Illinois General Assembly - Full Text of HB0274
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Full Text of HB0274  100th General Assembly

HB0274ham001 100TH GENERAL ASSEMBLY

Rep. Michelle Mussman

Filed: 4/6/2018

 

 


 

 


 
10000HB0274ham001LRB100 04385 SMS 38127 a

1
AMENDMENT TO HOUSE BILL 274

2    AMENDMENT NO. ______. Amend House Bill 274 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.17, 356z.22, and 356z.25, 356z.26, and
16356z.29 of the Illinois Insurance Code. The program of health

 

 

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1benefits must comply with Sections 155.22a, 155.37, 355b,
2356z.19, 370c, and 370c.1 of the Illinois Insurance Code.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
10100-138, eff. 8-18-17; revised 10-3-17.)
 
11    Section 10. The Department of Public Health Powers and
12Duties Law of the Civil Administrative Code of Illinois is
13amended by adding Section 2310-700 as follows:
 
14    (20 ILCS 2310/2310-700 new)
15    Sec. 2310-700. Contraceptive drugs and products; Director
16standing order.
17    (a) As used in this Section:
18    "Hormonal contraceptive" means a prescribed
19medically-acceptable oral drug, transdermal patch, or vaginal
20ring that is approved by the United States Food and Drug
21Administration to prevent pregnancy.
22    "Standing order" has the meaning given to that term in the
23Pharmacy Practice Act.
24    (b) If the Director of Public Health is a physician

 

 

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1licensed to practice medicine in all its branches in Illinois,
2the Director shall establish a standing order complete with the
3issuance of a prescription for a hormonal contraceptive in
4accordance with this Section. If the Director is not a
5physician licensed to practice medicine in all its branches in
6Illinois, then the Medical Director of the Department of Public
7Health shall establish a standing order in accordance with this
8Section.
9    (c) The standing order, at a minimum, shall comply with the
10following:
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
23Section 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,
2including a home rule county, is a self-insurer for purposes of
3providing health insurance coverage for its employees, the
4coverage shall include coverage for the post-mastectomy care
5benefits required to be covered by a policy of accident and
6health insurance under Section 356t and the coverage required
7under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
8356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
9356z.14, 356z.15, 356z.22, and 356z.25, 356z.26, and 356z.29 of
10the Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The requirement that health benefits be covered
13as provided in this Section is an exclusive power and function
14of the State and is a denial and limitation under Article VII,
15Section 6, subsection (h) of the Illinois Constitution. A home
16rule county to which this Section applies must comply with
17every provision of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
25100-138, eff. 8-18-17; revised 10-5-17.)
 

 

 

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1    Section 20. The Illinois Municipal Code is amended by
2changing 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
5municipality, including a home rule municipality, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the coverage shall include coverage
8for the post-mastectomy care benefits required to be covered by
9a policy of accident and health insurance under Section 356t
10and the coverage required under Sections 356g, 356g.5,
11356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
12356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, and
13356z.25, 356z.26, and 356z.29 of the Illinois Insurance Code.
14The coverage shall comply with Sections 155.22a, 355b, 356z.19,
15and 370c of the Illinois Insurance Code. The requirement that
16health benefits be covered as provided in this is an exclusive
17power and function of the State and is a denial and limitation
18under Article VII, Section 6, subsection (h) of the Illinois
19Constitution. A home rule municipality to which this Section
20applies must comply with every provision of this Section.
21    Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on
25Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
3100-138, eff. 8-18-17; revised 10-5-17.)
 
4    Section 25. The School Code is amended by changing Section
510-22.3f as follows:
 
6    (105 ILCS 5/10-22.3f)
7    Sec. 10-22.3f. Required health benefits. Insurance
8protection and benefits for employees shall provide the
9post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t and
11the coverage required under Sections 356g, 356g.5, 356g.5-1,
12356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
13356z.13, 356z.14, 356z.15, 356z.22, and 356z.25, 356z.26, and
14356z.29 of the Illinois Insurance Code. Insurance policies
15shall comply with Section 356z.19 of the Illinois Insurance
16Code. The coverage shall comply with Sections 155.22a and 355b
17of the Illinois Insurance Code.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

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1revised 9-25-17.)
 
