Illinois General Assembly - Full Text of SB1802
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Full Text of SB1802  97th General Assembly




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1    AN ACT concerning State government.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. The Department of Human Services Act is amended
5by adding Section 10-66 as follows:
6    (20 ILCS 1305/10-66 new)
7    Sec. 10-66. Rate reductions. Rates for medical services
8purchased by the Divisions of Alcohol and Substance Abuse,
9Community Health and Prevention, Developmental Disabilities,
10Mental Health, or Rehabilitation Services within the
11Department of Human Services shall not be reduced below the
12rates calculated on April 1, 2011 unless the Department of
13Human Services promulgates rules and rules are implemented
14authorizing rate reductions.
15    Section 2. The Civil Administrative Code of Illinois is
16amended by changing Section 2310-315 as follows:
17    (20 ILCS 2310/2310-315)  (was 20 ILCS 2310/55.41)
18    Sec. 2310-315. Prevention and treatment of AIDS. To perform
19the following in relation to the prevention and treatment of
20acquired immunodeficiency syndrome (AIDS):
21    (1) Establish a State AIDS Control Unit within the



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1Department as a separate administrative subdivision, to
2coordinate all State programs and services relating to the
3prevention, treatment, and amelioration of AIDS.
4    (2) Conduct a public information campaign for physicians,
5hospitals, health facilities, public health departments, law
6enforcement personnel, public employees, laboratories, and the
7general public on acquired immunodeficiency syndrome (AIDS)
8and promote necessary measures to reduce the incidence of AIDS
9and the mortality from AIDS. This program shall include, but
10not be limited to, the establishment of a statewide hotline and
11a State AIDS information clearinghouse that will provide
12periodic reports and releases to public officials, health
13professionals, community service organizations, and the
14general public regarding new developments or procedures
15concerning prevention and treatment of AIDS.
16    (3) (Blank).
17    (4) Establish alternative blood test services that are not
18operated by a blood bank, plasma center or hospital. The
19Department shall prescribe by rule minimum criteria, standards
20and procedures for the establishment and operation of such
21services, which shall include, but not be limited to
22requirements for the provision of information, counseling and
23referral services that ensure appropriate counseling and
24referral for persons whose blood is tested and shows evidence
25of exposure to the human immunodeficiency virus (HIV) or other
26identified causative agent of acquired immunodeficiency



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1syndrome (AIDS).
2    (5) Establish regional and community service networks of
3public and private service providers or health care
4professionals who may be involved in AIDS research, prevention
5and treatment.
6    (6) Provide grants to individuals, organizations or
7facilities to support the following:
8        (A) Information, referral, and treatment services.
9        (B) Interdisciplinary workshops for professionals
10    involved in research and treatment.
11        (C) Establishment and operation of a statewide
12    hotline.
13        (D) Establishment and operation of alternative testing
14    services.
15        (E) Research into detection, prevention, and
16    treatment.
17        (F) Supplementation of other public and private
18    resources.
19        (G) Implementation by long-term care facilities of
20    Department standards and procedures for the care and
21    treatment of persons with AIDS and the development of
22    adequate numbers and types of placements for those persons.
23    (7) (Blank).
24    (8) Accept any gift, donation, bequest, or grant of funds
25from private or public agencies, including federal funds that
26may be provided for AIDS control efforts.



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1    (9) Develop and implement, in consultation with the
2Long-Term Care Facility Advisory Board, standards and
3procedures for long-term care facilities that provide care and
4treatment of persons with AIDS, including appropriate
5infection control procedures. The Department shall work
6cooperatively with organizations representing those facilities
7to develop adequate numbers and types of placements for persons
8with AIDS and shall advise those facilities on proper
9implementation of its standards and procedures.
10    (10) The Department shall create and administer a training
11program for State employees who have a need for understanding
12matters relating to AIDS in order to deal with or advise the
13public. The training shall include information on the cause and
14effects of AIDS, the means of detecting it and preventing its
15transmission, the availability of related counseling and
16referral, and other matters that may be appropriate. The
17training may also be made available to employees of local
18governments, public service agencies, and private agencies
19that contract with the State; in those cases the Department may
20charge a reasonable fee to recover the cost of the training.
21    (11) Approve tests or testing procedures used in
22determining exposure to HIV or any other identified causative
23agent of AIDS.
24    (12) Provide prescription drug benefits counseling for
25persons with HIV or AIDS.
26    (13) Continue to administer the AIDS Drug Assistance



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1Program that provides drugs to prolong the lives of low income
2Persons with Acquired Immunodeficiency Syndrome (AIDS) or
3Human Immunodeficiency Virus (HIV) infection who are not
4eligible under Article V of the Illinois Public Aid Code for
5Medical Assistance, as provided under Title 77, Chapter 1,
6Subchapter (k), Part 692, Section 692.10 of the Illinois
7Administrative Code, effective August 1, 2000, except that the
8financial qualification for that program shall be that the
9anticipated gross monthly income shall be at or below 500% of
10the most recent Federal Poverty Guidelines published annually
11by the United States Department of Health and Human Services
12for the size of the household. Notwithstanding the preceding
13sentence, the Department of Public Health may determine the
14income eligibility standard for the AIDS Drug Assistance
15Program each year and may set the standard at more than 500% of
16the Federal Poverty Guidelines for the size of the household,
17provided that moneys appropriated to the Department for the
18program are sufficient to cover the increased cost of
19implementing the higher income eligibility standard.
20Rulemaking authority to implement this amendatory Act of the
2195th General Assembly, if any, is conditioned on the rules
22being adopted in accordance with all provisions of the Illinois
23Administrative Procedure Act and all rules and procedures of
24the Joint Committee on Administrative Rules; any purported rule
25not so adopted, for whatever reason, is unauthorized. If the
26Department reduces the financial qualification for new



