|
Rep. Michelle Mussman
Filed: 4/6/2018
| | 10000HB0274ham001 | | LRB100 04385 SMS 38127 a |
|
|
1 | | AMENDMENT TO HOUSE BILL 274
|
2 | | AMENDMENT NO. ______. Amend House Bill 274 by replacing |
3 | | everything after the enacting clause with the following:
|
4 | | "Section 5. The State Employees Group Insurance Act of 1971 |
5 | | is amended by changing Section 6.11 as follows:
|
6 | | (5 ILCS 375/6.11)
|
7 | | Sec. 6.11. Required health benefits; Illinois Insurance |
8 | | Code
requirements. The program of health
benefits shall provide |
9 | | the post-mastectomy care benefits required to be covered
by a |
10 | | policy of accident and health insurance under Section 356t of |
11 | | the Illinois
Insurance Code. The program of health benefits |
12 | | shall provide the coverage
required under Sections 356g, |
13 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, |
14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
15 | | 356z.14, 356z.15, 356z.17, 356z.22, and 356z.25 , 356z.26, and |
16 | | 356z.29 of the
Illinois Insurance Code.
The program of health |
|
| | 10000HB0274ham001 | - 2 - | LRB100 04385 SMS 38127 a |
|
|
1 | | benefits must comply with Sections 155.22a, 155.37, 355b, |
2 | | 356z.19, 370c, and 370c.1 of the
Illinois Insurance Code.
|
3 | | Rulemaking authority to implement Public Act 95-1045, if |
4 | | any, is conditioned on the rules being adopted in accordance |
5 | | with all provisions of the Illinois Administrative Procedure |
6 | | Act and all rules and procedures of the Joint Committee on |
7 | | Administrative Rules; any purported rule not so adopted, for |
8 | | whatever reason, is unauthorized. |
9 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; |
10 | | 100-138, eff. 8-18-17; revised 10-3-17.) |
11 | | Section 10. The Department of Public Health Powers and |
12 | | Duties Law of the
Civil Administrative Code of Illinois is |
13 | | amended by adding Section 2310-700 as follows: |
14 | | (20 ILCS 2310/2310-700 new) |
15 | | Sec. 2310-700. Contraceptive drugs and products; Director |
16 | | standing order. |
17 | | (a) As used in this Section: |
18 | | "Hormonal contraceptive" means a prescribed |
19 | | medically-acceptable oral drug, transdermal patch, or vaginal |
20 | | ring that is approved by the United States Food and Drug |
21 | | Administration to prevent pregnancy. |
22 | | "Standing order" has the meaning given to that term in the |
23 | | Pharmacy Practice Act. |
24 | | (b) If the Director of Public Health is a physician |
|
| | 10000HB0274ham001 | - 3 - | LRB100 04385 SMS 38127 a |
|
|
1 | | licensed to practice medicine in all its branches in Illinois, |
2 | | the Director shall establish a standing order complete with the |
3 | | issuance of a prescription for a hormonal contraceptive in |
4 | | accordance with this Section. If the Director is not a |
5 | | physician licensed to practice medicine in all its branches in |
6 | | Illinois, then the Medical Director of the Department of Public |
7 | | Health shall establish a standing order in accordance with this |
8 | | Section. |
9 | | (c) The standing order, at a minimum, shall comply with the |
10 | | following: |
11 | | (1) A pharmacist may dispense a 12-month supply of |
12 | | hormonal contraceptives to a patient. |
13 | | (2) A pharmacist shall have the patient complete the |
14 | | self-screening risk assessment tool. The self-screening |
15 | | risk assessment tool is to be based on the most current |
16 | | version of the United States Medical Eligibility Criteria |
17 | | for Contraceptive Use published by the federal Centers for |
18 | | Disease Control and Prevention. |
19 | | (3) Based upon the results of the self-screening risk |
20 | | assessment and the patient assessment, the pharmacist |
21 | | shall use his or her professional and clinical judgment as |
22 | | to when a patient should be referred to the patient's |
23 | | physician or another health care provider. |
24 | | (4) The pharmacist shall provide, during the patient |
25 | | assessment and consultation, counseling and education |
26 | | about all methods of contraception, including methods not |
|
| | 10000HB0274ham001 | - 4 - | LRB100 04385 SMS 38127 a |
|
|
1 | | covered under the standing order, and their proper use and |
2 | | effectiveness. |
3 | | (6) The patient consultation shall take place in a |
4 | | private manner consistent with rules adopted by the |
5 | | Department of Financial and Professional Regulation. |
6 | | (7) The Department shall adopt rules under this Section |
7 | | that require a pharmacist to: |
8 | | (A) complete an educational training program |
9 | | accredited by the Accreditation Council for Pharmacy |
10 | | Education and approved by the Department that is |
11 | | related to the patient self-screening risk assessment, |