2    Section 30. The Illinois Insurance Code is amended by
3adding Section 356z.29 as follows:
 
4    (215 ILCS 5/356z.29 new)
5    Sec. 356z.29. Coverage for patient care services provided
6by a pharmacist.
7    (a) As used in this Section:
8    "Medication therapy management services" has the meaning
9given to the term in the Pharmacy Practice Act.
10    "Patient counseling" has the meaning given to the term in
11the Pharmacy Practice Act.
12    "Pharmacist care" has the meaning given to the term in the
13Pharmacy Practice Act.
14    "Telepharmacy" has the meaning given to the term in the
15Pharmacy Practice Act.
16    (b) A group or individual policy of accident and health
17insurance or a managed care plan that is amended, delivered,
18issued, or renewed after the effective date of this amendatory
19Act of the 100th General Assembly shall provide coverage for
20patient care services provided by a pharmacist, including, but
21not limited to: medication therapy management services,
22medication optimization services, comprehensive medication
23reviews, pharmacist care services, patient counseling
24(including those provided through telepharmacy), patient

 

 

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1consultations (including those provided through telepharmacy),
2disease state management (including self-management training),
3naloxone hydrochloride assessment or administration, hormonal
4contraceptives assessment and consultation, immunization
5assessment or administration, administration of medications,
6and other such services that are considered within the scope of
7practice of pharmacy under the Pharmacy Practice Act.
 
8    Section 35. The Pharmacy Practice Act is amended by
9changing 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
13where otherwise limited therein:
14    (a) "Pharmacy" or "drugstore" means and includes every
15store, shop, pharmacy department, or other place where
16pharmacist care is provided by a pharmacist (1) where drugs,
17medicines, or poisons are dispensed, sold or offered for sale
18at retail, or displayed for sale at retail; or (2) where
19prescriptions of physicians, dentists, advanced practice
20registered nurses, physician assistants, veterinarians,
21podiatric physicians, or optometrists, within the limits of
22their licenses, are compounded, filled, or dispensed; or (3)
23which has upon it or displayed within it, or affixed to or used
24in 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
4similar or like import, either in the English language or any
5other language; or (4) where the characteristic prescription
6sign (Rx) or similar design is exhibited; or (5) any store, or
7shop, or other place with respect to which any of the above
8words, objects, signs or designs are used in any advertisement.
9    (b) "Drugs" means and includes (1) articles recognized in
10the official United States Pharmacopoeia/National Formulary
11(USP/NF), or any supplement thereto and being intended for and
12having for their main use the diagnosis, cure, mitigation,
13treatment or prevention of disease in man or other animals, as
14approved by the United States Food and Drug Administration, but
15does not include devices or their components, parts, or
16accessories; and (2) all other articles intended for and having
17for their main use the diagnosis, cure, mitigation, treatment
18or prevention of disease in man or other animals, as approved
19by the United States Food and Drug Administration, but does not
20include devices or their components, parts, or accessories; and
21(3) articles (other than food) having for their main use and
22intended to affect the structure or any function of the body of
23man or other animals; and (4) articles having for their main
24use and intended for use as a component or any articles
25specified in clause (1), (2) or (3); but does not include
26devices or their components, parts or accessories.

 

 

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1    (c) "Medicines" means and includes all drugs intended for
2human or veterinary use approved by the United States Food and
3Drug 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
12practice of pharmacy in this State must be actively licensed as
13a pharmacist under this Act.
14    (e) "Prescription" means and includes any written, oral,
15facsimile, or electronically transmitted order for drugs or
16medical devices, issued by a physician licensed to practice
17medicine in all its branches, dentist, veterinarian, podiatric
18physician, or optometrist, within the limits of his or her
19license their licenses, by a physician assistant in accordance
20with subsection (f) of Section 4, or by an advanced practice
21registered nurse in accordance with subsection (g) of Section
224, containing the following: (1) name of the patient; (2) date
23when prescription was issued; (3) name and strength of drug or
24description of the medical device prescribed; and (4) quantity;
25(5) directions for use; (6) prescriber's name, address, and
26signature; and (7) DEA registration number where required, for

 

 

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1controlled substances. The prescription may, but is not
2required to, list the illness, disease, or condition for which
3the drug or device is being prescribed. DEA registration
4numbers shall not be required on inpatient drug orders.
5    (f) "Person" means and includes a natural person,
6partnership, association, corporation, government entity, or
7any other legal entity.
8    (g) "Department" means the Department of Financial and
9Professional Regulation.
10    (h) "Board of Pharmacy" or "Board" means the State Board of
11Pharmacy of the Department of Financial and Professional
12Regulation.
13    (i) "Secretary" means the Secretary of Financial and
14Professional Regulation.
15    (j) "Drug product selection" means the interchange for a
16prescribed pharmaceutical product in accordance with Section
1725 of this Act and Section 3.14 of the Illinois Food, Drug and
18Cosmetic Act.
19    (k) "Inpatient drug order" means an order issued by an
20authorized prescriber for a resident or patient of a facility
21licensed under the Nursing Home Care Act, the ID/DD Community
22Care Act, the MC/DD Act, the Specialized Mental Health
23Rehabilitation Act of 2013, the Hospital Licensing Act, or the
24University of Illinois Hospital Act "An Act in relation to the
25founding and operation of the University of Illinois Hospital
26and the conduct of University of Illinois health care