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1applicants while allowing currently enrolled individuals to
2remain on the program, the Department shall maintain a waiting
3list of applicants who would otherwise be eligible except that
4they do not meet the financial qualifications. Upon
5determination that program finances are adequate, the
6Department shall permit qualified individuals who are on the
7waiting list to enroll in the program.
8    (14) In order to implement the provisions of Public Act
995-7, the Department must expand HIV testing in health care
10settings where undiagnosed individuals are likely to be
11identified. The Department must purchase rapid HIV kits and
12make grants for technical assistance, staff to conduct HIV
13testing and counseling, and related purposes. The Department
14must make grants to (i) facilities serving patients that are
15uninsured at high rates, (ii) facilities located in areas with
16a high prevalence of HIV or AIDS, (iii) facilities that have a
17high likelihood of identifying individuals who are undiagnosed
18with HIV or AIDS, or (iv) any combination of items (i), (ii),
19and (iii).
20(Source: P.A. 94-909, eff. 6-23-06; 95-744, eff. 7-18-08;
2195-1042, eff. 3-25-09.)
22    Section 3. The Disabled Persons Rehabilitation Act is
23amended by adding Section 10a as follows:
24    (20 ILCS 2405/10a new)



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1    Sec. 10a. Financial Participation of Students Attending
2the Illinois School for the Deaf and the Illinois School for
3the Visually Impaired.
4    (a) General. The Illinois School for the Deaf and the
5Illinois School for the Visually Impaired are required to
6provide eligible students with disabilities with a free and
7appropriate education. As part of the admission process to
8either school, the Department shall complete a financial
9analysis on each student attending the Illinois School for the
10Deaf or the Illinois School for the Visually Impaired and shall
11ask parents or guardians to participate, if applicable, in the
12cost of identified services or activities that are not
13education related.
14    (b) Completion of financial analysis. Prior to admission,
15and annually thereafter, a financial analysis shall be
16completed on each student attending the Illinois School for the
17Deaf or the Illinois School for the Visually Impaired. If at
18any time there is reason to believe there is a change in the
19student's financial situation that will affect their financial
20participation, a new financial analysis shall be completed.
21        (1) In completing the student's financial analysis,
22    the income of the student's family shall be used. Proof of
23    income must be provided and retained for each parent or
24    guardian.
25        (2) Any funds that have been established on behalf of
26    the student for completion of their primary or secondary



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1    education shall be considered when completing the
2    financial analysis.
3        (3) Falsification of information used to complete the
4    financial analysis may result in the Department taking
5    action to recoup monies previously expended by the
6    Department in providing services to the student.
7    (c) Financial Participation. Utilizing a sliding scale
8based on income standards developed by rule by the Department
9with input from the superintendent of each school, parents or
10guardians of students attending the Illinois School for the
11Deaf or the Illinois School for the Visually Impaired may be
12asked to financially participate in the following fees for
13services or activities provided at the schools:
14        (1) Registration.
15        (2) Books, labs, and supplies (fees may vary depending
16    on the classes in which a student participates).
17        (3) Room and board for residential students.
18        (4) Meals for day students.
19        (5) Athletic or extracurricular activities (students
20    participating in multiple activities will not be required
21    to pay for more than 2 activities).
22        (6) Driver's education (if applicable).
23        (7) Graduation.
24        (8) Yearbook (optional).
25        (9) Activities (field trips or other leisure
26    activities).



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1        (10) Other activities or services identified by the
2    Department.
3    Students, parents, or guardians who are receiving Medicaid
4or Temporary Assistance for Needy Families (TANF) shall not be
5required to financially participate in the fees established in
6this subsection (c).
7    Exceptions may be granted to parents or guardians who are
8unable to meet the financial participation obligations due to
9extenuating circumstances. Requests for exceptions must be
10made in writing and must be submitted to the superintendent for
11initial recommendation with a final determination by the
12Director of the Division of Rehabilitation Services.
13    Any fees collected under this subsection (c) shall be held
14locally by the school and used exclusively for the purpose for
15which the fee was assessed.
16    Section 5. The State Prompt Payment Act is amended by
17changing Section 3-2 as follows:
18    (30 ILCS 540/3-2)
19    Sec. 3-2. Beginning July 1, 1993, in any instance where a
20State official or agency is late in payment of a vendor's bill
21or invoice for goods or services furnished to the State, as
22defined in Section 1, properly approved in accordance with
23rules promulgated under Section 3-3, the State official or
24agency shall pay interest to the vendor in accordance with the



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2        (1) Any bill, except a bill submitted under Article V
3    of the Illinois Public Aid Code and except as provided
4    under paragraph (1.05) of this Section, approved for
5    payment under this Section must be paid or the payment
6    issued to the payee within 60 days of receipt of a proper
7    bill or invoice. If payment is not issued to the payee
8    within this 60-day 60 day period, an interest penalty of
9    1.0% of any amount approved and unpaid shall be added for
10    each month or fraction thereof after the end of this 60-day
11    60 day period, until final payment is made. Any bill,
12    except a bill for pharmacy or nursing facility services or
13    goods and except as provided under paragraph (1.05) of this
14    Section, submitted under Article V of the Illinois Public
15    Aid Code approved for payment under this Section must be
16    paid or the payment issued to the payee within 60 days
17    after receipt of a proper bill or invoice, and, if payment
18    is not issued to the payee within this 60-day period, an
19    interest penalty of 2.0% of any amount approved and unpaid
20    shall be added for each month or fraction thereof after the
21    end of this 60-day period, until final payment is made. Any
22    bill for pharmacy or nursing facility services or goods
23    submitted under Article V of the Illinois Public Aid Code,
24    except as provided under paragraph (1.05) of this Section,
25    , approved for payment under this Section must be paid or
26    the payment issued to the payee within 60 days of receipt