12 | | patient assessment, contraceptive counseling and |
13 | | education, and dispensation of hormonal |
14 | | contraceptives; and |
15 | | (B) dispense the hormonal contraceptive to the |
16 | | patient as soon as practicable after meeting the |
17 | | requirements of paragraph (2). |
18 | | (8) All State and federal laws governing insurance |
19 | | coverage of contraceptive drugs shall apply to hormonal |
20 | | contraceptives dispensed by a pharmacist under this |
21 | | Section. |
22 | | Section 15. The Counties Code is amended by changing |
23 | | Section 5-1069.3 as follows: |
24 | | (55 ILCS 5/5-1069.3)
|
|
| | 10000HB0274ham001 | - 5 - | LRB100 04385 SMS 38127 a |
|
|
1 | | Sec. 5-1069.3. Required health benefits. If a county, |
2 | | including a home
rule
county, is a self-insurer for purposes of |
3 | | providing health insurance coverage
for its employees, the |
4 | | coverage shall include coverage for the post-mastectomy
care |
5 | | benefits required to be covered by a policy of accident and |
6 | | health
insurance under Section 356t and the coverage required |
7 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, |
8 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
9 | | 356z.14, 356z.15, 356z.22, and 356z.25 , 356z.26, and 356z.29 of
|
10 | | the Illinois Insurance Code. The coverage shall comply with |
11 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois |
12 | | Insurance Code. The requirement that health benefits be covered
|
13 | | as provided in this Section is an
exclusive power and function |
14 | | of the State and is a denial and limitation under
Article VII, |
15 | | Section 6, subsection (h) of the Illinois Constitution. A home
|
16 | | rule county to which this Section applies must comply with |
17 | | every provision of
this Section.
|
18 | | Rulemaking authority to implement Public Act 95-1045, if |
19 | | any, is conditioned on the rules being adopted in accordance |
20 | | with all provisions of the Illinois Administrative Procedure |
21 | | Act and all rules and procedures of the Joint Committee on |
22 | | Administrative Rules; any purported rule not so adopted, for |
23 | | whatever reason, is unauthorized. |
24 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; |
25 | | 100-138, eff. 8-18-17; revised 10-5-17.) |
|
| | 10000HB0274ham001 | - 6 - | LRB100 04385 SMS 38127 a |
|
|
1 | | Section 20. The Illinois Municipal Code is amended by |
2 | | changing Section 10-4-2.3 as follows: |
3 | | (65 ILCS 5/10-4-2.3)
|
4 | | Sec. 10-4-2.3. Required health benefits. If a |
5 | | municipality, including a
home rule municipality, is a |
6 | | self-insurer for purposes of providing health
insurance |
7 | | coverage for its employees, the coverage shall include coverage |
8 | | for
the post-mastectomy care benefits required to be covered by |
9 | | a policy of
accident and health insurance under Section 356t |
10 | | and the coverage required
under Sections 356g, 356g.5, |
11 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, |
12 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, and |
13 | | 356z.25 , 356z.26, and 356z.29 of the Illinois
Insurance
Code. |
14 | | The coverage shall comply with Sections 155.22a, 355b, 356z.19, |
15 | | and 370c of
the Illinois Insurance Code. The requirement that |
16 | | health
benefits be covered as provided in this is an exclusive |
17 | | power and function of
the State and is a denial and limitation |
18 | | under Article VII, Section 6,
subsection (h) of the Illinois |
19 | | Constitution. A home rule municipality to which
this Section |
20 | | applies must comply with every provision of this Section.
|
21 | | Rulemaking authority to implement Public Act 95-1045, if |
22 | | any, is conditioned on the rules being adopted in accordance |
23 | | with all provisions of the Illinois Administrative Procedure |
24 | | Act and all rules and procedures of the Joint Committee on |
25 | | Administrative Rules; any purported rule not so adopted, for |
|
| | 10000HB0274ham001 | - 7 - | LRB100 04385 SMS 38127 a |
|
|
1 | | whatever reason, is unauthorized. |
2 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; |
3 | | 100-138, eff. 8-18-17; revised 10-5-17.) |
4 | | Section 25. The School Code is amended by changing Section |
5 | | 10-22.3f as follows: |
6 | | (105 ILCS 5/10-22.3f)
|
7 | | Sec. 10-22.3f. Required health benefits. Insurance |
8 | | protection and
benefits
for employees shall provide the |
9 | | post-mastectomy care benefits required to be
covered by a |
10 | | policy of accident and health insurance under Section 356t and |
11 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, |
12 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, |
13 | | 356z.13, 356z.14, 356z.15, 356z.22, and 356z.25 , 356z.26, and |
14 | | 356z.29 of
the
Illinois Insurance Code.
