Full Text of SB2444 95th General Assembly
SB2444 95TH GENERAL ASSEMBLY
|
|
|
95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008 SB2444
Introduced 2/15/2008, by Sen. Linda Holmes SYNOPSIS AS INTRODUCED: |
|
320 ILCS 25/3.15 |
from Ch. 67 1/2, par. 403.15 |
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. Provides that beginning January 1, 2009, "covered prescription drug" includes any
prescription drug used in treating the effects of multiple sclerosis (instead of providing that the term includes any
prescription drug used in the treatment of multiple sclerosis). Effective immediately.
|
| |
|
|
| FISCAL NOTE ACT MAY APPLY | |
|
|
A BILL FOR
|
|
|
|
|
SB2444 |
|
LRB095 17729 DRJ 43805 b |
|
| 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 Sections 3.15 and 4 as follows:
| 7 |
| (320 ILCS 25/3.15) (from Ch. 67 1/2, par. 403.15)
| 8 |
| Sec. 3.15. "Covered prescription drug" means (1) any | 9 |
| cardiovascular agent
or drug; (2) any insulin or other | 10 |
| prescription drug used in the treatment of
diabetes, including | 11 |
| syringe and needles used to administer the insulin; (3)
any | 12 |
| prescription drug used in the treatment of arthritis, (4) | 13 |
| beginning on
January 1, 2001, any prescription drug used in the | 14 |
| treatment of cancer, (5)
beginning on January 1, 2001, any | 15 |
| prescription drug used in the treatment of
Alzheimer's disease, | 16 |
| (6) beginning on January 1, 2001, any prescription drug
used in | 17 |
| the treatment of Parkinson's disease, (7) beginning on January | 18 |
| 1,
2001, any prescription drug used in the treatment of | 19 |
| glaucoma, (8)
beginning on January 1, 2001, any prescription | 20 |
| drug used in the treatment of
lung disease and smoking related | 21 |
| illnesses, (9) beginning on July 1,
2001, any prescription drug | 22 |
| used in the treatment
of osteoporosis, and
(10) beginning
on | 23 |
| January 1, 2009 2004 , any
prescription drug used in treating |
|
|
|
SB2444 |
- 2 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| the effects the treatment of multiple sclerosis.
The
specific | 2 |
| agents or products to be included under such categories shall | 3 |
| be
listed in a handbook to be prepared and distributed by the | 4 |
| Department. The
general types of covered prescription drugs | 5 |
| shall be indicated by rule.
| 6 |
| (Source: P.A. 92-10, eff. 6-11-01; 92-790, eff. 8-6-02; 93-528, | 7 |
| eff.
1-1-04.)
| 8 |
| (320 ILCS 25/4) (from Ch. 67 1/2, par. 404)
| 9 |
| Sec. 4. Amount of Grant.
| 10 |
| (a) In general. Any individual 65 years or older or any | 11 |
| individual who will
become 65 years old during the calendar | 12 |
| year in which a claim is filed, and any
surviving spouse of | 13 |
| such a claimant, who at the time of death received or was
| 14 |
| entitled to receive a grant pursuant to this Section, which | 15 |
| surviving spouse
will become 65 years of age within the 24 | 16 |
| months immediately following the
death of such claimant and | 17 |
| which surviving spouse but for his or her age is
otherwise | 18 |
| qualified to receive a grant pursuant to this Section, and any
| 19 |
| disabled person whose annual household income is less than the | 20 |
| income eligibility limitation, as defined in subsection (a-5)
| 21 |
| and whose household is liable for payment of property taxes | 22 |
| accrued or has
paid rent constituting property taxes accrued | 23 |
| and is domiciled in this State
at the time he or she files his | 24 |
| or her claim is entitled to claim a
grant under this Act.