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1    of a proper bill or invoice. If payment is not issued to
2    the payee within this 60-day 60 day period, an interest
3    penalty of 1.0% of any amount approved and unpaid shall be
4    added for each month or fraction thereof after the end of
5    this 60-day 60 day period, until final payment is made.
6        (1.05) For State fiscal year 2012 and future fiscal
7    years, any bill approved for payment under this Section
8    must be paid or the payment issued to the payee within 90
9    days of receipt of a proper bill or invoice. If payment is
10    not issued to the payee within this 90-day period, an
11    interest penalty of 1.0% of any amount approved and unpaid
12    shall be added for each month or fraction thereof after the
13    end of this 90-day period, until final payment is made.
14        (1.1) A State agency shall review in a timely manner
15    each bill or invoice after its receipt. If the State agency
16    determines that the bill or invoice contains a defect
17    making it unable to process the payment request, the agency
18    shall notify the vendor requesting payment as soon as
19    possible after discovering the defect pursuant to rules
20    promulgated under Section 3-3; provided, however, that the
21    notice for construction related bills or invoices must be
22    given not later than 30 days after the bill or invoice was
23    first submitted. The notice shall identify the defect and
24    any additional information necessary to correct the
25    defect. If one or more items on a construction related bill
26    or invoice are disapproved, but not the entire bill or



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1    invoice, then the portion that is not disapproved shall be
2    paid.
3        (2) Where a State official or agency is late in payment
4    of a vendor's bill or invoice properly approved in
5    accordance with this Act, and different late payment terms
6    are not reduced to writing as a contractual agreement, the
7    State official or agency shall automatically pay interest
8    penalties required by this Section amounting to $50 or more
9    to the appropriate vendor. Each agency shall be responsible
10    for determining whether an interest penalty is owed and for
11    paying the interest to the vendor. Interest due to a vendor
12    that amounts to less than $50 shall not be paid but shall
13    be accrued until all interest due the vendor for all
14    similar warrants exceeds $50, at which time the accrued
15    interest shall be payable and interest will begin accruing
16    again, except that interest accrued as of the end of the
17    fiscal year that does not exceed $50 shall be payable at
18    that time. In the event an individual has paid a vendor for
19    services in advance, the provisions of this Section shall
20    apply until payment is made to that individual.
21        (3) The provisions of Public Act 96-1501 this
22    amendatory Act of the 96th General Assembly reducing the
23    interest rate on pharmacy claims under Article V of the
24    Illinois Public Aid Code to 1.0% per month shall apply to
25    any pharmacy bills for services and goods under Article V
26    of the Illinois Public Aid Code received on or after the



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1    date 60 days before January 25, 2011 (the effective date of
2    Public Act 96-1501) except as provided under paragraph
3    (1.05) of this Section this amendatory Act of the 96th
4    General Assembly.
5(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10;
696-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff.
71-25-11; 96-1530, eff. 2-16-11; revised 2-22-11.)
8    Section 10. The Children's Health Insurance Program Act is
9amended by changing Section 30 as follows:
10    (215 ILCS 106/30)
11    Sec. 30. Cost sharing.
12    (a) Children enrolled in a health benefits program pursuant
13to subdivision (a)(2) of Section 25 and persons enrolled in a
14health benefits waiver program pursuant to Section 40 shall be
15subject to the following cost sharing requirements:
16        (1) There shall be no co-payment required for well-baby
17    or well-child care, including age-appropriate
18    immunizations as required under federal law.
19        (2) Health insurance premiums for family members,
20    either children or adults, in families whose household
21    income is above 150% of the federal poverty level shall be
22    payable monthly, subject to rules promulgated by the
23    Department for grace periods and advance payments, and
24    shall be as follows:



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1            (A) $15 per month for one family member.
2            (B) $25 per month for 2 family members.
3            (C) $30 per month for 3 family members.
4            (D) $35 per month for 4 family members.
5            (E) $40 per month for 5 or more family members.
6        (3) Co-payments for children or adults in families
7    whose income is at or below 150% of the federal poverty
8    level, at a minimum and to the extent permitted under
9    federal law, shall be $2 for all medical visits and
10    prescriptions provided under this Act and up to $10 for
11    emergency room use for a non-emergency situation as defined
12    by the Department by rule and subject to federal approval.
13        (4) Co-payments for children or adults in families
14    whose income is above 150% of the federal poverty level, at
15    a minimum and to the extent permitted under federal law
16    shall be as follows:
17            (A) $5 for medical visits.
18            (B) $3 for generic prescriptions and $5 for brand
19        name prescriptions.
20            (C) $25 for emergency room use for a non-emergency
21        situation as defined by the Department by rule.
22        (5) (Blank) The maximum amount of out-of-pocket
23    expenses for co-payments shall be $100 per family per year.
24        (6) Co-payments shall be maximized to the extent
25    permitted by federal law and are subject to federal
26    approval.



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1    (b) Individuals enrolled in a privately sponsored health
2insurance plan pursuant to subdivision (a)(1) of Section 25
3shall be subject to the cost sharing provisions as stated in
4the privately sponsored health insurance plan.
5(Source: P.A. 94-48, eff. 7-1-05.)
6    Section 15. The Illinois Public Aid Code is amended by
7changing Sections 5-2, 5-4.1, 5-5.12, and 5A-10 as follows:
8    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
9    Sec. 5-2. Classes of Persons Eligible. Medical assistance
10under this Article shall be available to any of the following
11classes of persons in respect to whom a plan for coverage has
12been submitted to the Governor by the Illinois Department and
13approved by him:
14        1. Recipients of basic maintenance grants under
15    Articles III and IV.
16        2. Persons otherwise eligible for basic maintenance
17    under Articles III and IV, excluding any eligibility
18    requirements that are inconsistent with any federal law or
19    federal regulation, as interpreted by the U.S. Department
20    of Health and Human Services, but who fail to qualify
21    thereunder on the basis of need or who qualify but are not
22    receiving basic maintenance under Article IV, and who have
23    insufficient income and resources to meet the costs of
24    necessary medical care, including but not limited to the



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1    following:
2            (a) All persons otherwise eligible for basic
3        maintenance under Article III but who fail to qualify
4        under that Article on the basis of need and who meet
5        either of the following requirements:
6                (i) their income, as determined by the
7            Illinois Department in accordance with any federal
8            requirements, is equal to or less than 70% in
9            fiscal year 2001, equal to or less than 85% in
10            fiscal year 2002 and until a date to be determined
11            by the Department by rule, and equal to or less
12            than 100% beginning on the date determined by the
13            Department by rule, of the nonfarm income official
14            poverty line, as defined by the federal Office of
15            Management and Budget and revised annually in
16            accordance with Section 673(2) of the Omnibus
17            Budget Reconciliation Act of 1981, applicable to
18            families of the same size; or
19                (ii) their income, after the deduction of
20            costs incurred for medical care and for other types
21            of remedial care, is equal to or less than 70% in
22            fiscal year 2001, equal to or less than 85% in
23            fiscal year 2002 and until a date to be determined
24            by the Department by rule, and equal to or less
25            than 100% beginning on the date determined by the
26            Department by rule, of the nonfarm income official