Insurance policies |
15 | | shall comply with Section 356z.19 of the Illinois Insurance |
16 | | Code. The coverage shall comply with Sections 155.22a and 355b |
17 | | of
the Illinois Insurance Code.
|
18 | | Rulemaking authority to implement Public Act 95-1045, if |
19 | | any, is conditioned on the rules being adopted in accordance |
20 | | with all provisions of the Illinois Administrative Procedure |
21 | | Act and all rules and procedures of the Joint Committee on |
22 | | Administrative Rules; any purported rule not so adopted, for |
23 | | whatever reason, is unauthorized. |
24 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
|
| | 10000HB0274ham001 | - 8 - | LRB100 04385 SMS 38127 a |
|
|
1 | | revised 9-25-17.) |
2 | | Section 30. The Illinois Insurance Code is amended by |
3 | | adding Section 356z.29 as follows: |
4 | | (215 ILCS 5/356z.29 new) |
5 | | Sec. 356z.29. Coverage for patient care services provided |
6 | | by a pharmacist. |
7 | | (a) As used in this Section: |
8 | | "Medication therapy management services" has the meaning |
9 | | given to the term in the Pharmacy Practice Act. |
10 | | "Patient counseling" has the meaning given to the term in |
11 | | the Pharmacy Practice Act. |
12 | | "Pharmacist care" has the meaning given to the term in the |
13 | | Pharmacy Practice Act. |
14 | | "Telepharmacy" has the meaning given to the term in the |
15 | | Pharmacy Practice Act. |
16 | | (b) A group or individual policy of accident and health |
17 | | insurance or a managed care plan that is amended, delivered, |
18 | | issued, or renewed after the effective date of this amendatory |
19 | | Act of the 100th General Assembly shall provide coverage for |
20 | | patient care services provided by a pharmacist, including, but |
21 | | not limited to: medication therapy management services, |
22 | | medication optimization services, comprehensive medication |
23 | | reviews, pharmacist care services, patient counseling |
24 | | (including those provided through telepharmacy), patient |
|
| | 10000HB0274ham001 | - 9 - | LRB100 04385 SMS 38127 a |
|
|
1 | | consultations (including those provided through telepharmacy), |
2 | | disease state management (including self-management training), |
3 | | naloxone hydrochloride assessment or administration, hormonal |
4 | | contraceptives assessment and consultation, immunization |
5 | | assessment or administration, administration of medications, |
6 | | and other such services that are considered within the scope of |
7 | | practice of pharmacy under the Pharmacy Practice Act. |
8 | | Section 35. The Pharmacy Practice Act is amended by |
9 | | changing Section 3 as follows:
|
10 | | (225 ILCS 85/3)
|
11 | | (Section scheduled to be repealed on January 1, 2020)
|
12 | | Sec. 3. Definitions. For the purpose of this Act, except |
13 | | where otherwise
limited therein:
|
14 | | (a) "Pharmacy" or "drugstore" means and includes every |
15 | | store, shop,
pharmacy department, or other place where |
16 | | pharmacist
care is
provided
by a pharmacist (1) where drugs, |
17 | | medicines, or poisons are
dispensed, sold or
offered for sale |
18 | | at retail, or displayed for sale at retail; or
(2)
where
|
19 | | prescriptions of physicians, dentists, advanced practice |
20 | | registered nurses, physician assistants, veterinarians, |
21 | | podiatric physicians, or
optometrists, within the limits of |
22 | | their
licenses, are
compounded, filled, or dispensed; or (3) |
23 | | which has upon it or
displayed within
it, or affixed to or used |
24 | | in connection with it, a sign bearing the word or
words |
|
| | 10000HB0274ham001 | - 10 - | LRB100 04385 SMS 38127 a |
|
|
1 | | "Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical
Care", |
2 | | "Apothecary", "Drugstore",
"Medicine Store", "Prescriptions", |
3 | | "Drugs", "Dispensary", "Medicines", or any word
or words of |
4 | | similar or like import, either in the English language
or any |
5 | | other language; or (4) where the characteristic prescription
|
6 | | sign (Rx) or similar design is exhibited; or (5) any store, or
|
7 | | shop,
or other place with respect to which any of the above |
8 | | words, objects,
signs or designs are used in any advertisement.