With | 25 |
| respect to claims filed by individuals who will become 65 years |
|
|
|
SB2444 |
- 3 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| old
during the calendar year in which a claim is filed, the | 2 |
| amount of any grant
to which that household is entitled shall | 3 |
| be an amount equal to 1/12 of the
amount to which the claimant | 4 |
| would otherwise be entitled as provided in
this Section, | 5 |
| multiplied by the number of months in which the claimant was
65 | 6 |
| in the calendar year in which the claim is filed.
| 7 |
| (a-5) Income eligibility limitation. For purposes of this | 8 |
| Section, "income eligibility limitation" means an amount: | 9 |
| (i) for grant years before the 1998 grant year, less | 10 |
| than $14,000; | 11 |
| (ii) for the 1998 and 1999 grant year, less than | 12 |
| $16,000; | 13 |
| (iii) for grant years 2000 through 2007: | 14 |
| (A) less than $21,218 for a household containing | 15 |
| one person; | 16 |
| (B) less than $28,480 for a household containing 2 | 17 |
| persons; or | 18 |
| (C) less than $35,740 for a
household containing 3 | 19 |
| or more persons; or | 20 |
| (iv) for grant years 2008 and thereafter:
| 21 |
| (A) less than $22,218 for a household containing | 22 |
| one person; | 23 |
| (B) less than $29,480 for a household containing 2 | 24 |
| persons; or | 25 |
| (C) less than $36,740 for a
household containing 3 | 26 |
| or more persons. |
|
|
|
SB2444 |
- 4 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| (b) Limitation. Except as otherwise provided in | 2 |
| subsections (a) and (f)
of this Section, the maximum amount of | 3 |
| grant which a claimant is
entitled to claim is the amount by | 4 |
| which the property taxes accrued which
were paid or payable | 5 |
| during the last preceding tax year or rent
constituting | 6 |
| property taxes accrued upon the claimant's residence for the
| 7 |
| last preceding taxable year exceeds 3 1/2% of the claimant's | 8 |
| household
income for that year but in no event is the grant to | 9 |
| exceed (i) $700 less
4.5% of household income for that year for | 10 |
| those with a household income of
$14,000 or less or (ii) $70 if | 11 |
| household income for that year is more than
$14,000.
| 12 |
| (c) Public aid recipients. If household income in one or | 13 |
| more
months during a year includes cash assistance in excess of | 14 |
| $55 per month
from the Department of Healthcare and Family | 15 |
| Services or the Department of Human Services (acting
as | 16 |
| successor to the Department of Public Aid under the Department | 17 |
| of Human
Services Act) which was determined under regulations | 18 |
| of
that Department on a measure of need that included an | 19 |
| allowance for actual
rent or property taxes paid by the | 20 |
| recipient of that assistance, the amount
of grant to which that | 21 |
| household is entitled, except as otherwise provided in
| 22 |
| subsection (a), shall be the product of (1) the maximum amount | 23 |
| computed as
specified in subsection (b) of this Section and (2) | 24 |
| the ratio of the number of
months in which household income did | 25 |
| not include such cash assistance over $55
to the number twelve. | 26 |
| If household income did not include such cash assistance
over |
|
|
|
SB2444 |
- 5 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| $55 for any months during the year, the amount of the grant to | 2 |
| which the
household is entitled shall be the maximum amount | 3 |
| computed as specified in
subsection (b) of this Section. For | 4 |
| purposes of this paragraph (c), "cash
assistance" does not | 5 |
| include any amount received under the federal Supplemental
| 6 |
| Security Income (SSI) program.
| 7 |
| (d) Joint ownership. If title to the residence is held | 8 |
| jointly by
the claimant with a person who is not a member of | 9 |
| his or her household,
the amount of property taxes accrued used | 10 |
| in computing the amount of grant
to which he or she is entitled | 11 |
| shall be the same percentage of property
taxes accrued as is | 12 |
| the percentage of ownership held by the claimant in the
| 13 |
| residence.
