Full Text of HB0274 100th General Assembly
HB0274ham001 100TH GENERAL ASSEMBLY | Rep. Michelle Mussman Filed: 4/6/2018
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| 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 |
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| 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 |
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| 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 |
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| 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)
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| 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.) |
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| 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 |
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| 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; |
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| 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 |
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| 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 |
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| 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.
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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, |
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| 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) |
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| 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; |
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| 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 |
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| 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 |
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| 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: |
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| 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 |
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| 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.".
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