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1            poverty line, as defined in item (i) of this
2            subparagraph (a).
3            (b) All persons who, excluding any eligibility
4        requirements that are inconsistent with any federal
5        law or federal regulation, as interpreted by the U.S.
6        Department of Health and Human Services, would be
7        determined eligible for such basic maintenance under
8        Article IV by disregarding the maximum earned income
9        permitted by federal law.
10        3. Persons who would otherwise qualify for Aid to the
11    Medically Indigent under Article VII.
12        4. Persons not eligible under any of the preceding
13    paragraphs who fall sick, are injured, or die, not having
14    sufficient money, property or other resources to meet the
15    costs of necessary medical care or funeral and burial
16    expenses.
17        5.(a) Women during pregnancy, after the fact of
18    pregnancy has been determined by medical diagnosis, and
19    during the 60-day period beginning on the last day of the
20    pregnancy, together with their infants and children born
21    after September 30, 1983, whose income and resources are
22    insufficient to meet the costs of necessary medical care to
23    the maximum extent possible under Title XIX of the Federal
24    Social Security Act.
25        (b) The Illinois Department and the Governor shall
26    provide a plan for coverage of the persons eligible under



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1    paragraph 5(a) by April 1, 1990. Such plan shall provide
2    ambulatory prenatal care to pregnant women during a
3    presumptive eligibility period and establish an income
4    eligibility standard that is equal to 133% of the nonfarm
5    income official poverty line, as defined by the federal
6    Office of Management and Budget and revised annually in
7    accordance with Section 673(2) of the Omnibus Budget
8    Reconciliation Act of 1981, applicable to families of the
9    same size, provided that costs incurred for medical care
10    are not taken into account in determining such income
11    eligibility.
12        (c) The Illinois Department may conduct a
13    demonstration in at least one county that will provide
14    medical assistance to pregnant women, together with their
15    infants and children up to one year of age, where the
16    income eligibility standard is set up to 185% of the
17    nonfarm income official poverty line, as defined by the
18    federal Office of Management and Budget. The Illinois
19    Department shall seek and obtain necessary authorization
20    provided under federal law to implement such a
21    demonstration. Such demonstration may establish resource
22    standards that are not more restrictive than those
23    established under Article IV of this Code.
24        6. Persons under the age of 18 who fail to qualify as
25    dependent under Article IV and who have insufficient income
26    and resources to meet the costs of necessary medical care



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1    to the maximum extent permitted under Title XIX of the
2    Federal Social Security Act.
3        7. Persons who are under 21 years of age and would
4    qualify as disabled as defined under the Federal
5    Supplemental Security Income Program, provided medical
6    service for such persons would be eligible for Federal
7    Financial Participation, and provided the Illinois
8    Department determines that:
9            (a) the person requires a level of care provided by
10        a hospital, skilled nursing facility, or intermediate
11        care facility, as determined by a physician licensed to
12        practice medicine in all its branches;
13            (b) it is appropriate to provide such care outside
14        of an institution, as determined by a physician
15        licensed to practice medicine in all its branches;
16            (c) the estimated amount which would be expended
17        for care outside the institution is not greater than
18        the estimated amount which would be expended in an
19        institution.
20        8. Persons who become ineligible for basic maintenance
21    assistance under Article IV of this Code in programs
22    administered by the Illinois Department due to employment
23    earnings and persons in assistance units comprised of
24    adults and children who become ineligible for basic
25    maintenance assistance under Article VI of this Code due to
26    employment earnings. The plan for coverage for this class



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1    of persons shall:
2            (a) extend the medical assistance coverage for up
3        to 12 months following termination of basic
4        maintenance assistance; and
5            (b) offer persons who have initially received 6
6        months of the coverage provided in paragraph (a) above,
7        the option of receiving an additional 6 months of
8        coverage, subject to the following:
9                (i) such coverage shall be pursuant to
10            provisions of the federal Social Security Act;
11                (ii) such coverage shall include all services
12            covered while the person was eligible for basic
13            maintenance assistance;
14                (iii) no premium shall be charged for such
15            coverage; and
16                (iv) such coverage shall be suspended in the
17            event of a person's failure without good cause to
18            file in a timely fashion reports required for this
19            coverage under the Social Security Act and
20            coverage shall be reinstated upon the filing of
21            such reports if the person remains otherwise
22            eligible.
23        9. Persons with acquired immunodeficiency syndrome
24    (AIDS) or with AIDS-related conditions with respect to whom
25    there has been a determination that but for home or
26    community-based services such individuals would require



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1    the level of care provided in an inpatient hospital,
2    skilled nursing facility or intermediate care facility the
3    cost of which is reimbursed under this Article. Assistance
4    shall be provided to such persons to the maximum extent
5    permitted under Title XIX of the Federal Social Security
6    Act.
7        10. Participants in the long-term care insurance
8    partnership program established under the Illinois
9    Long-Term Care Partnership Program Act who meet the
10    qualifications for protection of resources described in
11    Section 15 of that Act.
12        11. Persons with disabilities who are employed and
13    eligible for Medicaid, pursuant to Section
14    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
15    subject to federal approval, persons with a medically
16    improved disability who are employed and eligible for
17    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
18    the Social Security Act, as provided by the Illinois
19    Department by rule. In establishing eligibility standards
20    under this paragraph 11, the Department shall, subject to
21    federal approval:
22            (a) set the income eligibility standard at not
23        lower than 350% of the federal poverty level;
24            (b) exempt retirement accounts that the person
25        cannot access without penalty before the age of 59 1/2,
26        and medical savings accounts established pursuant to