| 14 |
| (e) More than one residence. If a claimant has occupied | 15 |
| more than
one residence in the taxable year, he or she may | 16 |
| claim only one residence
for any part of a month. In the case | 17 |
| of property taxes accrued, he or she
shall prorate 1/12 of the | 18 |
| total property taxes accrued on
his or her residence to each | 19 |
| month that he or she owned and occupied
that residence; and, in | 20 |
| the case of rent constituting property taxes accrued,
shall | 21 |
| prorate each month's rent payments to the residence
actually | 22 |
| occupied during that month.
| 23 |
| (f) There is hereby established a program of pharmaceutical | 24 |
| assistance
to the aged and disabled which shall be administered | 25 |
| by the Department in
accordance with this Act, to consist of | 26 |
| payments to authorized pharmacies, on
behalf of beneficiaries |
|
|
|
SB2444 |
- 6 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| of the program, for the reasonable costs of covered
| 2 |
| prescription drugs. Each beneficiary who pays $5 for an | 3 |
| identification card
shall pay no additional prescription | 4 |
| costs. Each beneficiary who pays $25 for
an identification card | 5 |
| shall pay $3 per prescription. In addition, after a
beneficiary | 6 |
| receives $2,000 in benefits during a State fiscal year, that
| 7 |
| beneficiary shall also be charged 20% of the cost of each | 8 |
| prescription for
which payments are made by the program during | 9 |
| the remainder of the fiscal
year. To become a beneficiary under | 10 |
| this program a person must: (1)
be (i) 65 years of age or | 11 |
| older, or (ii) the surviving spouse of such
a claimant, who at | 12 |
| the time of death received or was entitled to receive
benefits | 13 |
| pursuant to this subsection, which surviving spouse will become | 14 |
| 65
years of age within the 24 months immediately following the | 15 |
| death of such
claimant and which surviving spouse but for his | 16 |
| or her age is otherwise
qualified to receive benefits pursuant | 17 |
| to this subsection, or (iii) disabled,
and (2) be domiciled in | 18 |
| this State at the time he or she files
his or her claim, and (3) | 19 |
| have a maximum household income of less
than the income | 20 |
| eligibility limitation, as defined in subsection (a-5). In | 21 |
| addition, each eligible person must (1) obtain an
| 22 |
| identification card from the Department, (2) at the time the | 23 |
| card is obtained,
sign a statement assigning to the State of | 24 |
| Illinois benefits which may be
otherwise claimed under any | 25 |
| private insurance plans, and (3) present the
identification | 26 |
| card to the dispensing pharmacist.
|
|
|
|
SB2444 |
- 7 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| The Department may adopt rules specifying
participation
| 2 |
| requirements for the pharmaceutical assistance program, | 3 |
| including copayment
amounts,
identification card fees, | 4 |
| expenditure limits, and the benefit threshold after
which a 20% | 5 |
| charge is imposed on the cost of each prescription, to be in
| 6 |
| effect on and
after July 1, 2004.
Notwithstanding any other | 7 |
| provision of this paragraph, however, the Department
may not
| 8 |
| increase the identification card fee above the amount in effect | 9 |
| on May 1, 2003
without
the express consent of the General | 10 |
| Assembly.
To the extent practicable, those requirements shall | 11 |
| be
commensurate
with the requirements provided in rules adopted | 12 |
| by the Department of Healthcare and Family Services
to
| 13 |
| implement the pharmacy assistance program under Section | 14 |
| 5-5.12a of the Illinois
Public
Aid Code.
