94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB4713

 

Introduced 1/12/2006, by Rep. Linda Chapa LaVia

 

SYNOPSIS AS INTRODUCED:
 
320 ILCS 25/4   from Ch. 67 1/2, par. 404

    Amends the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act. Creates a program of hearing aid assistance to the aged and disabled. Provides that, to offset the cost of the hearing aids, a person entitled to claim a grant under certain provisions of the Act is entitled to receive a payment of up to $100 each calendar year in which he or she purchases a hearing aid for his or her personal use. Creates a program of dental services assistance to the aged and disabled. Provides that to offset the cost of the dental services, a person entitled to claim a grant under certain provisions of the Act is entitled to receive a payment of up to $500 each calendar year in which he or she purchases dental services for his or her personal use.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1     AN ACT concerning aging.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Senior Citizens and Disabled Persons
5 Property Tax Relief and Pharmaceutical Assistance Act is
6 amended by changing Section 4 as follows:
 
7     (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
8     Sec. 4. Amount of Grant.
9     (a) In general. Any individual 65 years or older or any
10 individual who will become 65 years old during the calendar
11 year in which a claim is filed, and any surviving spouse of
12 such a claimant, who at the time of death received or was
13 entitled to receive a grant pursuant to this Section, which
14 surviving spouse will become 65 years of age within the 24
15 months immediately following the death of such claimant and
16 which surviving spouse but for his or her age is otherwise
17 qualified to receive a grant pursuant to this Section, and any
18 disabled person whose annual household income is less than
19 $14,000 for grant years before the 1998 grant year, less than
20 $16,000 for the 1998 and 1999 grant years, and less than (i)
21 $21,218 for a household containing one person, (ii) $28,480 for
22 a household containing 2 persons, or (iii) $35,740 for a
23 household containing 3 or more persons for the 2000 grant year
24 and thereafter and whose household is liable for payment of
25 property taxes accrued or has paid rent constituting property
26 taxes accrued and is domiciled in this State at the time he or
27 she files his or her claim is entitled to claim a grant under
28 this Act. With respect to claims filed by individuals who will
29 become 65 years old during the calendar year in which a claim
30 is filed, the amount of any grant to which that household is
31 entitled shall be an amount equal to 1/12 of the amount to
32 which the claimant would otherwise be entitled as provided in

 

 

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1 this Section, multiplied by the number of months in which the
2 claimant was 65 in the calendar year in which the claim is
3 filed.
4     (b) Limitation. Except as otherwise provided in
5 subsections (a) and (f) of this Section, the maximum amount of
6 grant which a claimant is entitled to claim is the amount by
7 which the property taxes accrued which were paid or payable
8 during the last preceding tax year or rent constituting
9 property taxes accrued upon the claimant's residence for the
10 last preceding taxable year exceeds 3 1/2% of the claimant's
11 household income for that year but in no event is the grant to
12 exceed (i) $700 less 4.5% of household income for that year for
13 those with a household income of $14,000 or less or (ii) $70 if
14 household income for that year is more than $14,000.
15     (c) Public aid recipients. If household income in one or
16 more months during a year includes cash assistance in excess of
17 $55 per month from the Department of Healthcare and Family
18 Services Public Aid or the Department of Human Services (acting
19 as successor to the Department of Public Aid under the
20 Department of Human Services Act) which was determined under
21 regulations of that Department on a measure of need that
22 included an allowance for actual rent or property taxes paid by
23 the recipient of that assistance, the amount of grant to which
24 that household is entitled, except as otherwise provided in
25 subsection (a), shall be the product of (1) the maximum amount
26 computed as specified in subsection (b) of this Section and (2)
27 the ratio of the number of months in which household income did
28 not include such cash assistance over $55 to the number twelve.
29 If household income did not include such cash assistance over
30 $55 for any months during the year, the amount of the grant to
31 which the household is entitled shall be the maximum amount
32 computed as specified in subsection (b) of this Section. For
33 purposes of this paragraph (c), "cash assistance" does not
34 include any amount received under the federal Supplemental
35 Security Income (SSI) program.
36     (d) Joint ownership. If title to the residence is held