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1        26 U.S.C. 220;
2            (c) allow non-exempt assets up to $25,000 as to
3        those assets accumulated during periods of eligibility
4        under this paragraph 11; and
5            (d) continue to apply subparagraphs (b) and (c) in
6        determining the eligibility of the person under this
7        Article even if the person loses eligibility under this
8        paragraph 11.
9        12. Subject to federal approval, persons who are
10    eligible for medical assistance coverage under applicable
11    provisions of the federal Social Security Act and the
12    federal Breast and Cervical Cancer Prevention and
13    Treatment Act of 2000. Those eligible persons are defined
14    to include, but not be limited to, the following persons:
15            (1) persons who have been screened for breast or
16        cervical cancer under the U.S. Centers for Disease
17        Control and Prevention Breast and Cervical Cancer
18        Program established under Title XV of the federal
19        Public Health Services Act in accordance with the
20        requirements of Section 1504 of that Act as
21        administered by the Illinois Department of Public
22        Health; and
23            (2) persons whose screenings under the above
24        program were funded in whole or in part by funds
25        appropriated to the Illinois Department of Public
26        Health for breast or cervical cancer screening.



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1        "Medical assistance" under this paragraph 12 shall be
2    identical to the benefits provided under the State's
3    approved plan under Title XIX of the Social Security Act.
4    The Department must request federal approval of the
5    coverage under this paragraph 12 within 30 days after the
6    effective date of this amendatory Act of the 92nd General
7    Assembly.
8        In addition to the persons who are eligible for medical
9    assistance pursuant to subparagraphs (1) and (2) of this
10    paragraph 12, and to be paid from funds appropriated to the
11    Department for its medical programs, any uninsured person
12    as defined by the Department in rules residing in Illinois
13    who is younger than 65 years of age, who has been screened
14    for breast and cervical cancer in accordance with standards
15    and procedures adopted by the Department of Public Health
16    for screening, and who is referred to the Department by the
17    Department of Public Health as being in need of treatment
18    for breast or cervical cancer is eligible for medical
19    assistance benefits that are consistent with the benefits
20    provided to those persons described in subparagraphs (1)
21    and (2). Medical assistance coverage for the persons who
22    are eligible under the preceding sentence is not dependent
23    on federal approval, but federal moneys may be used to pay
24    for services provided under that coverage upon federal
25    approval.
26        13. Subject to appropriation and to federal approval,



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1    persons living with HIV/AIDS who are not otherwise eligible
2    under this Article and who qualify for services covered
3    under Section 5-5.04 as provided by the Illinois Department
4    by rule.
5        14. Subject to the availability of funds for this
6    purpose, the Department may provide coverage under this
7    Article to persons who reside in Illinois who are not
8    eligible under any of the preceding paragraphs and who meet
9    the income guidelines of paragraph 2(a) of this Section and
10    (i) have an application for asylum pending before the
11    federal Department of Homeland Security or on appeal before
12    a court of competent jurisdiction and are represented
13    either by counsel or by an advocate accredited by the
14    federal Department of Homeland Security and employed by a
15    not-for-profit organization in regard to that application
16    or appeal, or (ii) are receiving services through a
17    federally funded torture treatment center. Medical
18    coverage under this paragraph 14 may be provided for up to
19    24 continuous months from the initial eligibility date so
20    long as an individual continues to satisfy the criteria of
21    this paragraph 14. If an individual has an appeal pending
22    regarding an application for asylum before the Department
23    of Homeland Security, eligibility under this paragraph 14
24    may be extended until a final decision is rendered on the
25    appeal. The Department may adopt rules governing the
26    implementation of this paragraph 14.



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1        15. Family Care Eligibility.
2            (a) Through December 31, 2013, a A caretaker
3        relative who is 19 years of age or older when countable
4        income is at or below 185% of the Federal Poverty Level
5        Guidelines, as published annually in the Federal
6        Register, for the appropriate family size. Beginning
7        January 1, 2014, a caretaker relative who is 19 years
8        of age or older when countable income is at or below
9        133% of the Federal Poverty Level Guidelines, as
10        published annually in the Federal Register, for the
11        appropriate family size. A person may not spend down to
12        become eligible under this paragraph 15.
13            (b) Eligibility shall be reviewed annually.
14            (c) Caretaker relatives enrolled under this
15        paragraph 15 in families with countable income above
16        150% and at or below 185% of the Federal Poverty Level
17        Guidelines shall be counted as family members and pay
18        premiums as established under the Children's Health
19        Insurance Program Act.
20            (d) Premiums shall be billed by and payable to the
21        Department or its authorized agent, on a monthly basis.
22            (e) The premium due date is the last day of the
23        month preceding the month of coverage.
24            (f) Individuals shall have a grace period through
25        30 days of coverage to pay the premium.
26            (g) Failure to pay the full monthly premium by the



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1        last day of the grace period shall result in
2        termination of coverage.
3            (h) Partial premium payments shall not be
4        refunded.
5            (i) Following termination of an individual's
6        coverage under this paragraph 15, the following action
7        is required before the individual can be re-enrolled:
8                (1) A new application must be completed and the
9            individual must be determined otherwise eligible.
10                (2) There must be full payment of premiums due
11            under this Code, the Children's Health Insurance
12            Program Act, the Covering ALL KIDS Health
13            Insurance Act, or any other healthcare program
14            administered by the Department for periods in
15            which a premium was owed and not paid for the
16            individual.
17                (3) The first month's premium must be paid if
18            there was an unpaid premium on the date the
19            individual's previous coverage was canceled.
20        The Department is authorized to implement the
21    provisions of this amendatory Act of the 95th General
22    Assembly by adopting the medical assistance rules in effect
23    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
24    89 Ill. Admin. Code 120.32 along with only those changes
25    necessary to conform to federal Medicaid requirements,
26    federal laws, and federal regulations, including but not