|
9 | | (b) "Drugs" means and includes (1) articles recognized
in |
10 | | the official United States Pharmacopoeia/National Formulary |
11 | | (USP/NF),
or any supplement thereto and being intended for and |
12 | | having for their
main use the diagnosis, cure, mitigation, |
13 | | treatment or prevention of
disease in man or other animals, as |
14 | | approved by the United States Food and
Drug Administration, but |
15 | | does not include devices or their components, parts,
or |
16 | | accessories; and (2) all other articles intended
for and having |
17 | | for their main use the diagnosis, cure, mitigation,
treatment |
18 | | or prevention of disease in man or other animals, as approved
|
19 | | by the United States Food and Drug Administration, but does not |
20 | | include
devices or their components, parts, or accessories; and |
21 | | (3) articles
(other than food) having for their main use and |
22 | | intended
to affect the structure or any function of the body of |
23 | | man or other
animals; and (4) articles having for their main |
24 | | use and intended
for use as a component or any articles |
25 | | specified in clause (1), (2)
or (3); but does not include |
26 | | devices or their components, parts or
accessories.
|
|
| | 10000HB0274ham001 | - 11 - | LRB100 04385 SMS 38127 a |
|
|
1 | | (c) "Medicines" means and includes all drugs intended for
|
2 | | human or veterinary use approved by the United States Food and |
3 | | Drug
Administration.
|
4 | | (d) "Practice of pharmacy" means: |
5 | | (1) the interpretation and the provision of assistance |
6 | | in the monitoring, evaluation, and implementation of |
7 | | prescription drug orders; |
8 | | (2) the dispensing of prescription drug orders; |
9 | | (3) participation in drug and device selection; |
10 | | (4) drug administration limited to the administration |
11 | | of oral, topical, injectable, and inhalation as follows: |
12 | | (A) in the context of patient education on the |
13 | | proper use or delivery of medications; |
14 | | (B) vaccination of patients 14 years of age and |
15 | | older pursuant to a valid prescription or standing |
16 | | order, by a physician licensed to practice medicine in |
17 | | all its branches, upon completion of appropriate |
18 | | training, including how to address contraindications |
19 | | and adverse reactions set forth by rule, with |
20 | | notification to the patient's physician and |
21 | | appropriate record retention, or pursuant to hospital |
22 | | pharmacy and therapeutics committee policies and |
23 | | procedures; and |
24 | | (C) administration of injections of |
25 | | alpha-hydroxyprogesterone caproate, pursuant to a |
26 | | valid prescription, by a physician licensed to |
|
| | 10000HB0274ham001 | - 12 - | LRB100 04385 SMS 38127 a |
|
|
1 | | practice medicine in all its branches, upon completion |
2 | | of appropriate training, including how to address |
3 | | contraindications and adverse reactions set forth by |
4 | | rule, with notification to the patient's physician and |
5 | | appropriate record retention, or pursuant to hospital |
6 | | pharmacy and therapeutics committee policies and |
7 | | procedures; |
8 | | (5) vaccination of patients ages 10 through 13 limited |
9 | | to the Influenza (inactivated influenza vaccine and live |
10 | | attenuated influenza intranasal vaccine) and Tdap (defined |
11 | | as tetanus, diphtheria, acellular pertussis) vaccines, |
12 | | pursuant to a valid prescription or standing order, by a |
13 | | physician licensed to practice medicine in all its |
14 | | branches, upon completion of appropriate training, |
15 | | including how to address contraindications and adverse |
16 | | reactions set forth by rule, with notification to the |
17 | | patient's physician and appropriate record retention, or |
18 | | pursuant to hospital pharmacy and therapeutics committee |
19 | | policies and procedures; |
20 | | (6) drug regimen review; |
21 | | (7) drug or drug-related research; |
22 | | (8) the provision of patient counseling; |
23 | | (9) the practice of telepharmacy; |
24 | | (10) the provision of those acts or services necessary |
25 | | to provide pharmacist care; |
26 | | (11) medication therapy management; and |
|
| | 10000HB0274ham001 | - 13 - | LRB100 04385 SMS 38127 a |
|
|
1 | | (12) the responsibility for compounding and labeling |
2 | | of drugs and devices (except labeling by a manufacturer, |
3 | | repackager, or distributor of non-prescription drugs and |
4 | | commercially packaged legend drugs and devices), proper |
5 | | and safe storage of drugs and devices, and maintenance of |
6 | | required records ; and . |
7 | | (13) the dispensing of hormonal contraceptives |
8 | | pursuant to the standing order under Section 2310-700 of |
9 | | the Department of Public Health Powers and Duties Law of |
10 | | the Civil Administrative Code of Illinois. |
11 | | A pharmacist who performs any of the acts defined as the |
12 | | practice of pharmacy in this State must be actively licensed as |
13 | | a pharmacist under this Act.
