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| [ Introduced ] | [ Engrossed ] | [ House Amendment 002 ] |
90_HB1072ham001
LRB9003786SMdvam03
1 AMENDMENT TO HOUSE BILL 1072
2 AMENDMENT NO. . Amend House Bill 1072 by replacing
3 the title with the following:
4 "AN ACT concerning kidney transplants."; and
5 by replacing everything after the enacting clause with the
6 following:
7 "Section 5. The Illinois Public Aid Code is amended by
8 adding Section 12-4.35 as follows:
9 (305 ILCS 5/12-4.35 new)
10 Sec. 12-4.35. Payments for post-kidney transplant
11 maintenance drugs.
12 (a) The Department of Public Aid shall establish and
13 administer a program to pay recipients for costs of drugs
14 prescribed exclusively for post-kidney transplant maintenance
15 when those costs are not otherwise reimbursed. The
16 Department of Public Aid shall establish eligibility
17 standards and an application process by rule.
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.
-2- LRB9003786SMdvam03
1 The program shall be available only to eligible Illinois
2 residents who have resided in Illinois for at least 12
3 months, however, a person shall not be excluded because he or
4 she received the transplant outside the State of Illinois.
5 (c) The Department of Public Aid shall pay a maximum
6 amount per kidney transplant recipient based on the
7 following:
8 (1) Available moneys.
9 (2) Covered immunosuppressive drugs.
10 (3) The terms of any contract between the
11 Department of Public Aid and the provider.
12 (4) The reimbursement rates shall be the same as
13 the Medicaid reimbursement rate for the drug, minus the
14 copayment.
15 (d) Payment shall be made under the program to or on
16 behalf of a program eligible recipient only for costs not
17 reimbursed or eligible for reimbursement by any other third
18 party or governmental entity (including, without limitation,
19 private or group insurance, Medicaid, Medicare, or the
20 Veterans Administration). The Director of Public Aid may,
21 however, waive this requirement in individually considered
22 cases if he or she determines that its enforcement will deny
23 services to a class of post-kidney transplant patients
24 because of conflicting State or federal laws or regulations.
25 (e) The Director of Public Aid may restrict or
26 categorize reimbursements to meet budgetary limitations.
27 (f) The Director of Public Aid shall maintain an
28 immunosuppressive drug formulary that shall include all drugs
29 eligible for reimbursement by the program. The Director of
30 Public Aid shall establish an internal review procedure for
31 updating the formulary; the procedure shall allow the
32 addition and deletion of allowable drugs to the formulary.
33 The internal review procedure shall take place at least
34 quarterly during a fiscal year.
-3- LRB9003786SMdvam03
1 (g) Payments made under the program established under
2 this Section shall be made, subject to appropriations, from
3 the Post-Kidney Transplant Maintenance Drug Fund, a special
4 fund that is hereby established in the State treasury. The
5 following shall be deposited into the Fund: (1) amounts
6 appropriated to the Department of Public Aid for that purpose
7 and (ii) gifts, grants, and donations for that purpose from
8 public and private sources. Interest accruing on moneys in
9 the Fund shall remain in the Fund. Moneys in the Fund may be
10 used only by the Department of Public Aid to make payments
11 for post-kidney transplant maintenance drugs under the
12 program established under this Section.
13 (h) Moneys remaining in the Post-Kidney Transplant
14 Maintenance Drug Fund at the end of the fiscal year may be
15 used in the following fiscal year.
16 Section 10. The State Finance Act is amended by adding
17 Section 5.480 as follows:
18 (30 ILCS 105/5.480 new)
19 Sec. 5.480. The Post-Kidney Transplant Maintenance Drug
20 Fund.
21 Section 99. Effective date. This Act takes effect July
22 1, 1998.".