State of Illinois
91st General Assembly
Legislation

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91_HB0486

 
                                               LRB9100447SMdv

 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 12-4.36 as follows:

 6        (305 ILCS 5/12-4.36 new)
 7        Sec.  12-4.36.  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.
 
                            -2-                LRB9100447SMdv
 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
 
                            -3-                LRB9100447SMdv
 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 5.490 as follows:

 9        (30 ILCS 105/5.490 new)
10        Sec. 5.490.  The Post-Kidney Transplant Maintenance  Drug
11    Fund.

12        Section  99.  Effective date.  This Act takes effect July
13    1, 1999.

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