| 15 |
| Whenever a generic equivalent for a covered prescription | 16 |
| drug is available,
the Department shall reimburse only for the | 17 |
| reasonable costs of the generic
equivalent, less the co-pay | 18 |
| established in this Section, unless (i) the covered
| 19 |
| prescription drug contains one or more ingredients defined as a | 20 |
| narrow
therapeutic index drug at 21 CFR 320.33, (ii) the | 21 |
| prescriber indicates on the
face of the prescription "brand | 22 |
| medically necessary", and (iii) the prescriber
specifies that a | 23 |
| substitution is not permitted. When issuing an oral
| 24 |
| prescription for covered prescription medication described in | 25 |
| item (i) of this
paragraph, the prescriber shall stipulate | 26 |
| "brand medically necessary" and
that a substitution is not |
|
|
|
SB2444 |
- 8 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| permitted. If the covered prescription drug and its
authorizing | 2 |
| prescription do not meet the criteria listed above, the | 3 |
| beneficiary
may purchase the non-generic equivalent of the | 4 |
| covered prescription drug by
paying the difference between the | 5 |
| generic cost and the non-generic cost plus
the beneficiary | 6 |
| co-pay.
| 7 |
| Any person otherwise eligible for pharmaceutical | 8 |
| assistance under this
Act whose covered drugs are covered by | 9 |
| any public program for assistance in
purchasing any covered | 10 |
| prescription drugs shall be ineligible for assistance
under | 11 |
| this Act to the extent such costs are covered by such other | 12 |
| plan.
| 13 |
| The fee to be charged by the Department for the | 14 |
| identification card shall
be equal to $5 per coverage year for | 15 |
| persons below the official poverty line
as defined by the | 16 |
| United States Department of Health and Human Services and
$25 | 17 |
| per coverage year for all other persons.
| 18 |
| In the event that 2 or more persons are eligible for any | 19 |
| benefit under
this Act, and are members of the same household, | 20 |
| (1) each such person shall
be entitled to participate in the | 21 |
| pharmaceutical assistance program, provided
that he or she | 22 |
| meets all other requirements imposed by this subsection
and (2) | 23 |
| each participating household member contributes the fee | 24 |
| required
for that person by the preceding paragraph for the | 25 |
| purpose
of obtaining an identification card. | 26 |
| The provisions of this subsection (f), other than this |
|
|
|
SB2444 |
- 9 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| paragraph, are inoperative after December 31, 2005. | 2 |
| Beneficiaries who received benefits under the program | 3 |
| established by this subsection (f) are not entitled, at the | 4 |
| termination of the program, to any refund of the identification | 5 |
| card fee paid under this subsection. | 6 |
| (g) Effective January 1, 2006, there is hereby established | 7 |
| a program of pharmaceutical assistance to the aged and | 8 |
| disabled, entitled the Illinois Seniors and Disabled Drug | 9 |
| Coverage Program, which shall be administered by the Department | 10 |
| of Healthcare and Family Services and the Department on Aging | 11 |
| in accordance with this subsection, to consist of coverage of | 12 |
| specified prescription drugs on behalf of beneficiaries of the | 13 |
| program as set forth in this subsection. The program under this | 14 |
| subsection replaces and supersedes the program established | 15 |
| under subsection (f), which shall end at midnight on December | 16 |
| 31, 2005. | 17 |
| To become a beneficiary under the program established under | 18 |
| this subsection, a person must: | 19 |
| (1) be (i) 65 years of age or older or (ii) disabled; | 20 |
| and | 21 |
| (2) be domiciled in this State; and | 22 |
| (3) enroll with a qualified Medicare Part D | 23 |
| Prescription Drug Plan if eligible and apply for all | 24 |
| available subsidies under Medicare Part D; and | 25 |
| (4) have a maximum household income of (i) less than | 26 |
| $21,218 for a household containing one person, (ii) less |
|
|
|
SB2444 |