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1    limited to Section 1931 of the Social Security Act (42
2    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
3    of Health and Human Services, and the countable income
4    eligibility standard authorized by this paragraph 15. The
5    Department may not otherwise adopt any rule to implement
6    this increase except as authorized by law, to meet the
7    eligibility standards authorized by the federal government
8    in the Medicaid State Plan or the Title XXI Plan, or to
9    meet an order from the federal government or any court.
10        16. Subject to appropriation, uninsured persons who
11    are not otherwise eligible under this Section who have been
12    certified and referred by the Department of Public Health
13    as having been screened and found to need diagnostic
14    evaluation or treatment, or both diagnostic evaluation and
15    treatment, for prostate or testicular cancer. For the
16    purposes of this paragraph 16, uninsured persons are those
17    who do not have creditable coverage, as defined under the
18    Health Insurance Portability and Accountability Act, or
19    have otherwise exhausted any insurance benefits they may
20    have had, for prostate or testicular cancer diagnostic
21    evaluation or treatment, or both diagnostic evaluation and
22    treatment. To be eligible, a person must furnish a Social
23    Security number. A person's assets are exempt from
24    consideration in determining eligibility under this
25    paragraph 16. Such persons shall be eligible for medical
26    assistance under this paragraph 16 for so long as they need



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1    treatment for the cancer. A person shall be considered to
2    need treatment if, in the opinion of the person's treating
3    physician, the person requires therapy directed toward
4    cure or palliation of prostate or testicular cancer,
5    including recurrent metastatic cancer that is a known or
6    presumed complication of prostate or testicular cancer and
7    complications resulting from the treatment modalities
8    themselves. Persons who require only routine monitoring
9    services are not considered to need treatment. "Medical
10    assistance" under this paragraph 16 shall be identical to
11    the benefits provided under the State's approved plan under
12    Title XIX of the Social Security Act. Notwithstanding any
13    other provision of law, the Department (i) does not have a
14    claim against the estate of a deceased recipient of
15    services under this paragraph 16 and (ii) does not have a
16    lien against any homestead property or other legal or
17    equitable real property interest owned by a recipient of
18    services under this paragraph 16.
19    In implementing the provisions of Public Act 96-20, the
20Department is authorized to adopt only those rules necessary,
21including emergency rules. Nothing in Public Act 96-20 permits
22the Department to adopt rules or issue a decision that expands
23eligibility for the FamilyCare Program to a person whose income
24exceeds 185% of the Federal Poverty Level as determined from
25time to time by the U.S. Department of Health and Human
26Services, unless the Department is provided with express



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1statutory authority.
2    The Illinois Department and the Governor shall provide a
3plan for coverage of the persons eligible under paragraph 7 as
4soon as possible after July 1, 1984.
5    The eligibility of any such person for medical assistance
6under this Article is not affected by the payment of any grant
7under the Senior Citizens and Disabled Persons Property Tax
8Relief and Pharmaceutical Assistance Act or any distributions
9or items of income described under subparagraph (X) of
10paragraph (2) of subsection (a) of Section 203 of the Illinois
11Income Tax Act. The Department shall by rule establish the
12amounts of assets to be disregarded in determining eligibility
13for medical assistance, which shall at a minimum equal the
14amounts to be disregarded under the Federal Supplemental
15Security Income Program. The amount of assets of a single
16person to be disregarded shall not be less than $2,000, and the
17amount of assets of a married couple to be disregarded shall
18not be less than $3,000.
19    To the extent permitted under federal law, any person found
20guilty of a second violation of Article VIIIA shall be
21ineligible for medical assistance under this Article, as
22provided in Section 8A-8.
23    The eligibility of any person for medical assistance under
24this Article shall not be affected by the receipt by the person
25of donations or benefits from fundraisers held for the person
26in cases of serious illness, as long as neither the person nor



SB1802 Enrolled- 30 -LRB097 09314 ASK 49449 b

1members of the person's family have actual control over the
2donations or benefits or the disbursement of the donations or
4(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
596-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.
68-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123,
7eff. 1-1-11; 96-1270, eff. 7-26-10; revised 9-16-10.)
8    (305 ILCS 5/5-4.1)  (from Ch. 23, par. 5-4.1)
9    Sec. 5-4.1. Co-payments. The Department may by rule provide
10that recipients under any Article of this Code shall pay a fee
11as a co-payment for services. Co-payments shall be maximized to
12the extent permitted by federal law. Provided, however, that
13any such rule must provide that no co-payment requirement can
14exist for renal dialysis, radiation therapy, cancer
15chemotherapy, or insulin, and other products necessary on a
16recurring basis, the absence of which would be life
17threatening, or where co-payment expenditures for required
18services and/or medications for chronic diseases that the
19Illinois Department shall by rule designate shall cause an
20extensive financial burden on the recipient, and provided no
21co-payment shall exist for emergency room encounters which are
22for medical emergencies. The Department shall seek approval of
23a State plan amendment that allows pharmacies to refuse to
24dispense drugs in circumstances where the recipient does not
25pay 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 $10
7for emergency room use for a non-emergency situation as defined
8by the Department by rule and subject to federal approval.
9Co-payments may not exceed $3 for hospital outpatient and
10clinic services.
11(Source: P.A. 96-1501, eff. 1-25-11.)
12    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
13    Sec. 5-5.12. Pharmacy payments.
14    (a) Every request submitted by a pharmacy for reimbursement
15under this Article for prescription drugs provided to a
16recipient of aid under this Article shall include the name of
17the prescriber or an acceptable identification number as
18established by the Department.
19    (b) Pharmacies providing prescription drugs under this
20Article shall be reimbursed at a rate which shall include a
21professional dispensing fee as determined by the Illinois
22Department, plus the current acquisition cost of the
23prescription drug dispensed. The Illinois Department shall
24update its information on the acquisition costs of all
25prescription drugs no less frequently than every 30 days.