 

 

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1 jointly by the claimant with a person who is not a member of
2 his or her household, the amount of property taxes accrued used
3 in computing the amount of grant to which he or she is entitled
4 shall be the same percentage of property taxes accrued as is
5 the percentage of ownership held by the claimant in the
6 residence.
7     (e) More than one residence. If a claimant has occupied
8 more than one residence in the taxable year, he or she may
9 claim only one residence for any part of a month. In the case
10 of property taxes accrued, he or she shall prorate 1/12 of the
11 total property taxes accrued on his or her residence to each
12 month that he or she owned and occupied that residence; and, in
13 the case of rent constituting property taxes accrued, shall
14 prorate each month's rent payments to the residence actually
15 occupied during that month.
16     (f) There is hereby established a program of pharmaceutical
17 assistance to the aged and disabled which shall be administered
18 by the Department in accordance with this Act, to consist of
19 payments to authorized pharmacies, on behalf of beneficiaries
20 of the program, for the reasonable costs of covered
21 prescription drugs. Each beneficiary who pays $5 for an
22 identification card shall pay no additional prescription
23 costs. Each beneficiary who pays $25 for an identification card
24 shall pay $3 per prescription. In addition, after a beneficiary
25 receives $2,000 in benefits during a State fiscal year, that
26 beneficiary shall also be charged 20% of the cost of each
27 prescription for which payments are made by the program during
28 the remainder of the fiscal year. To become a beneficiary under
29 this program a person must: (1) be (i) 65 years of age or
30 older, or (ii) the surviving spouse of such a claimant, who at
31 the time of death received or was entitled to receive benefits
32 pursuant to this subsection, which surviving spouse will become
33 65 years of age within the 24 months immediately following the
34 death of such claimant and which surviving spouse but for his
35 or her age is otherwise qualified to receive benefits pursuant
36 to this subsection, or (iii) disabled, and (2) be domiciled in

 

 

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1 this State at the time he or she files his or her claim, and (3)
2 have a maximum household income of less than $14,000 for grant
3 years before the 1998 grant year, less than $16,000 for the
4 1998 and 1999 grant years, and less than (i) $21,218 for a
5 household containing one person, (ii) $28,480 for a household
6 containing 2 persons, or (iii) $35,740 for a household
7 containing 3 more persons for the 2000 grant year and
8 thereafter. In addition, each eligible person must (1) obtain
9 an identification card from the Department, (2) at the time the
10 card is obtained, sign a statement assigning to the State of
11 Illinois benefits which may be otherwise claimed under any
12 private insurance plans, and (3) present the identification
13 card to the dispensing pharmacist.
14     The Department may adopt rules specifying participation
15 requirements for the pharmaceutical assistance program,
16 including copayment amounts, identification card fees,
17 expenditure limits, and the benefit threshold after which a 20%
18 charge is imposed on the cost of each prescription, to be in
19 effect on and after July 1, 2004. Notwithstanding any other
20 provision of this paragraph, however, the Department may not
21 increase the identification card fee above the amount in effect
22 on May 1, 2003 without the express consent of the General
23 Assembly. To the extent practicable, those requirements shall
24 be commensurate with the requirements provided in rules adopted
25 by the Department of Healthcare and Family Services Public Aid
26 to implement the pharmacy assistance program under Section
27 5-5.12a of the Illinois Public Aid Code.
28     Whenever a generic equivalent for a covered prescription
29 drug is available, the Department shall reimburse only for the
30 reasonable costs of the generic equivalent, less the co-pay
31 established in this Section, unless (i) the covered
32 prescription drug contains one or more ingredients defined as a
33 narrow therapeutic index drug at 21 CFR 320.33, (ii) the
34 prescriber indicates on the face of the prescription "brand
35 medically necessary", and (iii) the prescriber specifies that a
36 substitution is not permitted. When issuing an oral

