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90_HB1072eng
20 ILCS 1305/10-30 new
30 ILCS 105/5.449 new
Amends the Department of Human Services Act and the State
Finance Act. Requires the Department to establish a program
to pay for drugs prescribed exclusively for post-kidney
transplant maintenance. Creates the Post-Kidney Transplant
Maintenance Drug Fund as a special fund in the State
treasury, from which payments shall be made. Effective July
1, 1997.
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1 AN ACT concerning kidney transplants.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5 adding Section 12-4.35 as follows:
6 (305 ILCS 5/12-4.35 new)
7 Sec. 12-4.35. Payments for post-kidney transplant
8 maintenance drugs.
9 (a) The Department of Public Aid shall establish and
10 administer a program to pay recipients for costs of drugs
11 prescribed exclusively for post-kidney transplant maintenance
12 when those costs are not otherwise reimbursed. The
13 Department of Public Aid shall establish eligibility
14 standards and an application process by rule. Notwithstanding
15 any other provision of this Code to the contrary, the
16 Department of Public Aid may, by rule, require participants
17 to pay a co-payment for the drugs covered under this program.
18 (b) Participation in the program shall be limited to
19 persons whose household income is not greater than 200% of
20 the federal poverty level as established by the federal
21 Office of Management and Budget.
22 The program shall be available only to eligible Illinois
23 residents who have resided in Illinois for at least 12
24 months, however, a person shall not be excluded because he or
25 she received the transplant outside the State of Illinois.
26 (c) The Department of Public Aid shall pay a maximum
27 amount per kidney transplant recipient based on the
28 following:
29 (1) Available moneys in the Post-Kidney Transplant
30 Maintenance Drug Fund.
31 (2) Covered immunosuppressive drugs.
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1 (3) The terms of any contract between the
2 Department of Public Aid and the provider.
3 (4) The reimbursement rates shall be the same as
4 the Medicaid reimbursement rate for the drug, minus the
5 copayment.
6 (d) Payment shall be made under the program to or on
7 behalf of a program eligible recipient only for costs not
8 reimbursed or eligible for reimbursement by any other third
9 party or governmental entity (including, without limitation,
10 private or group insurance, Medicaid, Medicare, or the
11 Veterans Administration). The Director of Public Aid may,
12 however, waive this requirement in individually considered
13 cases if he or she determines that its enforcement will deny
14 services to a class of post-kidney transplant patients
15 because of conflicting State or federal laws or regulations.
16 (e) The Director of Public Aid may restrict or
17 categorize reimbursements to meet budgetary limitations.
18 (f) The Director of Public Aid shall maintain an
19 immunosuppressive drug formulary that shall include all drugs
20 eligible for reimbursement by the program. The Director of
21 Public Aid shall establish an internal review procedure for
22 updating the formulary; the procedure shall allow the
23 addition and deletion of allowable drugs to the formulary.
24 The internal review procedure shall take place at least
25 quarterly during a fiscal year.
26 (g) Payments made under the program established under
27 this Section shall be made, subject to appropriations, from
28 the Post-Kidney Transplant Maintenance Drug Fund, a special
29 fund that is hereby established in the State treasury. The
30 following shall be deposited into the Fund: (1) amounts
31 appropriated to the Department of Public Aid for that purpose
32 and (ii) gifts, grants, and donations for that purpose from
33 public and private sources. Interest accruing on moneys in
34 the Fund shall remain in the Fund. Moneys in the Fund may be
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1 used only by the Department of Public Aid to make payments
2 for post-kidney transplant maintenance drugs under the
3 program established under this Section.
4 (h) Moneys remaining in the Post-Kidney Transplant
5 Maintenance Drug Fund at the end of the fiscal year may be
6 used in the following fiscal year.
7 Section 10. The State Finance Act is amended by adding
8 Section 5.480 as follows:
9 (30 ILCS 105/5.480 new)
10 Sec. 5.480. The Post-Kidney Transplant Maintenance Drug
11 Fund.
12 Section 99. Effective date. This Act takes effect July
13 1, 1998.