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Public Act 91-0873
HB0486 Enrolled LRB9100447SMdv
AN ACT concerning organ transplants.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Civil Administrative Code of Illinois is
amended by adding Section 2310-260 as follows:
(20 ILCS 2310/2310-260 new)
Sec. 2310-260. Payments for post transplant maintenance
and retention.
(a) The Department shall establish and administer a
program to pay recipients for drugs and other costs
prescribed exclusively for post transplant maintenance and
retention when those costs are not otherwise reimbursed. The
Department shall establish eligibility standards and an
application process by rule. Notwithstanding any other
provision of this Code to the contrary, the Department may,
by rule, require participants to pay a co-payment for the
drugs covered under this program.
(b) Participation in the program shall be limited to
persons whose household income is not greater than 400% of
the federal poverty level as established by the federal
Office of Management and Budget. The program shall be
available only to eligible Illinois residents who have
resided in Illinois for at least 12 months; however, a person
shall not be excluded because that person received the
transplant outside of the State of Illinois.
(c) The Department shall pay a maximum amount per
transplant recipient based on the following:
(1) Available moneys in the Post Transplant
Maintenance and Retention Fund.
(2) Covered immunosuppressive drugs.
(3) The terms of any contract between the Department
and the provider.
The reimbursement rates shall be the same as the Medicaid
reimbursement rate for the drug, minus any co-payment and
other medical services.
(d) Payment shall be made under the program to or on
behalf of a program-eligible recipient only for costs not
reimbursed or eligible for reimbursement by any other third
party or governmental entity, including, without limitation,
private or group insurance, Medicaid, Medicare, and the
Veterans Administration. The Director may, however, waive
this requirement in individually considered cases if the
Director determines that its enforcement will deny services
to a class of post transplant patients because of conflicting
State or federal laws or regulations.
(e) The Director may restrict or categorize
reimbursements to meet budgetary limitations.
(f) The Director shall maintain an immunosuppressive drug
formulary that shall include all drugs eligible for
reimbursement by the program. The Director shall establish an
internal review procedure for updating the formulary; the
procedure shall allow the addition and deletion of allowable
drugs to the formulary. The internal review procedure shall
take place at least quarterly during a fiscal year.
(g) Payments made under the program established under
this Section shall be made, subject to appropriations, from
the Post Transplant Maintenance and Retention Fund, a special
fund that is hereby created in the State Treasury. The
following shall be deposited into the Fund: (i) amounts
appropriated to the Department for that purpose, and (ii)
gifts, grants, and donations for that purpose from public and
private sources. Interest accruing on moneys in the Fund
shall remain in the Fund. Moneys in the Fund may be used only
by the Department to make payments for post transplant
maintenance and retention under the program established under
this Section.
(h) Moneys remaining in the Post Transplant Maintenance
and Retention Fund at the end of the fiscal year may be used
in the following fiscal year.
Section 10. The State Finance Act is amended by adding
Section 5.541 as follows:
(30 ILCS 105/5.541 new)
Sec. 5.541. The Post Transplant Maintenance and
Retention Fund.
Section 99. Effective date. This Act takes effect on
July 1, 2000.
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