 

 

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1 prescription for covered prescription medication described in
2 item (i) of this paragraph, the prescriber shall stipulate
3 "brand medically necessary" and that a substitution is not
4 permitted. If the covered prescription drug and its authorizing
5 prescription do not meet the criteria listed above, the
6 beneficiary may purchase the non-generic equivalent of the
7 covered prescription drug by paying the difference between the
8 generic cost and the non-generic cost plus the beneficiary
9 co-pay.
10     Any person otherwise eligible for pharmaceutical
11 assistance under this Act whose covered drugs are covered by
12 any public program for assistance in purchasing any covered
13 prescription drugs shall be ineligible for assistance under
14 this Act to the extent such costs are covered by such other
15 plan.
16     The fee to be charged by the Department for the
17 identification card shall be equal to $5 per coverage year for
18 persons below the official poverty line as defined by the
19 United States Department of Health and Human Services and $25
20 per coverage year for all other persons.
21     In the event that 2 or more persons are eligible for any
22 benefit under this Act, and are members of the same household,
23 (1) each such person shall be entitled to participate in the
24 pharmaceutical assistance program, provided that he or she
25 meets all other requirements imposed by this subsection and (2)
26 each participating household member contributes the fee
27 required for that person by the preceding paragraph for the
28 purpose of obtaining an identification card.
29     The provisions of this subsection (f), other than this
30 paragraph, are inoperative after December 31, 2005.
31 Beneficiaries who received benefits under the program
32 established by this subsection (f) are not entitled, at the
33 termination of the program, to any refund of the identification
34 card fee paid under this subsection.
35     (g) Effective January 1, 2006, there is hereby established
36 a program of pharmaceutical assistance to the aged and

 

 

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1 disabled, entitled the Illinois Seniors and Disabled Drug
2 Coverage Program, which shall be administered by the Department
3 of Healthcare and Family Services and the Department on Aging
4 in accordance with this subsection, to consist of coverage of
5 specified prescription drugs on behalf of beneficiaries of the
6 program as set forth in this subsection. The program under this
7 subsection replaces and supersedes the program established
8 under subsection (f), which shall end at midnight on December
9 31, 2005.
10     To become a beneficiary under the program established under
11 this subsection, a person must:
12         (1) be (i) 65 years of age or older or (ii) disabled;
13     and
14         (2) be domiciled in this State; and
15         (3) enroll with a qualified Medicare Part D
16     Prescription Drug Plan if eligible and apply for all
17     available subsidies under Medicare Part D; and
18         (4) have a maximum household income of (i) less than
19     $21,218 for a household containing one person, (ii) less
20     than $28,480 for a household containing 2 persons, or (iii)
21     less than $35,740 for a household containing 3 or more
22     persons. If any income eligibility limit set forth in items
23     (i) through (iii) is less than 200% of the Federal Poverty
24     Level for any year, the income eligibility limit for that
25     year for households of that size shall be income equal to
26     or less than 200% of the Federal Poverty Level.
27     All individuals enrolled as of December 31, 2005, in the
28 pharmaceutical assistance program operated pursuant to
29 subsection (f) of this Section and all individuals enrolled as
30 of December 31, 2005, in the SeniorCare Medicaid waiver program
31 operated pursuant to Section 5-5.12a of the Illinois Public Aid
32 Code shall be automatically enrolled in the program established
33 by this subsection for the first year of operation without the
34 need for further application, except that they must apply for
35 Medicare Part D and the Low Income Subsidy under Medicare Part
36 D. A person enrolled in the pharmaceutical assistance program

 

 

