State of Illinois
90th General Assembly
Legislation

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90_HB1072

      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.
                                                    LRB9003786DNmbA
                                              LRB9003786DNmbA
 1        AN ACT concerning the Department of Human Services
 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:
 4        Section  5.  The  Department  of  Human  Services  Act is
 5    amended by adding Section 10-30 as follows:
 6        (20 ILCS 1305/10-30 new)
 7        Sec.   10-30.  Payments   for   post-kidney    transplant
 8    maintenance drugs.
 9        (a)  The  Department  shall  establish  and  administer a
10    program to pay  recipients  for  costs  of  drugs  prescribed
11    exclusively for post-kidney transplant maintenance when those
12    costs  are  not  otherwise  reimbursed.  The Department shall
13    establish eligibility standards and an application process by
14    rule.
15        (b)  Participation in the program  shall  be  limited  to
16    persons  whose  household  income is not greater than 200% of
17    the federal poverty  level  as  established  by  the  federal
18    Office of Management and Budget.
19        The  program shall be available only to eligible Illinois
20    residents who have  resided  in  Illinois  for  at  least  12
21    months, however, a person shall not be excluded because he or
22    she received the transplant outside the State of Illinois.
23        (c)  The Department shall pay a maximum amount per kidney
24    transplant recipient based on the following:
25             (1)  Available moneys.
26             (2)  Covered immunosuppressive drugs.
27             (3)  The   terms   of   any   contract  between  the
28        Department and the provider.
29             (4)  The reimbursement rates shall be  the  same  as
30        the  Medicaid  reimbursement rate for the drug, minus the
31        copayment.
                            -2-               LRB9003786DNmbA
 1        (d)  Payment shall be made under the  program  to  or  on
 2    behalf  of  a  program  eligible recipient only for costs not
 3    reimbursed or eligible for reimbursement by any  other  third
 4    party  or governmental entity (including, without limitation,
 5    private  or  group  insurance,  Medicaid,  Medicare,  or  the
 6    Veterans Administration).  The Secretary may, however,  waive
 7    this  requirement  in  individually  considered  cases if the
 8    Secretary determines that its enforcement will deny  services
 9    to  a  class  of  post-kidney  transplant patients because of
10    conflicting  State  or  federal  laws  or  regulations.   The
11    Department of Public Health shall make rules to  ensure  that
12    all  third  parties  and  governmental  entities  (including,
13    without  limitation,  private  or  group insurance, Medicaid,
14    Medicare, or the Veterans Administration) make  all  required
15    benefit payments.
16        (e)  The    Secretary    may   restrict   or   categorize
17    reimbursements to meet budgetary limitations.
18        (f)  The Secretary shall  maintain  an  immunosuppressive
19    drug  formulary  that  shall  include  all drugs eligible for
20    reimbursement by the program.  The Secretary shall  establish
21    an  internal review procedure for updating the formulary; the
22    procedure shall allow the addition and deletion of  allowable
23    drugs  to the formulary.  The internal review procedure shall
24    take place at least quarterly during a fiscal year.
25        (g)  Payments made under the  program  established  under
26    this  Section  shall be made, subject to appropriations, from
27    the Post-Kidney Transplant Maintenance Drug Fund,  a  special
28    fund  that  is hereby established in the State treasury.  The
29    following shall be  deposited  into  the  Fund:  (1)  amounts
30    appropriated  to  the  Department  for  that purpose and (ii)
31    gifts, grants, and donations for that purpose from public and
32    private sources.  Interest accruing on  moneys  in  the  Fund
33    shall  remain  in  the  Fund.  Moneys in the Fund may be used
34    only by the  Department  to  make  payments  for  post-kidney
                            -3-               LRB9003786DNmbA
 1    transplant  maintenance  drugs  under the program established
 2    under this Section.
 3        (h)  Moneys  remaining  in  the  Post-Kidney   Transplant
 4    Maintenance  Drug  Fund  at the end of the fiscal year may be
 5    used in the following fiscal year.
 6        Section 10.  The State Finance Act is amended  by  adding
 7    Section 5.449 as follows:
 8        (30 ILCS 105/5.449 new)
 9        Sec.  5.449.  The Post-Kidney Transplant Maintenance Drug
10    Fund.
11        Section 99.  Effective date.  This Act takes effect  July
12    1, 1997.

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