons below the official poverty line
as defined by the |
United States Department of Health and Human Services and
$25 |
per coverage year for all other persons.
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In the event that 2 or more persons are eligible for any |
benefit under
this Act, and are members of the same household, |
(1) each such person shall
be entitled to participate in the |
pharmaceutical assistance program, provided
that he or she |
meets all other requirements imposed by this subsection
and (2) |
each participating household member contributes the fee |
required
for that person by the preceding paragraph for the |
purpose
of obtaining an identification card. |
The provisions of this subsection (f), other than this |
paragraph, are inoperative after December 31, 2005. |
Beneficiaries who received benefits under the program |
established by this subsection (f) are not entitled, at the |
termination of the program, to any refund of the identification |
card fee paid under this subsection. |
(g) Effective January 1, 2006, there is hereby established |
a program of pharmaceutical assistance to the aged and |
disabled, entitled the Illinois Seniors and Disabled Drug |
Coverage Program, which shall be administered by the Department |
of Healthcare and Family Services and the Department on Aging |
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in accordance with this subsection, to consist of coverage of |
specified prescription drugs on behalf of beneficiaries of the |
program as set forth in this subsection. The program under this |
subsection replaces and supersedes the program established |
under subsection (f), which shall end at midnight on December |
31, 2005. |
To become a beneficiary under the program established under |
this subsection, a person must: |
(1) be (i) 65 years of age or older or (ii) disabled; |
and |
(2) be domiciled in this State; and |
(3) enroll with a qualified Medicare Part D |
Prescription Drug Plan if eligible and apply for all |
available subsidies under Medicare Part D; and |
(4) have a maximum household income of (i) less than |
$21,218 for a household containing one person, (ii) less |
than $28,480 for a household containing 2 persons, or (iii) |
less than $35,740 for a household containing 3 or more |
persons. If any income eligibility limit set forth in items |
(i) through (iii) is less than 200% of the Federal Poverty |
Level for any year, the income eligibility limit for that |
year for households of that size shall be income equal to |
or less than 200% of the Federal Poverty Level. |
All individuals enrolled as of December 31, 2005, in the |
pharmaceutical assistance program operated pursuant to |
subsection (f) of this Section and all individuals enrolled as |
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of December 31, 2005, in the SeniorCare Medicaid waiver program |
operated pursuant to Section 5-5.12a of the Illinois Public Aid |
Code shall be automatically enrolled in the program established |
by this subsection for the first year of operation without the |
need for further application, except that they must apply for |
Medicare Part D and the Low Income Subsidy under Medicare Part |
D. A person enrolled in the pharmaceutical assistance program |
operated pursuant to subsection (f) of this Section as of |
December 31, 2005, shall not lose eligibility in future years |
due only to the fact that they have not reached the age of 65. |
To the extent permitted by federal law, the Department may |
act as an authorized representative of a beneficiary in order |
to enroll the beneficiary in a Medicare Part D Prescription |
Drug Plan if the beneficiary has failed to choose a plan and, |
where possible, to enroll beneficiaries in the low-income |
subsidy program under Medicare Part D or assist them in |
enrolling in that program. |
Beneficiaries under the program established under this |
subsection shall be divided into the following 5 eligibility |
groups: |
(A) Eligibility Group 1 shall consist of beneficiaries |
who are not eligible for Medicare Part D coverage and who
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are: |
(i) disabled and under age 65; or |
(ii) age 65 or older, with incomes over 200% of the |
Federal Poverty Level; or |
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(iii) age 65 or older, with incomes at or below |
200% of the Federal Poverty Level and not eligible for |
federally funded means-tested benefits due to |
immigration status. |
(B) Eligibility Group 2 shall consist of beneficiaries |
otherwise described in Eligibility Group 1 but who are |
eligible for Medicare Part D coverage. |
(C) Eligibility Group 3 shall consist of beneficiaries |
age 65 or older, with incomes at or below 200% of the |
Federal Poverty Level, who are not barred from receiving |
federally funded means-tested benefits due to immigration |
status and are eligible for Medicare Part D coverage. |
(D) Eligibility Group 4 shall consist of beneficiaries |
age 65 or older, with incomes at or below 200% of the |
Federal Poverty Level, who are not barred from receiving |
federally funded means-tested benefits due to immigration |
status and are not eligible for Medicare Part D coverage. |
If the State applies and receives federal approval for |
a waiver under Title XIX of the Social Security Act, |
persons in Eligibility Group 4 shall continue to receive |
benefits through the approved waiver, and Eligibility |
Group 4 may be expanded to include disabled persons under |
age 65 with incomes under 200% of the Federal Poverty Level |
who are not eligible for Medicare and who are not barred |
from receiving federally funded means-tested benefits due |
to immigration status. |
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(E) On and after January 1, 2007, Eligibility Group 5 |
shall consist of beneficiaries who are otherwise described |
in Eligibility Groups 2 and 3 who
Group 1 but are eligible |
for Medicare Part D and have a diagnosis of HIV or AIDS.
