97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB1567

 

Introduced 2/15/2011, by Rep. Jim Watson

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-4.1  from Ch. 23, par. 5-4.1

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that nothwithstanding any provision to the contrary, medical assistance recipients utilizing emergency rooms for non-emergency services shall be required to pay the maximum co-payment permitted by federal law. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB1567LRB097 08682 KTG 48811 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-4.1 as follows:
 
6    (305 ILCS 5/5-4.1)  (from Ch. 23, par. 5-4.1)
7    Sec. 5-4.1. Co-payments. The Department may by rule provide
8that recipients under any Article of this Code shall pay a fee
9as a co-payment for services. Co-payments shall be maximized to
10the extent permitted by federal law. Provided, however, that
11any such rule must provide that no co-payment requirement can
12exist for renal dialysis, radiation therapy, cancer
13chemotherapy, or insulin, and other products necessary on a
14recurring basis, the absence of which would be life
15threatening, or where co-payment expenditures for required
16services and/or medications for chronic diseases that the
17Illinois Department shall by rule designate shall cause an
18extensive financial burden on the recipient, and provided no
19co-payment shall exist for emergency room encounters which are
20for medical emergencies. The Department shall seek approval of
21a State plan amendment that allows pharmacies to refuse to
22dispense drugs in circumstances where the recipient does not
23pay the required co-payment. In the event the State plan

 

 

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1amendment is rejected, co-payments may not exceed $3 for brand
2name drugs, $1 for other pharmacy services other than for
3generic drugs, and $2 for physician services, dental services,
4optical services and supplies, chiropractic services, podiatry
5services, and encounter rate clinic services. There shall be no
6co-payment for generic drugs. Co-payments may not exceed $3 for
7hospital outpatient and clinic services.
8    Nothwithstanding any provision in this Section to the
9contrary, recipients utilizing emergency rooms for
10non-emergency services shall be required to pay the maximum
11co-payment permitted by federal law.
12(Source: P.A. 96-1501, eff. 1-25-11.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.