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1 operated pursuant to subsection (f) of this Section as of
2 December 31, 2005, shall not lose eligibility in future years
3 due only to the fact that they have not reached the age of 65.
4     To the extent permitted by federal law, the Department may
5 act as an authorized representative of a beneficiary in order
6 to enroll the beneficiary in a Medicare Part D Prescription
7 Drug Plan if the beneficiary has failed to choose a plan and,
8 where possible, to enroll beneficiaries in the low-income
9 subsidy program under Medicare Part D or assist them in
10 enrolling in that program.
11     Beneficiaries under the program established under this
12 subsection shall be divided into the following 4 eligibility
13 groups:
14         (A) Eligibility Group 1 shall consist of beneficiaries
15     who are not eligible for Medicare Part D coverage and who
16     are:
17             (i) disabled and under age 65; or
18             (ii) age 65 or older, with incomes over 200% of the
19         Federal Poverty Level; or
20             (iii) age 65 or older, with incomes at or below
21         200% of the Federal Poverty Level and not eligible for
22         federally funded means-tested benefits due to
23         immigration status.
24         (B) Eligibility Group 2 shall consist of beneficiaries
25     otherwise described in Eligibility Group 1 but who are
26     eligible for Medicare Part D coverage.
27         (C) Eligibility Group 3 shall consist of beneficiaries
28     age 65 or older, with incomes at or below 200% of the
29     Federal Poverty Level, who are not barred from receiving
30     federally funded means-tested benefits due to immigration
31     status and are eligible for Medicare Part D coverage.
32         (D) Eligibility Group 4 shall consist of beneficiaries
33     age 65 or older, with incomes at or below 200% of the
34     Federal Poverty Level, who are not barred from receiving
35     federally funded means-tested benefits due to immigration
36     status and are not eligible for Medicare Part D coverage.

 

 

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1     If the State applies and receives federal approval for a
2 waiver under Title XIX of the Social Security Act, persons in
3 Eligibility Group 4 shall continue to receive benefits through
4 the approved waiver, and Eligibility Group 4 may be expanded to
5 include disabled persons under age 65 with incomes under 200%
6 of the Federal Poverty Level who are not eligible for Medicare
7 and who are not barred from receiving federally funded
8 means-tested benefits due to immigration status.
9     The program established under this subsection shall cover
10 the cost of covered prescription drugs in excess of the
11 beneficiary cost-sharing amounts set forth in this paragraph
12 that are not covered by Medicare. In 2006, beneficiaries shall
13 pay a co-payment of $2 for each prescription of a generic drug
14 and $5 for each prescription of a brand-name drug. In future
15 years, beneficiaries shall pay co-payments equal to the
16 co-payments required under Medicare Part D for "other
17 low-income subsidy eligible individuals" pursuant to 42 CFR
18 423.782(b). Once the program established under this subsection
19 and Medicare combined have paid $1,750 in a year for covered
20 prescription drugs, the beneficiary shall pay 20% of the cost
21 of each prescription in addition to the co-payments set forth
22 in this paragraph.
23     For beneficiaries eligible for Medicare Part D coverage,
24 the program established under this subsection shall pay 100% of
25 the premiums charged by a qualified Medicare Part D
26 Prescription Drug Plan for Medicare Part D basic prescription
27 drug coverage, not including any late enrollment penalties.
28 Qualified Medicare Part D Prescription Drug Plans may be
29 limited by the Department of Healthcare and Family Services to
30 those plans that sign a coordination agreement with the
31 Department.
32     Notwithstanding Section 3.15, for purposes of the program
33 established under this subsection, the term "covered
34 prescription drug" has the following meanings:
35         For Eligibility Group 1, "covered prescription drug"
36     means: (1) any cardiovascular agent or drug; (2) any

 

 