|
14 | | (e) "Prescription" means and includes any written, oral, |
15 | | facsimile, or
electronically transmitted order for drugs
or |
16 | | medical devices, issued by a physician licensed to practice |
17 | | medicine in
all its branches, dentist, veterinarian, podiatric |
18 | | physician, or
optometrist, within the
limits of his or her |
19 | | license their licenses , by a physician assistant in accordance |
20 | | with
subsection (f) of Section 4, or by an advanced practice |
21 | | registered nurse in
accordance with subsection (g) of Section |
22 | | 4, containing the
following: (1) name
of the patient; (2) date |
23 | | when prescription was issued; (3) name
and strength of drug or |
24 | | description of the medical device prescribed;
and (4) quantity; |
25 | | (5) directions for use; (6) prescriber's name,
address,
and |
26 | | signature; and (7) DEA registration number where required, for |
|
| | 10000HB0274ham001 | - 14 - | LRB100 04385 SMS 38127 a |
|
|
1 | | controlled
substances.
The prescription may, but is not |
2 | | required to, list the illness, disease, or condition for which |
3 | | the drug or device is being prescribed. DEA registration |
4 | | numbers shall not be required on inpatient drug orders.
|
5 | | (f) "Person" means and includes a natural person, |
6 | | partnership,
association, corporation, government entity, or |
7 | | any other legal
entity.
|
8 | | (g) "Department" means the Department of Financial and
|
9 | | Professional Regulation.
|
10 | | (h) "Board of Pharmacy" or "Board" means the State Board
of |
11 | | Pharmacy of the Department of Financial and Professional |
12 | | Regulation.
|
13 | | (i) "Secretary"
means the Secretary
of Financial and |
14 | | Professional Regulation.
|
15 | | (j) "Drug product selection" means the interchange for a
|
16 | | prescribed pharmaceutical product in accordance with Section |
17 | | 25 of
this Act and Section 3.14 of the Illinois Food, Drug and |
18 | | Cosmetic Act.
|
19 | | (k) "Inpatient drug order" means an order issued by an |
20 | | authorized
prescriber for a resident or patient of a facility |
21 | | licensed under the
Nursing Home Care Act, the ID/DD Community |
22 | | Care Act, the MC/DD Act, the Specialized Mental Health |
23 | | Rehabilitation Act of 2013, the Hospital Licensing Act, or the |
24 | | University of Illinois Hospital Act "An Act in relation to
the |
25 | | founding and operation of the University of Illinois Hospital |
26 | | and the
conduct of University of Illinois health care |
|
| | 10000HB0274ham001 | - 15 - | LRB100 04385 SMS 38127 a |
|
|
1 | | programs", approved July 3, 1931,
as amended , or a facility |
2 | | which is operated by the Department of Human
Services (as |
3 | | successor to the Department of Mental Health
and Developmental |
4 | | Disabilities) or the Department of Corrections.
|
5 | | (k-5) "Pharmacist" means an individual health care |
6 | | professional and
provider currently licensed by this State to |
7 | | engage in the practice of
pharmacy.
|
8 | | (l) "Pharmacist in charge" means the licensed pharmacist |
9 | | whose name appears
on a pharmacy license and who is responsible |
10 | | for all aspects of the
operation related to the practice of |
11 | | pharmacy.
|
12 | | (m) "Dispense" or "dispensing" means the interpretation, |
13 | | evaluation, and implementation of a prescription drug order, |
14 | | including the preparation and delivery of a drug or device to a |
15 | | patient or patient's agent in a suitable container |
16 | | appropriately labeled for subsequent administration to or use |
17 | | by a patient in accordance with applicable State and federal |
18 | | laws and regulations.