- 10 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| than $28,480 for a household containing 2 persons, or (iii) | 2 |
| less than $35,740 for a household containing 3 or more | 3 |
| persons. If any income eligibility limit set forth in items | 4 |
| (i) through (iii) is less than 200% of the Federal Poverty | 5 |
| Level for any year, the income eligibility limit for that | 6 |
| year for households of that size shall be income equal to | 7 |
| or less than 200% of the Federal Poverty Level. | 8 |
| All individuals enrolled as of December 31, 2005, in the | 9 |
| pharmaceutical assistance program operated pursuant to | 10 |
| subsection (f) of this Section and all individuals enrolled as | 11 |
| of December 31, 2005, in the SeniorCare Medicaid waiver program | 12 |
| operated pursuant to Section 5-5.12a of the Illinois Public Aid | 13 |
| Code shall be automatically enrolled in the program established | 14 |
| by this subsection for the first year of operation without the | 15 |
| need for further application, except that they must apply for | 16 |
| Medicare Part D and the Low Income Subsidy under Medicare Part | 17 |
| D. A person enrolled in the pharmaceutical assistance program | 18 |
| operated pursuant to subsection (f) of this Section as of | 19 |
| December 31, 2005, shall not lose eligibility in future years | 20 |
| due only to the fact that they have not reached the age of 65. | 21 |
| To the extent permitted by federal law, the Department may | 22 |
| act as an authorized representative of a beneficiary in order | 23 |
| to enroll the beneficiary in a Medicare Part D Prescription | 24 |
| Drug Plan if the beneficiary has failed to choose a plan and, | 25 |
| where possible, to enroll beneficiaries in the low-income | 26 |
| subsidy program under Medicare Part D or assist them in |
|
|
|
SB2444 |
- 11 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| enrolling in that program. | 2 |
| Beneficiaries under the program established under this | 3 |
| subsection shall be divided into the following 5 eligibility | 4 |
| groups: | 5 |
| (A) Eligibility Group 1 shall consist of beneficiaries | 6 |
| who are not eligible for Medicare Part D coverage and who
| 7 |
| are: | 8 |
| (i) disabled and under age 65; or | 9 |
| (ii) age 65 or older, with incomes over 200% of the | 10 |
| Federal Poverty Level; or | 11 |
| (iii) age 65 or older, with incomes at or below | 12 |
| 200% of the Federal Poverty Level and not eligible for | 13 |
| federally funded means-tested benefits due to | 14 |
| immigration status. | 15 |
| (B) Eligibility Group 2 shall consist of beneficiaries | 16 |
| otherwise described in Eligibility Group 1 but who are | 17 |
| eligible for Medicare Part D coverage. | 18 |
| (C) Eligibility Group 3 shall consist of beneficiaries | 19 |
| age 65 or older, with incomes at or below 200% of the | 20 |
| Federal Poverty Level, who are not barred from receiving | 21 |
| federally funded means-tested benefits due to immigration | 22 |
| status and are eligible for Medicare Part D coverage. | 23 |
| (D) Eligibility Group 4 shall consist of beneficiaries | 24 |
| age 65 or older, with incomes at or below 200% of the | 25 |
| Federal Poverty Level, who are not barred from receiving | 26 |
| federally funded means-tested benefits due to immigration |
|
|
|
SB2444 |
- 12 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| status and are not eligible for Medicare Part D coverage. | 2 |
| If the State applies and receives federal approval for | 3 |
| a waiver under Title XIX of the Social Security Act, | 4 |
| persons in Eligibility Group 4 shall continue to receive | 5 |
| benefits through the approved waiver, and Eligibility | 6 |
| Group 4 may be expanded to include disabled persons under | 7 |
| age 65 with incomes under 200% of the Federal Poverty Level | 8 |
| who are not eligible for Medicare and who are not barred | 9 |
| from receiving federally funded means-tested benefits due | 10 |
| to immigration status. | 11 |
| (E) On and after January 1, 2007, Eligibility Group 5 | 12 |
| shall consist of beneficiaries who are otherwise described | 13 |
| in Eligibility Groups 2 and 3 who have a diagnosis of HIV | 14 |
| or AIDS.