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1However, the Illinois Department may set the rate of
2reimbursement for the acquisition cost, by rule, at a
3percentage of the current average wholesale acquisition cost.
4    (c) (Blank).
5    (d) The Department shall not impose requirements for prior
6approval based on a preferred drug list for anti-retroviral,
7anti-hemophilic factor concentrates, or any atypical
8antipsychotics, conventional antipsychotics, or
9anticonvulsants used for the treatment of serious mental
10illnesses until 30 days after it has conducted a study of the
11impact of such requirements on patient care and submitted a
12report to the Speaker of the House of Representatives and the
13President of the Senate. The Department shall review
14utilization of narcotic medications in the medical assistance
15program and impose utilization controls that protect against
17    (e) When making determinations as to which drugs shall be
18on a prior approval list, the Department shall include as part
19of the analysis for this determination, the degree to which a
20drug may affect individuals in different ways based on factors
21including the gender of the person taking the medication.
22    (f) The Department shall cooperate with the Department of
23Public Health and the Department of Human Services Division of
24Mental Health in identifying psychotropic medications that,
25when given in a particular form, manner, duration, or frequency
26(including "as needed") in a dosage, or in conjunction with



SB1802 Enrolled- 33 -LRB097 09314 ASK 49449 b

1other psychotropic medications to a nursing home resident, may
2constitute a chemical restraint or an "unnecessary drug" as
3defined by the Nursing Home Care Act or Titles XVIII and XIX of
4the Social Security Act and the implementing rules and
5regulations. The Department shall require prior approval for
6any such medication prescribed for a nursing home resident that
7appears to be a chemical restraint or an unnecessary drug. The
8Department shall consult with the Department of Human Services
9Division of Mental Health in developing a protocol and criteria
10for deciding whether to grant such prior approval.
11    (g) The Department may by rule provide for reimbursement of
12the dispensing of a 90-day supply of a generic, non-narcotic
13maintenance medication in circumstances where it is cost
15    (h) Effective July 1, 2011, the Department shall
16discontinue coverage of select over-the-counter drugs,
17including analgesics and cough and cold and allergy
19    (i) The Department shall seek any necessary waiver from the
20federal government in order to establish a program limiting the
21pharmacies eligible to dispense specialty drugs and shall issue
22a Request for Proposals in order to maximize savings on these
23drugs. The Department shall by rule establish the drugs
24required to be dispensed in this program.
25(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
2696-1501, eff. 1-25-11.)



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1    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
2    Sec. 5A-10. Applicability.
3    (a) The assessment imposed by Section 5A-2 shall not take
4effect or shall cease to be imposed, and any moneys remaining
5in the Fund shall be refunded to hospital providers in
6proportion to the amounts paid by them, if:
7        (1) The sum of the appropriations for State fiscal
8    years 2004 and 2005 from the General Revenue Fund for
9    hospital payments under the medical assistance program is
10    less than $4,500,000,000 or the appropriation for each of
11    State fiscal years 2006, 2007 and 2008 from the General
12    Revenue Fund for hospital payments under the medical
13    assistance program is less than $2,500,000,000 increased
14    annually to reflect any increase in the number of
15    recipients, or the annual appropriation for State fiscal
16    years 2009, 2010, 2011, 2013, and 2014 through 2014, from
17    the General Revenue Fund combined with the Hospital
18    Provider Fund as authorized in Section 5A-8 for hospital
19    payments under the medical assistance program, is less than
20    the amount appropriated for State fiscal year 2009,
21    adjusted annually to reflect any change in the number of
22    recipients, excluding State fiscal year 2009 supplemental
23    appropriations made necessary by the enactment of the
24    American Recovery and Reinvestment Act of 2009; or
25        (2) For State fiscal years prior to State fiscal year



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1    2009, the Department of Healthcare and Family Services
2    (formerly Department of Public Aid) makes changes in its
3    rules that reduce the hospital inpatient or outpatient
4    payment rates, including adjustment payment rates, in
5    effect on October 1, 2004, except for hospitals described
6    in subsection (b) of Section 5A-3 and except for changes in
7    the methodology for calculating outlier payments to
8    hospitals for exceptionally costly stays, so long as those
9    changes do not reduce aggregate expenditures below the
10    amount expended in State fiscal year 2005 for such
11    services; or
12        (2.1) For State fiscal years 2009 through 2014, the
13    Department of Healthcare and Family Services adopts any
14    administrative rule change to reduce payment rates or
15    alters any payment methodology that reduces any payment
16    rates made to operating hospitals under the approved Title
17    XIX or Title XXI State plan in effect January 1, 2008
18    except for:
19            (A) any changes for hospitals described in
20        subsection (b) of Section 5A-3; or
21            (B) any rates for payments made under this Article
22        V-A; or
23            (C) any changes proposed in State plan amendment
24        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
25        08-07; or
26            (D) in relation to any admissions on or after



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1        January 1, 2011, a modification in the methodology for
2        calculating outlier payments to hospitals for
3        exceptionally costly stays, for hospitals reimbursed
4        under the diagnosis-related grouping methodology;
5        provided that the Department shall be limited to one
6        such modification during the 36-month period after the
7        effective date of this amendatory Act of the 96th
8        General Assembly; or
9        (3) The payments to hospitals required under Section
10    5A-12 or Section 5A-12.2 are changed or are not eligible
11    for federal matching funds under Title XIX or XXI of the
12    Social Security Act.
13    (b) The assessment imposed by Section 5A-2 shall not take
14effect or shall cease to be imposed if the assessment is
15determined to be an impermissible tax under Title XIX of the
16Social Security Act. Moneys in the Hospital Provider Fund
17derived from assessments imposed prior thereto shall be
18disbursed in accordance with Section 5A-8 to the extent federal
19financial participation is not reduced due to the
20impermissibility of the assessments, and any remaining moneys
21shall be refunded to hospital providers in proportion to the
22amounts paid by them.
23(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08; 96-8,
24eff. 4-28-09; 96-1530, eff. 2-16-11.)
25    Section 20. The Senior Citizens and Disabled Persons



