HB0591 102ND GENERAL ASSEMBLY

LRB102 14191 KTG 19543 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB0591

Introduced 2/8/2021, by Rep. La Shawn K. Ford - Kelly M. Cassidy - Carol Ammons - Terra Costa Howard - Lindsey LaPointe

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.12d new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to permit medical assistance recipients, including those enrolled in managed care, to obtain pharmacy services from the pharmacy of their choice if the pharmacy is licensed under the Pharmacy Practice Act and accepts the professional dispensing fee for pharmacy services as determined by the Department. Provides that no managed care organization that contracts with the Department to provide services to recipients may restrict a recipient's access to pharmacy services to a selected group of pharmacies. Provides that if a managed care organization merges with or is acquired by another entity, the resulting entity may not restrict a recipient's access to pharmacy services to a selected group of pharmacies. Permits the Department to renegotiate with the resulting entity the terms of the managed care contract the Department had with the original managed care organization prior to the merger or acquisition. Requires the Department to contract with an independent research organization to conduct a study and submit a report on those managed care organizations that are contracted to provide services to recipients. Requires the report to include an analysis of pharmacy access for medical assistance recipients with the aim of identifying "pharmacy deserts"; an analysis of the costs and benefits of having managed care organizations administer health care services, including pharmacy services, to recipients; and other matters. Prohibits the Department from entering into any new contract with a managed care organization before the report has been received and analyzed by the Department and posted on its website. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by adding Section 5-5.12d as follows:

(305 ILCS 5/5-5.12d new)

Sec. 5-5.12d. Pharmacy access in managed care; analysis report.

(a) To improve access to pharmacy services for recipients of medical assistance, including those who are enrolled in the State's managed care medical assistance program, the Department shall permit recipients to obtain pharmacy services from the pharmacy of their choice if the pharmacy is licensed under the Pharmacy Practice Act and accepts the professional dispensing fee for pharmacy services as determined by the Department.

(b) No managed care organization that contracts with the Department to provide services under the State's managed care medical assistance program may restrict a recipient's access to pharmacy services to a selected group of pharmacies. If a managed care organization merges with or is acquired by another entity, the resulting entity may not restrict a recipient's access to pharmacy services to a selected group of pharmacies. In the case of a merger or acquisition, the Department may renegotiate with the resulting entity the terms of the managed care contract the Department had with the original managed care organization prior to the merger or acquisition.

(c) No later than 3 months after the effective date of this amendatory Act of the 102nd General Assembly, the Department shall enter into a contract with an independent research organization to conduct a study and analysis of those managed care organizations that are contracted to provide services under the State's managed care medical assistance program. The independent research organization must have no affiliation with managed care organizations and must submit a report of its findings and analysis to the Department within 90 days after entering into a contract with the Department. The report must include the following:

(1) An analysis of pharmacy access for recipients of medical assistance with the aim of identifying "pharmacy deserts", which are areas without accessible pharmacy services for community residents. The analysis must focus especially on those areas of high social vulnerability indices with the aim of creating patient-relevant and research-based standards of distances from the recipient's residence to pharmacies that are based on roads or streets, including bus routes, traveled by recipients. This part of the analysis must not use aerial distances. Pharmacy access standards must be differentiated in rural, suburban, and urban areas. For example, the 15-mile access standard applies for rural areas, less than 5 miles for suburban, and less than 1/2 mile or one mile in urban areas that are low-income. The assessment must be detailed enough to help the Department propose a plan to meet the need for pharmacy services in the pharmacy deserts identified in the report.

(2) An analysis of the costs and benefits of having managed care organizations administer health care services, including pharmacy services, under the State's managed care medical assistance program.

(3) A detailed analysis of the overhead administrative costs associated with the provision of pharmacy services under the State's managed care medical assistance program in comparison with the overhead administrative costs associated with the provision of pharmacy services under the State's traditional fee-for-service program.

(4) A detailed survey based on significant input from both recipients and pharmacy providers regarding their assessment of pharmacy services provided under the State's managed care medical assistance program.

The Department may not enter into any new contract with a managed care organization to provide health care services, including pharmacy services, to recipients before the report from the independent research organization has been received and analyzed by the Department and posted on the Department's website.

Section 99. Effective date. This Act takes effect upon becoming law.