 

 

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1programs", approved July 3, 1931, as amended, or a facility
2which is operated by the Department of Human Services (as
3successor to the Department of Mental Health and Developmental
4Disabilities) or the Department of Corrections.
5    (k-5) "Pharmacist" means an individual health care
6professional and provider currently licensed by this State to
7engage in the practice of pharmacy.
8    (l) "Pharmacist in charge" means the licensed pharmacist
9whose name appears on a pharmacy license and who is responsible
10for all aspects of the operation related to the practice of
11pharmacy.
12    (m) "Dispense" or "dispensing" means the interpretation,
13evaluation, and implementation of a prescription drug order,
14including the preparation and delivery of a drug or device to a
15patient or patient's agent in a suitable container
16appropriately labeled for subsequent administration to or use
17by a patient in accordance with applicable State and federal
18laws and regulations. "Dispense" or "dispensing" does not mean
19the physical delivery to a patient or a patient's
20representative in a home or institution by a designee of a
21pharmacist or by common carrier. "Dispense" or "dispensing"
22also does not mean the physical delivery of a drug or medical
23device to a patient or patient's representative by a
24pharmacist's designee within a pharmacy or drugstore while the
25pharmacist is on duty and the pharmacy is open.
26    (n) "Nonresident pharmacy" means a pharmacy that is located

 

 

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1in a state, commonwealth, or territory of the United States,
2other than Illinois, that delivers, dispenses, or distributes,
3through the United States Postal Service, commercially
4acceptable parcel delivery service, or other common carrier, to
5Illinois residents, any substance which requires a
6prescription.
7    (o) "Compounding" means the preparation and mixing of
8components, excluding flavorings, (1) as the result of a
9prescriber's prescription drug order or initiative based on the
10prescriber-patient-pharmacist relationship in the course of
11professional practice or (2) for the purpose of, or incident
12to, research, teaching, or chemical analysis and not for sale
13or dispensing. "Compounding" includes the preparation of drugs
14or devices in anticipation of receiving prescription drug
15orders based on routine, regularly observed dispensing
16patterns. Commercially available products may be compounded
17for dispensing to individual patients only if all of the
18following conditions are met: (i) the commercial product is not
19reasonably available from normal distribution channels in a
20timely manner to meet the patient's needs and (ii) the
21prescribing practitioner has requested that the drug be
22compounded.
23    (p) (Blank).
24    (q) (Blank).
25    (r) "Patient counseling" means the communication between a
26pharmacist or a student pharmacist under the supervision of a

 

 

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1pharmacist and a patient or the patient's representative about
2the patient's medication or device for the purpose of
3optimizing proper use of prescription medications or devices.
4"Patient counseling" may include without limitation (1)
5obtaining a medication history; (2) acquiring a patient's
6allergies and health conditions; (3) facilitation of the
7patient's understanding of the intended use of the medication;
8(4) proper directions for use; (5) significant potential
9adverse events; (6) potential food-drug interactions; and (7)
10the need to be compliant with the medication therapy. A
11pharmacy technician may only participate in the following
12aspects of patient counseling under the supervision of a
13pharmacist: (1) obtaining medication history; (2) providing
14the offer for counseling by a pharmacist or student pharmacist;
15and (3) acquiring a patient's allergies and health conditions.
16    (s) "Patient profiles" or "patient drug therapy record"
17means the obtaining, recording, and maintenance of patient
18prescription information, including prescriptions for
19controlled substances, and personal information.
20    (t) (Blank).
21    (u) "Medical device" or "device" means an instrument,
22apparatus, implement, machine, contrivance, implant, in vitro
23reagent, or other similar or related article, including any
24component part or accessory, required under federal law to bear
25the label "Caution: Federal law requires dispensing by or on
26the order of a physician". A seller of goods and services who,

 

 

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1only for the purpose of retail sales, compounds, sells, rents,
2or leases medical devices shall not, by reasons thereof, be
3required to be a licensed pharmacy.
4    (v) "Unique identifier" means an electronic signature,
5handwritten signature or initials, thumb print, or other
6acceptable biometric or electronic identification process as
7approved by the Department.
8    (w) "Current usual and customary retail price" means the
9price that a pharmacy charges to a non-third-party payor.
10    (x) "Automated pharmacy system" means a mechanical system
11located within the confines of the pharmacy or remote location
12that performs operations or activities, other than compounding
13or administration, relative to storage, packaging, dispensing,
14or distribution of medication, and which collects, controls,
15and maintains all transaction information.
16    (y) "Drug regimen review" means and includes the evaluation
17of prescription drug orders and patient records for (1) known
18allergies; (2) drug or potential therapy contraindications;
19(3) reasonable dose, duration of use, and route of
20administration, taking into consideration factors such as age,
21gender, and contraindications; (4) reasonable directions for
22use; (5) potential or actual adverse drug reactions; (6)
23drug-drug interactions; (7) drug-food interactions; (8)
24drug-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