"Dispense" or "dispensing" does not mean |
19 | | the physical delivery to a patient or a
patient's |
20 | | representative in a home or institution by a designee of a |
21 | | pharmacist
or by common carrier. "Dispense" or "dispensing" |
22 | | also does not mean the physical delivery
of a drug or medical |
23 | | device to a patient or patient's representative by a
|
24 | | pharmacist's designee within a pharmacy or drugstore while the |
25 | | pharmacist is
on duty and the pharmacy is open.
|
26 | | (n) "Nonresident pharmacy"
means a pharmacy that is located |
|
| | 10000HB0274ham001 | - 16 - | LRB100 04385 SMS 38127 a |
|
|
1 | | in a state, commonwealth, or territory
of the United States, |
2 | | other than Illinois, that delivers, dispenses, or
distributes, |
3 | | through the United States Postal Service, commercially |
4 | | acceptable parcel delivery service, or other common
carrier, to |
5 | | Illinois residents, any substance which requires a |
6 | | prescription.
|
7 | | (o) "Compounding" means the preparation and mixing of |
8 | | components, excluding flavorings, (1) as the result of a |
9 | | prescriber's prescription drug order or initiative based on the |
10 | | prescriber-patient-pharmacist relationship in the course of |
11 | | professional practice or (2) for the purpose of, or incident |
12 | | to, research, teaching, or chemical analysis and not for sale |
13 | | or dispensing. "Compounding" includes the preparation of drugs |
14 | | or devices in anticipation of receiving prescription drug |
15 | | orders based on routine, regularly observed dispensing |
16 | | patterns. Commercially available products may be compounded |
17 | | for dispensing to individual patients only if all of the |
18 | | following conditions are met: (i) the commercial product is not |
19 | | reasonably available from normal distribution channels in a |
20 | | timely manner to meet the patient's needs and (ii) the |
21 | | prescribing practitioner has requested that the drug be |
22 | | compounded.
|
23 | | (p) (Blank).
|
24 | | (q) (Blank).
|
25 | | (r) "Patient counseling" means the communication between a |
26 | | pharmacist or a student pharmacist under the supervision of a |
|
| | 10000HB0274ham001 | - 17 - | LRB100 04385 SMS 38127 a |
|
|
1 | | pharmacist and a patient or the patient's representative about |
2 | | the patient's medication or device for the purpose of |
3 | | optimizing proper use of prescription medications or devices. |
4 | | "Patient counseling" may include without limitation (1) |
5 | | obtaining a medication history; (2) acquiring a patient's |
6 | | allergies and health conditions; (3) facilitation of the |
7 | | patient's understanding of the intended use of the medication; |
8 | | (4) proper directions for use; (5) significant potential |
9 | | adverse events; (6) potential food-drug interactions; and (7) |
10 | | the need to be compliant with the medication therapy. A |
11 | | pharmacy technician may only participate in the following |
12 | | aspects of patient counseling under the supervision of a |
13 | | pharmacist: (1) obtaining medication history; (2) providing |
14 | | the offer for counseling by a pharmacist or student pharmacist; |
15 | | and (3) acquiring a patient's allergies and health conditions.
|
16 | | (s) "Patient profiles" or "patient drug therapy record" |
17 | | means the
obtaining, recording, and maintenance of patient |
18 | | prescription
information, including prescriptions for |
19 | | controlled substances, and
personal information.
|
20 | | (t) (Blank).
|
21 | | (u) "Medical device" or "device" means an instrument, |
22 | | apparatus, implement, machine,
contrivance, implant, in vitro |
23 | | reagent, or other similar or related article,
including any |
24 | | component part or accessory, required under federal law to
bear |
25 | | the label "Caution: Federal law requires dispensing by or on |
26 | | the order
of a physician". A seller of goods and services who, |
|
| | 10000HB0274ham001 | - 18 - | LRB100 04385 SMS 38127 a |
|
|
1 | | only for the purpose of
retail sales, compounds, sells, rents, |
2 | | or leases medical devices shall not,
by reasons thereof, be |
3 | | required to be a licensed pharmacy.
|
4 | | (v) "Unique identifier" means an electronic signature, |
5 | | handwritten
signature or initials, thumb print, or other |
6 | | acceptable biometric
or electronic identification process as |
7 | | approved by the Department.
|
8 | | (w) "Current usual and customary retail price" means the |
9 | | price that a pharmacy charges to a non-third-party payor.
|
10 | | (x) "Automated pharmacy system" means a mechanical system |
11 | | located within the confines of the pharmacy or remote location |
12 | | that performs operations or activities, other than compounding |
13 | | or administration, relative to storage, packaging, dispensing, |
14 | | or distribution of medication, and which collects, controls, |
15 | | and maintains all transaction information. |
16 | | (y) "Drug regimen review" means and includes the evaluation |
17 | | of prescription drug orders and patient records for (1)
known |
18 | | allergies; (2) drug or potential therapy contraindications;
|
19 | | (3) reasonable dose, duration of use, and route of |
20 | | administration, taking into consideration factors such as age, |
21 | | gender, and contraindications; (4) reasonable directions for |
22 | | use; (5) potential or actual adverse drug reactions; (6) |
23 | | drug-drug interactions; (7) drug-food interactions; (8) |
24 | | drug-disease contraindications; (9) therapeutic duplication; |
25 | | (10) patient laboratory values when authorized and available; |
26 | | (11) proper utilization (including over or under utilization) |
|
| | 10000HB0274ham001 | - 19 - | LRB100 04385 SMS 38127 a |
|
|
1 | | and optimum therapeutic outcomes; and (12) abuse and misuse.
