Illinois General Assembly - Full Text of HB0591
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Full Text of HB0591  102nd General Assembly

HB0591 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB0591

 

Introduced 2/8/2021, by Rep. La Shawn K. Ford - Kelly M. Cassidy - Carol Ammons - Terra Costa Howard - Lindsey LaPointe

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.12d new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to permit medical assistance recipients, including those enrolled in managed care, to obtain pharmacy services from the pharmacy of their choice if the pharmacy is licensed under the Pharmacy Practice Act and accepts the professional dispensing fee for pharmacy services as determined by the Department. Provides that no managed care organization that contracts with the Department to provide services to recipients may restrict a recipient's access to pharmacy services to a selected group of pharmacies. Provides that if a managed care organization merges with or is acquired by another entity, the resulting entity may not restrict a recipient's access to pharmacy services to a selected group of pharmacies. Permits the Department to renegotiate with the resulting entity the terms of the managed care contract the Department had with the original managed care organization prior to the merger or acquisition. Requires the Department to contract with an independent research organization to conduct a study and submit a report on those managed care organizations that are contracted to provide services to recipients. Requires the report to include an analysis of pharmacy access for medical assistance recipients with the aim of identifying "pharmacy deserts"; an analysis of the costs and benefits of having managed care organizations administer health care services, including pharmacy services, to recipients; and other matters. Prohibits the Department from entering into any new contract with a managed care organization before the report has been received and analyzed by the Department and posted on its website. Effective immediately.


LRB102 14191 KTG 19543 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB0591LRB102 14191 KTG 19543 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
5adding Section 5-5.12d as follows:
 
6    (305 ILCS 5/5-5.12d new)
7    Sec. 5-5.12d. Pharmacy access in managed care; analysis
8report.
9    (a) To improve access to pharmacy services for recipients
10of medical assistance, including those who are enrolled in the
11State's managed care medical assistance program, the
12Department shall permit recipients to obtain pharmacy services
13from the pharmacy of their choice if the pharmacy is licensed
14under the Pharmacy Practice Act and accepts the professional
15dispensing fee for pharmacy services as determined by the
16Department.
17    (b) No managed care organization that contracts with the
18Department to provide services under the State's managed care
19medical assistance program may restrict a recipient's access
20to pharmacy services to a selected group of pharmacies. If a
21managed care organization merges with or is acquired by
22another entity, the resulting entity may not restrict a
23recipient's access to pharmacy services to a selected group of

 

 

HB0591- 2 -LRB102 14191 KTG 19543 b

1pharmacies. In the case of a merger or acquisition, the
2Department may renegotiate with the resulting entity the terms
3of the managed care contract the Department had with the
4original managed care organization prior to the merger or
5acquisition.
6    (c) No later than 3 months after the effective date of this
7amendatory Act of the 102nd General Assembly, the Department
8shall enter into a contract with an independent research
9organization to conduct a study and analysis of those managed
10care organizations that are contracted to provide services
11under the State's managed care medical assistance program. The
12independent research organization must have no affiliation
13with managed care organizations and must submit a report of
14its findings and analysis to the Department within 90 days
15after entering into a contract with the Department. The report
16must include the following:
17        (1) An analysis of pharmacy access for recipients of
18    medical assistance with the aim of identifying "pharmacy
19    deserts", which are areas without accessible pharmacy
20    services for community residents. The analysis must focus
21    especially on those areas of high social vulnerability
22    indices with the aim of creating patient-relevant and
23    research-based standards of distances from the recipient's
24    residence to pharmacies that are based on roads or
25    streets, including bus routes, traveled by recipients.
26    This part of the analysis must not use aerial distances.

 

 

HB0591- 3 -LRB102 14191 KTG 19543 b

1    Pharmacy access standards must be differentiated in rural,
2    suburban, and urban areas. For example, the 15-mile access
3    standard applies for rural areas, less than 5 miles for
4    suburban, and less than 1/2 mile or one mile in urban areas
5    that are low-income. The assessment must be detailed
6    enough to help the Department propose a plan to meet the
7    need for pharmacy services in the pharmacy deserts
8    identified in the report.
9        (2) An analysis of the costs and benefits of having
10    managed care organizations administer health care
11    services, including pharmacy services, under the State's
12    managed care medical assistance program.
13        (3) A detailed analysis of the overhead administrative
14    costs associated with the provision of pharmacy services
15    under the State's managed care medical assistance program
16    in comparison with the overhead administrative costs
17    associated with the provision of pharmacy services under
18    the State's traditional fee-for-service program.
19        (4) A detailed survey based on significant input from
20    both recipients and pharmacy providers regarding their
21    assessment of pharmacy services provided under the State's
22    managed care medical assistance program.
23    The Department may not enter into any new contract with a
24managed care organization to provide health care services,
25including pharmacy services, to recipients before the report
26from the independent research organization has been received

 

 

HB0591- 4 -LRB102 14191 KTG 19543 b

1and analyzed by the Department and posted on the Department's
2website.
 
3    Section 99. Effective date. This Act takes effect upon
4becoming law.