| 15 |
| The program established under this subsection shall cover | 16 |
| the cost of covered prescription drugs in excess of the | 17 |
| beneficiary cost-sharing amounts set forth in this paragraph | 18 |
| that are not covered by Medicare. In 2006, beneficiaries shall | 19 |
| pay a co-payment of $2 for each prescription of a generic drug | 20 |
| and $5 for each prescription of a brand-name drug. In future | 21 |
| years, beneficiaries shall pay co-payments equal to the | 22 |
| co-payments required under Medicare Part D for "other | 23 |
| low-income subsidy eligible individuals" pursuant to 42 CFR | 24 |
| 423.782(b). For individuals in Eligibility Groups 1, 2, 3, and | 25 |
| 4, once the program established under this subsection and | 26 |
| Medicare combined have paid $1,750 in a year for covered |
|
|
|
SB2444 |
- 13 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| prescription drugs, the beneficiary shall pay 20% of the cost | 2 |
| of each prescription in addition to the co-payments set forth | 3 |
| in this paragraph. For individuals in Eligibility Group 5, once | 4 |
| the program established under this subsection and Medicare | 5 |
| combined have paid $1,750 in a year for covered prescription | 6 |
| drugs, the beneficiary shall pay 20% of the cost of each | 7 |
| prescription in addition to the co-payments set forth in this | 8 |
| paragraph unless the drug is included in the formulary of the | 9 |
| Illinois AIDS Drug Assistance Program operated by the Illinois | 10 |
| Department of Public Health. If the drug is included in the | 11 |
| formulary of the Illinois AIDS Drug Assistance Program, | 12 |
| individuals in Eligibility Group 5 shall continue to pay the | 13 |
| co-payments set forth in this paragraph after the program | 14 |
| established under this subsection and Medicare combined have | 15 |
| paid $1,750 in a year for covered prescription drugs.
| 16 |
| For beneficiaries eligible for Medicare Part D coverage, | 17 |
| the program established under this subsection shall pay 100% of | 18 |
| the premiums charged by a qualified Medicare Part D | 19 |
| Prescription Drug Plan for Medicare Part D basic prescription | 20 |
| drug coverage, not including any late enrollment penalties. | 21 |
| Qualified Medicare Part D Prescription Drug Plans may be | 22 |
| limited by the Department of Healthcare and Family Services to | 23 |
| those plans that sign a coordination agreement with the | 24 |
| Department. | 25 |
| Notwithstanding Section 3.15, for purposes of the program | 26 |
| established under this subsection, the term "covered |
|
|
|
SB2444 |
- 14 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| prescription drug" has the following meanings: | 2 |
| For Eligibility Group 1, "covered prescription drug" | 3 |
| means: (1) any cardiovascular agent or drug; (2) any | 4 |
| insulin or other prescription drug used in the treatment of | 5 |
| diabetes, including syringe and needles used to administer | 6 |
| the insulin; (3) any prescription drug used in the | 7 |
| treatment of arthritis; (4) any prescription drug used in | 8 |
| the treatment of cancer; (5) any prescription drug used in | 9 |
| the treatment of Alzheimer's disease; (6) any prescription | 10 |
| drug used in the treatment of Parkinson's disease; (7) any | 11 |
| prescription drug used in the treatment of glaucoma; (8) | 12 |
| any prescription drug used in the treatment of lung disease | 13 |
| and smoking-related illnesses; (9) any prescription drug | 14 |
| used in the treatment of osteoporosis; and (10) beginning | 15 |
| January 1, 2009, any prescription drug used in treating the | 16 |
| effects the treatment of multiple sclerosis. The | 17 |
| Department may add additional therapeutic classes by rule. | 18 |
| The Department may adopt a preferred drug list within any | 19 |
| of the classes of drugs described in items (1) through (10) | 20 |
