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90_HB2872
20 ILCS 1305/10-30 new
30 ILCS 105/5.480 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, 1998.
LRB9009948KDks
LRB9009948KDks
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.
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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
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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 5.480 as follows:
8 (30 ILCS 105/5.480 new)
9 Sec. 5.480. The Post-Kidney Transplant Maintenance Drug
10 Fund.
11 Section 99. Effective date. This Act takes effect July
12 1, 1998.