|
2 | | (z) "Electronically transmitted prescription" means a |
3 | | prescription that is created, recorded, or stored by electronic |
4 | | means; issued and validated with an electronic signature; and |
5 | | transmitted by electronic means directly from the prescriber to |
6 | | a pharmacy. An electronic prescription is not an image of a |
7 | | physical prescription that is transferred by electronic means |
8 | | from computer to computer, facsimile to facsimile, or facsimile |
9 | | to computer.
|
10 | | (aa) "Medication therapy management services" means a |
11 | | distinct service or group of services offered by licensed |
12 | | pharmacists, physicians licensed to practice medicine in all |
13 | | its branches, advanced practice registered nurses authorized |
14 | | in a written agreement with a physician licensed to practice |
15 | | medicine in all its branches, or physician assistants |
16 | | authorized in guidelines by a supervising physician that |
17 | | optimize therapeutic outcomes for individual patients through |
18 | | improved medication use. In a retail or other non-hospital |
19 | | pharmacy, medication therapy management services shall consist |
20 | | of the evaluation of prescription drug orders and patient |
21 | | medication records to resolve conflicts with the following: |
22 | | (1) known allergies; |
23 | | (2) drug or potential therapy contraindications; |
24 | | (3) reasonable dose, duration of use, and route of |
25 | | administration, taking into consideration factors such as |
26 | | age, gender, and contraindications; |
|
| | 10000HB0274ham001 | - 20 - | LRB100 04385 SMS 38127 a |
|
|
1 | | (4) reasonable directions for use; |
2 | | (5) potential or actual adverse drug reactions; |
3 | | (6) drug-drug interactions; |
4 | | (7) drug-food interactions; |
5 | | (8) drug-disease contraindications; |
6 | | (9) identification of therapeutic duplication; |
7 | | (10) patient laboratory values when authorized and |
8 | | available; |
9 | | (11) proper utilization (including over or under |
10 | | utilization) and optimum therapeutic outcomes; and |
11 | | (12) drug abuse and misuse. |
12 | | "Medication therapy management services" includes the |
13 | | following: |
14 | | (1) documenting the services delivered and |
15 | | communicating the information provided to patients' |
16 | | prescribers within an appropriate time frame, not to exceed |
17 | | 48 hours; |
18 | | (2) providing patient counseling designed to enhance a |
19 | | patient's understanding and the appropriate use of his or |
20 | | her medications; and |
21 | | (3) providing information, support services, and |
22 | | resources designed to enhance a patient's adherence with |
23 | | his or her prescribed therapeutic regimens. |
24 | | "Medication therapy management services" may also include |
25 | | patient care functions authorized by a physician licensed to |
26 | | practice medicine in all its branches for his or her identified |
|
| | 10000HB0274ham001 | - 21 - | LRB100 04385 SMS 38127 a |
|
|
1 | | patient or groups of patients under specified conditions or |
2 | | limitations in a standing order from the physician. |
3 | | "Medication therapy management services" in a licensed |
4 | | hospital may also include the following: |
5 | | (1) reviewing assessments of the patient's health |
6 | | status; and |
7 | | (2) following protocols of a hospital pharmacy and |
8 | | therapeutics committee with respect to the fulfillment of |
9 | | medication orders.
|
10 | | (bb) "Pharmacist care" means the provision by a pharmacist |
11 | | of medication therapy management services, with or without the |
12 | | dispensing of drugs or devices, intended to achieve outcomes |
13 | | that improve patient health, quality of life, and comfort and |
14 | | enhance patient safety.