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The program established under this subsection shall cover |
the cost of covered prescription drugs in excess of the |
beneficiary cost-sharing amounts set forth in this paragraph |
that are not covered by Medicare. In 2006, beneficiaries shall |
pay a co-payment of $2 for each prescription of a generic drug |
and $5 for each prescription of a brand-name drug. In future |
years, beneficiaries shall pay co-payments equal to the |
co-payments required under Medicare Part D for "other |
low-income subsidy eligible individuals" pursuant to 42 CFR |
423.782(b). For individuals in Eligibility Groups 1, 2, 3, and |
4, once the program established under this subsection and |
Medicare combined have paid $1,750 in a year for covered |
prescription drugs, the beneficiary shall pay 20% of the cost |
of each prescription in addition to the co-payments set forth |
in this paragraph. For individuals in Eligibility Group 5, once |
the program established under this subsection and Medicare |
combined have paid $1,750 in a year for covered prescription |
drugs, the beneficiary shall pay 20% of the cost of each |
prescription in addition to the co-payments set forth in this |
paragraph unless the drug is included in the formulary of the |
Illinois AIDS Drug Assistance Program operated by the Illinois |
Department of Public Health. If the drug is included in the |
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formulary of the Illinois AIDS Drug Assistance Program, |
individuals in Eligibility Group 5 shall continue to pay the |
co-payments set forth in this paragraph after the program |
established under this subsection and Medicare combined have |
paid $1,750 in a year for covered prescription drugs.
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For beneficiaries eligible for Medicare Part D coverage, |
the program established under this subsection shall pay 100% of |
the premiums charged by a qualified Medicare Part D |
Prescription Drug Plan for Medicare Part D basic prescription |
drug coverage, not including any late enrollment penalties. |
Qualified Medicare Part D Prescription Drug Plans may be |
limited by the Department of Healthcare and Family Services to |
those plans that sign a coordination agreement with the |
Department. |
Notwithstanding Section 3.15, for purposes of the program |
established under this subsection, the term "covered |
prescription drug" has the following meanings: |
For Eligibility Group 1, "covered prescription drug" |
means: (1) any cardiovascular agent or drug; (2) any |
insulin or other prescription drug used in the treatment of |
diabetes, including syringe and needles used to administer |
the insulin; (3) any prescription drug used in the |
treatment of arthritis; (4) any prescription drug used in |
the treatment of cancer; (5) any prescription drug used in |
the treatment of Alzheimer's disease; (6) any prescription |
drug used in the treatment of Parkinson's disease; (7) any |
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prescription drug used in the treatment of glaucoma; (8) |
any prescription drug used in the treatment of lung disease |
and smoking-related illnesses; (9) any prescription drug |
used in the treatment of osteoporosis; and (10) any |
prescription drug used in the treatment of multiple |
sclerosis. The Department may add additional therapeutic |
classes by rule. The Department may adopt a preferred drug |
list within any of the classes of drugs described in items |
(1) through (10) of this paragraph. The specific drugs or |
therapeutic classes of covered prescription drugs shall be |
indicated by rule. |
For Eligibility Group 2, "covered prescription drug" |
means those drugs covered for Eligibility Group 1 that are |
also covered by the Medicare Part D Prescription Drug Plan |
in which the beneficiary is enrolled. |
For Eligibility Group 3, "covered prescription drug" |
means those drugs covered by the Medicare Part D |
Prescription Drug Plan in which the beneficiary is |
enrolled. |
For Eligibility Group 4, "covered prescription drug" |
means those drugs covered by the Medical Assistance Program |
under Article V of the Illinois Public Aid Code. |
For Eligibility Group 5, for individuals otherwise |
described in Eligibility Group 2, "covered prescription |
drug" means:
(1) those drugs covered for Eligibility Group |
2
1 that are also covered by the Medicare Part D |
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Prescription Drug Plan in which the beneficiary is |
enrolled; and
(2) those drugs included in the formulary of |
the Illinois AIDS Drug Assistance Program operated by the |
Illinois Department of Public Health that are also covered |
by the Medicare Part D Prescription Drug Plan in which the |
beneficiary is enrolled.
For Eligibility Group 5, for |
individuals otherwise described in Eligibility Group 3, |
"covered prescription drug" means those drugs covered by |
the Medicare Part D Prescription Drug Plan in which the |
beneficiary is enrolled.
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An individual in Eligibility Group 1, 2, 3 ,
or 4 , or 5 may |
opt to receive a $25 monthly payment in lieu of the direct |
coverage described in this subsection. |
Any person otherwise eligible for pharmaceutical |
assistance under this subsection whose covered drugs are |
covered by any public program is ineligible for assistance |
under this subsection to the extent that the cost of those |
drugs is covered by the other program. |
The Department of Healthcare and Family Services shall |
establish by rule the methods by which it will provide for the |
coverage called for in this subsection. Those methods may |
include direct reimbursement to pharmacies or the payment of a |
capitated amount to Medicare Part D Prescription Drug Plans. |
For a pharmacy to be reimbursed under the program |
established under this subsection, it must comply with rules |
adopted by the Department of Healthcare and Family Services |
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regarding coordination of benefits with Medicare Part D |
Prescription Drug Plans. A pharmacy may not charge a |
Medicare-enrolled beneficiary of the program established under |
this subsection more for a covered prescription drug than the |
appropriate Medicare cost-sharing less any payment from or on |
behalf of the Department of Healthcare and Family Services. |
The Department of Healthcare and Family Services or the |
Department on Aging, as appropriate, may adopt rules regarding |
applications, counting of income, proof of Medicare status, |
mandatory generic policies, and pharmacy reimbursement rates |
and any other rules necessary for the cost-efficient operation |
of the program established under this subsection.
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(Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; 94-909, |
eff. 6-23-06.)
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Section 99. Effective date. This Act takes effect upon |
becoming law.
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