| of this paragraph. The specific drugs or therapeutic | 21 |
| classes of covered prescription drugs shall be indicated by | 22 |
| rule. | 23 |
| For Eligibility Group 2, "covered prescription drug" | 24 |
| means those drugs covered for Eligibility Group 1 that are | 25 |
| also covered by the Medicare Part D Prescription Drug Plan | 26 |
| in which the beneficiary is enrolled. |
|
|
|
SB2444 |
- 15 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| For Eligibility Group 3, "covered prescription drug" | 2 |
| means those drugs covered by the Medicare Part D | 3 |
| Prescription Drug Plan in which the beneficiary is | 4 |
| enrolled. | 5 |
| For Eligibility Group 4, "covered prescription drug" | 6 |
| means those drugs covered by the Medical Assistance Program | 7 |
| under Article V of the Illinois Public Aid Code. | 8 |
| For Eligibility Group 5, for individuals otherwise | 9 |
| described in Eligibility Group 2, "covered prescription | 10 |
| drug" means:
(1) those drugs covered for Eligibility Group | 11 |
| 2 that are also covered by the Medicare Part D Prescription | 12 |
| Drug Plan in which the beneficiary is enrolled; and
(2) | 13 |
| those drugs included in the formulary of the Illinois AIDS | 14 |
| Drug Assistance Program operated by the Illinois | 15 |
| Department of Public Health that are also covered by the | 16 |
| Medicare Part D Prescription Drug Plan in which the | 17 |
| beneficiary is enrolled.
For Eligibility Group 5, for | 18 |
| individuals otherwise described in Eligibility Group 3, | 19 |
| "covered prescription drug" means those drugs covered by | 20 |
| the Medicare Part D Prescription Drug Plan in which the | 21 |
| beneficiary is enrolled. | 22 |
| An individual in Eligibility Group 1, 2, 3, 4, or 5 may opt | 23 |
| to receive a $25 monthly payment in lieu of the direct coverage | 24 |
| described in this subsection. | 25 |
| Any person otherwise eligible for pharmaceutical | 26 |
| assistance under this subsection whose covered drugs are |
|
|
|
SB2444 |
- 16 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| covered by any public program is ineligible for assistance | 2 |
| under this subsection to the extent that the cost of those | 3 |
| drugs is covered by the other program. | 4 |
| The Department of Healthcare and Family Services shall | 5 |
| establish by rule the methods by which it will provide for the | 6 |
| coverage called for in this subsection. Those methods may | 7 |
| include direct reimbursement to pharmacies or the payment of a | 8 |
| capitated amount to Medicare Part D Prescription Drug Plans. | 9 |
| For a pharmacy to be reimbursed under the program | 10 |
| established under this subsection, it must comply with rules | 11 |
| adopted by the Department of Healthcare and Family Services | 12 |
| regarding coordination of benefits with Medicare Part D | 13 |
| Prescription Drug Plans. A pharmacy may not charge a | 14 |
| Medicare-enrolled beneficiary of the program established under | 15 |
| this subsection more for a covered prescription drug than the | 16 |
| appropriate Medicare cost-sharing less any payment from or on | 17 |
| behalf of the Department of Healthcare and Family Services. | 18 |
| The Department of Healthcare and Family Services or the | 19 |
| Department on Aging, as appropriate, may adopt rules regarding | 20 |
| applications, counting of income, proof of Medicare status, | 21 |
| mandatory generic policies, and pharmacy reimbursement rates | 22 |
| and any other rules necessary for the cost-efficient operation | 23 |
| of the program established under this subsection.
| 24 |
| (Source: P.A. 94-86, eff. 1-1-06; 94-909, eff. 6-23-06; 95-208, | 25 |
| eff. 8-16-07; 95-644, eff. 10-12-07; revised 10-25-07.)
| 26 |
| Section 99. Effective date. This Act takes effect upon |
|
|
|
SB2444 |
- 17 - |
LRB095 17729 DRJ 43805 b |
|
| 1 |
| becoming law.
|
|