TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 119 ILLINOIS CARES RX PROGRAM
SECTION 119.10 DEFINITIONS
Section 119.10 Definitions
The following definitions apply for purposes of this Part:
"Act" means the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act [320 ILCS 25].
"AIDS Drug Assistance Program" or "ADAP" means the program administered by the Illinois Department of Public Health (DPH) that provides pharmaceutical assistance for AIDS/HIV drugs for eligible Illinois citizens.
"AIDS Drug Assistance Program formulary" or "ADAP formulary" means the formulary developed and published by DPH for ADAP.
"Applicant" means any person in a household who has requested pharmaceutical assistance benefits on an application filed by an applicant.
"Beneficiary" means a person whose application for pharmaceutical assistance benefits under the Act has been approved by the Department on Aging.
"Brand name drug" means those drugs as defined in 89 Ill. Adm. Code 140.440(g)(3) when dispensed to an individual not enrolled in Medicare Part D. When dispensed to an individual enrolled in Medicare Part D, brand name drugs means those legend drugs defined as brand name drugs by the individual's Medicare Prescription Drug Plan (PDP).
"Coordinating Prescription Drug Plan" means a Medicare Part D Prescription Drug Plan that has signed a coordination agreement with the Department and to which the Department pays a per member/per month (PM/PM) payment for each Illinois Cares Rx beneficiary enrolled in that plan.
"Department" means the Illinois Department of Healthcare and Family Services.
"Director" means the Director of the Illinois Department of Healthcare and Family Services.
"Disabled person" means a person who is unable to engage in any substantial gainful activity by reason of medically determinable physical or mental impairment that can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months. [320 ILCS 25/3.14]
"Disease" means a chronic and possibly recurrent illness of long duration, as distinguished from an acute illness that is of short duration with recovery due to limited medical treatment (such as in the case of colds, flu, pneumonia, bronchitis, or other similar illnesses).
"Domiciled" means having a fixed habitation at a permanent residence in Illinois at the time of filing the application and during the coverage year.
"Electronic application" means the electronic document set forth in 86 Ill. Adm. Code 530.305(a).
"FPL" means the federal poverty income guideline as determined annually by the United States Department of Health and Human Services.
"Generic drug" means those legend drugs as defined in 89 Ill. Adm. Code 140.440(g)(2) when dispensed to individuals not enrolled in Medicare Part D. When dispensed to individuals enrolled in Medicare Part D, generic drugs means those legend drugs defined as generic drugs by the individual's Medicare Prescription Drug Plan (PDP).
"Household" means an applicant or an applicant and his or her spouse living together in the same residence. [320 ILCS 25/3.05]
"Household income" means the combined income of the members of a household for a year. [320 ILCS 25/3.06]
"Illinois Cares Rx Plus" means the provision of benefits to individuals in eligibility group 2, 3 or 4, as defined in 320 ILCS 25/4(g).
"Illinois Cares Rx Basic" means the provision of benefits to individuals in eligibility group 1, as defined in 320 ILCS 25/4(g).
"Illinois Cares Rx Basic Covered Prescription Drug" means any drug included in the categories listed in Section 119.80 and prescribed as set forth in Section 119.80.
"Illinois Cares Rx Rebate" means an Illinois Cares Rx benefit in the form of a monthly monetary payment made to an individual enrolled in a third-party plan that provides a pharmacy benefit or a PDP that is not a Coordinating Medicare PDP. The payment is made in lieu of the covered services described in Section 119.60.
"Income" means adjusted gross income, properly reportable for federal income tax purposes under the provisions of the Internal Revenue Code, modified as defined in 320 ILCS 25/3.07.
"Non-Preferred Drug" means those drugs that are 3rd tier or higher on an individual's Medicare Part D Prescription Drug Plan's (PDPs) formulary or are listed as non-preferred on the Department's Preferred Drug List.
"Over-the-counter items" means those pharmaceutical items that may be purchased off the shelf by the general public.
"Pharmaceutical product" means a brand name drug, a generic drug, or an over-the-counter item.
"Prescription Drug Plan" or "PDP" means a Medicare Part D Prescription Drug Plan.
"Program" means the Illinois Cares Rx Pharmaceutical Assistance Program provided for under the Act.
"Projected income" means household income expected to be received for a coverage year.
(Source: Amended at 34 Ill. Reg. 6788, effective May 1, 2010)