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1     insulin or other prescription drug used in the treatment of
2     diabetes, including syringe and needles used to administer
3     the insulin; (3) any prescription drug used in the
4     treatment of arthritis; (4) any prescription drug used in
5     the treatment of cancer; (5) any prescription drug used in
6     the treatment of Alzheimer's disease; (6) any prescription
7     drug used in the treatment of Parkinson's disease; (7) any
8     prescription drug used in the treatment of glaucoma; (8)
9     any prescription drug used in the treatment of lung disease
10     and smoking-related illnesses; (9) any prescription drug
11     used in the treatment of osteoporosis; and (10) any
12     prescription drug used in the treatment of multiple
13     sclerosis. The Department may add additional therapeutic
14     classes by rule. The Department may adopt a preferred drug
15     list within any of the classes of drugs described in items
16     (1) through (10) of this paragraph. The specific drugs or
17     therapeutic classes of covered prescription drugs shall be
18     indicated by rule.
19         For Eligibility Group 2, "covered prescription drug"
20     means those drugs covered for Eligibility Group 1 that are
21     also covered by the Medicare Part D Prescription Drug Plan
22     in which the beneficiary is enrolled.
23         For Eligibility Group 3, "covered prescription drug"
24     means those drugs covered by the Medicare Part D
25     Prescription Drug Plan in which the beneficiary is
26     enrolled.
27         For Eligibility Group 4, "covered prescription drug"
28     means those drugs covered by the Medical Assistance Program
29     under Article V of the Illinois Public Aid Code.
30     An individual in Eligibility Group 3 or 4 may opt to
31 receive a $25 monthly payment in lieu of the direct coverage
32 described in this subsection.
33     Any person otherwise eligible for pharmaceutical
34 assistance under this subsection whose covered drugs are
35 covered by any public program is ineligible for assistance
36 under this subsection to the extent that the cost of those

 

 

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1 drugs is covered by the other program.
2     The Department of Healthcare and Family Services shall
3 establish by rule the methods by which it will provide for the
4 coverage called for in this subsection. Those methods may
5 include direct reimbursement to pharmacies or the payment of a
6 capitated amount to Medicare Part D Prescription Drug Plans.
7     For a pharmacy to be reimbursed under the program
8 established under this subsection, it must comply with rules
9 adopted by the Department of Healthcare and Family Services
10 regarding coordination of benefits with Medicare Part D
11 Prescription Drug Plans. A pharmacy may not charge a
12 Medicare-enrolled beneficiary of the program established under
13 this subsection more for a covered prescription drug than the
14 appropriate Medicare cost-sharing less any payment from or on
15 behalf of the Department of Healthcare and Family Services.
16     The Department of Healthcare and Family Services or the
17 Department on Aging, as appropriate, may adopt rules regarding
18 applications, counting of income, proof of Medicare status,
19 mandatory generic policies, and pharmacy reimbursement rates
20 and any other rules necessary for the cost-efficient operation
21 of the program established under this subsection.
22     (h) There is established a program of hearing aid
23 assistance to the aged and disabled that shall be administered
24 by the Department in accordance with this Act, to consist of
25 payments to eligible claimants to offset the costs of hearing
26 aids.
27     To offset the cost of the hearing aids, a person entitled
28 to claim a grant under subsection (a) of this Section is
29 entitled to receive a payment of up to $100 each calendar year
30 in which he or she purchases a hearing aid for his or her
31 personal use.
32     For purposes of this subsection (g), "hearing aid" means an
33 ear-level or body-worn electroacoustic instrument that is used
34 for the purpose of amplifying sound and the basic components of
35 which are a microphone, amplifier, and receiver. "Hearing aid"
36 also includes prosthetic devices that produce perception of

 

 

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1 sound by replacing the function of the middle ear, cochlea, or
2 auditory nerve, such as auditory osseointegrated devices and
3 auditory brainstem devices.
4     (i) There is established a program of dental services
5 assistance to the aged and disabled that shall be administered
6 by the Department in accordance with this Act, to consist of
7 payments to eligible claimants to offset the costs of dental
8 services.
9     To offset the cost of the dental services, a person
10 entitled to claim a grant under subsection (a) of this Section
11 is entitled to receive a payment of up to $500 each calendar
12 year in which he or she purchases dental services for his or
13 her personal use.
14     For the purposes of this subsection (i), "dental services"
15 means dental care, dental surgery, dental treatment, any other
16 dental procedure involving the teeth or periodontium or any
17 dental appliances, including crowns, bridges, implants, or
18 partial or complete dentures.
19 (Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; revised
20 12-15-05.)