1and optimum therapeutic outcomes; and (12) abuse and misuse.
2    (z) "Electronically transmitted prescription" means a
3prescription that is created, recorded, or stored by electronic
4means; issued and validated with an electronic signature; and
5transmitted by electronic means directly from the prescriber to
6a pharmacy. An electronic prescription is not an image of a
7physical prescription that is transferred by electronic means
8from computer to computer, facsimile to facsimile, or facsimile
9to computer.
10    (aa) "Medication therapy management services" means a
11distinct service or group of services offered by licensed
12pharmacists, physicians licensed to practice medicine in all
13its branches, advanced practice registered nurses authorized
14in a written agreement with a physician licensed to practice
15medicine in all its branches, or physician assistants
16authorized in guidelines by a supervising physician that
17optimize therapeutic outcomes for individual patients through
18improved medication use. In a retail or other non-hospital
19pharmacy, medication therapy management services shall consist
20of the evaluation of prescription drug orders and patient
21medication 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
13following:
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
25patient care functions authorized by a physician licensed to
26practice medicine in all its branches for his or her identified

 

 

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1patient or groups of patients under specified conditions or
2limitations in a standing order from the physician.
3    "Medication therapy management services" in a licensed
4hospital 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
11of medication therapy management services, with or without the
12dispensing of drugs or devices, intended to achieve outcomes
13that improve patient health, quality of life, and comfort and
14enhance patient safety.
15    (cc) "Protected health information" means individually
16identifiable health information that, except as otherwise
17provided, 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
25individually 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
5or group of patients issued by a physician licensed to practice
6medicine in all its branches in Illinois.
7    (ee) "Address of record" means the designated address
8recorded by the Department in the applicant's application file
9or licensee's license file maintained by the Department's
10licensure maintenance unit.
11    (ff) "Home pharmacy" means the location of a pharmacy's
12primary operations.
13    (gg) "Email address of record" means the designated email
14address recorded by the Department in the applicant's
15application file or the licensee's license file, as maintained
16by the Department's licensure maintenance unit.
17(Source: P.A. 99-180, eff. 7-29-15; 100-208, eff. 1-1-18;
18100-497, 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
20adding 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
23by a pharmacist.
24    (a) As used in this Section:

 

 

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1    "Medication therapy management services" has the meaning
2given to the term in the Pharmacy Practice Act.
3    "Patient counseling" has the meaning given to the term in
4the Pharmacy Practice Act.
5    "Pharmacist care" has the meaning given to the term in the
6Pharmacy Practice Act.
7    "Telepharmacy" has the meaning given to the term in the
8Pharmacy Practice Act.
9    (b) Subject to approval by the federal Centers for Medicare
10and Medicaid Services, the medical assistance program,
11including both the fee-for-service and managed care medical
12assistance programs established under this Article, shall
13cover patient care services provided by a pharmacist.
14    (c) The Department shall establish a fee schedule for the
15list of pharmacist-provided patient care services.
16    (d) The rate of reimbursement for pharmacist-provided
17patient care services shall be at 85% of the fee schedule for
18physician services by the medical assistance program.
19    (e) The covered pharmacist-provided patient care services
20include, but are not limited to: medication therapy management
21services, medication optimization services, comprehensive
22medication reviews, pharmacist care services, patient
23counseling (including those provided through telepharmacy),
24patient consultations (including those provided through
25telepharmacy), disease state management (including
26self-management training), naloxone hydrochloride assessment

 

 

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1or administration, hormonal contraceptives assessment and
2consultation, immunization assessment or administration,
3administration of medications, and other such services that are
4considered within the scope of practice of pharmacy under the
5Pharmacy Practice Act.
6    (f) A pharmacist must be enrolled in the medical assistance
7program as an ordering and referring provider prior to
8rendering a pharmacist-provided patient care service that is
9submitted by a pharmacy or pharmacist provider for
10reimbursement pursuant to this Section.
11    (g) The Director shall seek any necessary federal waivers
12or approvals to implement this Section. This Section shall not
13be implemented until the receipt of all necessary federal
14waivers or approvals and shall be implemented only to the
15extent that federal financial participation is available.
16    (h) This Section does not restrict or prohibit any services
17currently provided by pharmacists as authorized by law,
18including, but not limited to, pharmacist services provided
19under this Code or authorized under the Illinois XIX State
20Plan.
21    (i) The Department shall adopt administrative rules for
22this Section as soon as practicable but no later than May 1,
232019.
 
24    Section 99. Effective date. This Act takes effect January
251, 2019.".