|
15 | | (cc) "Protected health information" means individually |
16 | | identifiable health information that, except as otherwise |
17 | | provided, is:
|
18 | | (1) transmitted by electronic media; |
19 | | (2) maintained in any medium set forth in the |
20 | | definition of "electronic media" in the federal Health |
21 | | Insurance Portability and Accountability Act; or |
22 | | (3) transmitted or maintained in any other form or |
23 | | medium. |
24 | | "Protected health information" does not include |
25 | | individually identifiable health information found in: |
26 | | (1) education records covered by the federal Family |
|
| | 10000HB0274ham001 | - 22 - | LRB100 04385 SMS 38127 a |
|
|
1 | | Educational Right and Privacy Act; or |
2 | | (2) employment records held by a licensee in its role |
3 | | as an employer. |
4 | | (dd) "Standing order" means a specific order for a patient |
5 | | or group of patients issued by a physician licensed to practice |
6 | | medicine in all its branches in Illinois. |
7 | | (ee) "Address of record" means the designated address |
8 | | recorded by the Department in the applicant's application file |
9 | | or licensee's license file maintained by the Department's |
10 | | licensure maintenance unit. |
11 | | (ff) "Home pharmacy" means the location of a pharmacy's |
12 | | primary operations.
|
13 | | (gg) "Email address of record" means the designated email |
14 | | address recorded by the Department in the applicant's |
15 | | application file or the licensee's license file, as maintained |
16 | | by the Department's licensure maintenance unit. |
17 | | (Source: P.A. 99-180, eff. 7-29-15; 100-208, eff. 1-1-18; |
18 | | 100-497, eff. 9-8-17; 100-513, eff. 1-1-18; revised 9-29-17.) |
19 | | Section 40. The Illinois Public Aid Code is amended by |
20 | | adding Section 5-5.12b as follows: |
21 | | (305 ILCS 5/5-5.12b new) |
22 | | Sec. 5-5.12b. Coverage for patient care services provided |
23 | | by a pharmacist. |
24 | | (a) As used in this Section: |
|
| | 10000HB0274ham001 | - 23 - | LRB100 04385 SMS 38127 a |
|
|
1 | | "Medication therapy management services" has the meaning |
2 | | given to the term in the Pharmacy Practice Act. |
3 | | "Patient counseling" has the meaning given to the term in |
4 | | the Pharmacy Practice Act. |
5 | | "Pharmacist care" has the meaning given to the term in the |
6 | | Pharmacy Practice Act. |
7 | | "Telepharmacy" has the meaning given to the term in the |
8 | | Pharmacy Practice Act. |
9 | | (b) Subject to approval by the federal Centers for Medicare |
10 | | and Medicaid Services, the medical assistance program, |
11 | | including both the fee-for-service and managed care medical |
12 | | assistance programs established under this Article, shall |
13 | | cover patient care services provided by a pharmacist. |
14 | | (c) The Department shall establish a fee schedule for the |
15 | | list of pharmacist-provided patient care services. |
16 | | (d) The rate of reimbursement for pharmacist-provided |
17 | | patient care services shall be at 85% of the fee schedule for |
18 | | physician services by the medical assistance program. |
19 | | (e) The covered pharmacist-provided patient care services |
20 | | include, but are not limited to: medication therapy management |
21 | | services, medication optimization services, comprehensive |
22 | | medication reviews, pharmacist care services, patient |
23 | | counseling (including those provided through telepharmacy), |
24 | | patient consultations (including those provided through |
25 | | telepharmacy), disease state management (including |
26 | | self-management training), naloxone hydrochloride assessment |
|
| | 10000HB0274ham001 | - 24 - | LRB100 04385 SMS 38127 a |
|
|
1 | | or administration, hormonal contraceptives assessment and |
2 | | consultation, immunization assessment or administration, |
3 | | administration of medications, and other such services that are |
4 | | considered within the scope of practice of pharmacy under the |
5 | | Pharmacy Practice Act. |
6 | | (f) A pharmacist must be enrolled in the medical assistance |
7 | | program as an ordering and referring provider prior to |
8 | | rendering a pharmacist-provided patient care service that is |
9 | | submitted by a pharmacy or pharmacist provider for |
10 | | reimbursement pursuant to this Section. |
11 | | (g) The Director shall seek any necessary federal waivers |
12 | | or approvals to implement this Section. This Section shall not |
13 | | be implemented until the receipt of all necessary federal |
14 | | waivers or approvals and shall be implemented only to the |
15 | | extent that federal financial participation is available. |
16 | | (h) This Section does not restrict or prohibit any services |
17 | | currently provided by pharmacists as authorized by law, |
18 | | including, but not limited to, pharmacist services provided |
19 | | under this Code or authorized under the Illinois XIX State |
20 | | Plan. |
21 | | (i) The Department shall adopt administrative rules for |
22 | | this Section as soon as practicable but no later than May 1, |
23 | | 2019.
|
24 | | Section 99. Effective date. This Act takes effect January |
25 | | 1, 2019.".
|