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1Property Tax Relief and Pharmaceutical Assistance Act is
2amended by changing Section 4 as follows:
3    (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
4    Sec. 4. Amount of Grant.
5    (a) In general. Any individual 65 years or older or any
6individual who will become 65 years old during the calendar
7year in which a claim is filed, and any surviving spouse of
8such a claimant, who at the time of death received or was
9entitled to receive a grant pursuant to this Section, which
10surviving spouse will become 65 years of age within the 24
11months immediately following the death of such claimant and
12which surviving spouse but for his or her age is otherwise
13qualified to receive a grant pursuant to this Section, and any
14disabled person whose annual household income is less than the
15income eligibility limitation, as defined in subsection (a-5)
16and whose household is liable for payment of property taxes
17accrued or has paid rent constituting property taxes accrued
18and is domiciled in this State at the time he or she files his
19or her claim is entitled to claim a grant under this Act. With
20respect to claims filed by individuals who will become 65 years
21old during the calendar year in which a claim is filed, the
22amount of any grant to which that household is entitled shall
23be an amount equal to 1/12 of the amount to which the claimant
24would otherwise be entitled as provided in this Section,
25multiplied by the number of months in which the claimant was 65



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1in the calendar year in which the claim is filed.
2    (a-5) Income eligibility limitation. For purposes of this
3Section, "income eligibility limitation" means an amount for
4grant years 2008 and thereafter:
5        (1) less than $22,218 for a household containing one
6    person;
7        (2) less than $29,480 for a household containing 2
8    persons; or
9        (3) less than $36,740 for a household containing 3 or
10    more persons.
11    For 2009 claim year applications submitted during calendar
12year 2010, a household must have annual household income of
13less than $27,610 for a household containing one person; less
14than $36,635 for a household containing 2 persons; or less than
15$45,657 for a household containing 3 or more persons.
16    The Department on Aging may adopt rules such that on
17January 1, 2011, and thereafter, the foregoing household income
18eligibility limits may be changed to reflect the annual cost of
19living adjustment in Social Security and Supplemental Security
20Income benefits that are applicable to the year for which those
21benefits are being reported as income on an application.
22    If a person files as a surviving spouse, then only his or
23her income shall be counted in determining his or her household
25    (b) Limitation. Except as otherwise provided in
26subsections (a) and (f) of this Section, the maximum amount of



SB1802 Enrolled- 39 -LRB097 09314 ASK 49449 b

1grant which a claimant is entitled to claim is the amount by
2which the property taxes accrued which were paid or payable
3during the last preceding tax year or rent constituting
4property taxes accrued upon the claimant's residence for the
5last preceding taxable year exceeds 3 1/2% of the claimant's
6household income for that year but in no event is the grant to
7exceed (i) $700 less 4.5% of household income for that year for
8those with a household income of $14,000 or less or (ii) $70 if
9household income for that year is more than $14,000.
10    (c) Public aid recipients. If household income in one or
11more months during a year includes cash assistance in excess of
12$55 per month from the Department of Healthcare and Family
13Services or the Department of Human Services (acting as
14successor to the Department of Public Aid under the Department
15of Human Services Act) which was determined under regulations
16of that Department on a measure of need that included an
17allowance for actual rent or property taxes paid by the
18recipient of that assistance, the amount of grant to which that
19household is entitled, except as otherwise provided in
20subsection (a), shall be the product of (1) the maximum amount
21computed as specified in subsection (b) of this Section and (2)
22the ratio of the number of months in which household income did
23not include such cash assistance over $55 to the number twelve.
24If household income did not include such cash assistance over
25$55 for any months during the year, the amount of the grant to
26which the household is entitled shall be the maximum amount



SB1802 Enrolled- 40 -LRB097 09314 ASK 49449 b

1computed as specified in subsection (b) of this Section. For
2purposes of this paragraph (c), "cash assistance" does not
3include any amount received under the federal Supplemental
4Security Income (SSI) program.
5    (d) Joint ownership. If title to the residence is held
6jointly by the claimant with a person who is not a member of
7his or her household, the amount of property taxes accrued used
8in computing the amount of grant to which he or she is entitled
9shall be the same percentage of property taxes accrued as is
10the percentage of ownership held by the claimant in the
12    (e) More than one residence. If a claimant has occupied
13more than one residence in the taxable year, he or she may
14claim only one residence for any part of a month. In the case
15of property taxes accrued, he or she shall prorate 1/12 of the
16total property taxes accrued on his or her residence to each
17month that he or she owned and occupied that residence; and, in
18the case of rent constituting property taxes accrued, shall
19prorate each month's rent payments to the residence actually
20occupied during that month.
21    (f) (Blank).
22    (g) Effective January 1, 2006, there is hereby established
23a program of pharmaceutical assistance to the aged and
24disabled, entitled the Illinois Seniors and Disabled Drug
25Coverage Program, which shall be administered by the Department
26of Healthcare and Family Services and the Department on Aging



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1in accordance with this subsection, to consist of coverage of
2specified prescription drugs on behalf of beneficiaries of the
3program as set forth in this subsection.
4    To become a beneficiary under the program established under
5this subsection, a person must:
6        (1) be (i) 65 years of age or older or (ii) disabled;
7    and
8        (2) be domiciled in this State; and
9        (3) enroll with a qualified Medicare Part D
10    Prescription Drug Plan if eligible and apply for all
11    available subsidies under Medicare Part D; and
12        (4) for the 2006 and 2007 claim years, have a maximum
13    household income of (i) less than $21,218 for a household
14    containing one person, (ii) less than $28,480 for a
15    household containing 2 persons, or (iii) less than $35,740
16    for a household containing 3 or more persons; and
17        (5) for the 2008 claim year, have a maximum household
18    income of (i) less than $22,218 for a household containing
19    one person, (ii) $29,480 for a household containing 2
20    persons, or (iii) $36,740 for a household containing 3 or
21    more persons; and
22        (6) for 2009 claim year applications submitted during
23    calendar year 2010, have annual household income of less
24    than (i) $27,610 for a household containing one person;
25    (ii) less than $36,635 for a household containing 2
26    persons; or (iii) less than $45,657 for a household



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1    containing 3 or more persons; and .
2        (7) as of September 1, 2011, have a maximum household
3    income at or below 200% of the federal poverty level.
4    The Department of Healthcare and Family Services may adopt
5rules such that on January 1, 2011, and thereafter, the
6foregoing household income eligibility limits may be changed to
7reflect the annual cost of living adjustment in Social Security
8and Supplemental Security Income benefits that are applicable
9to the year for which those benefits are being reported as
10income on an application.
11    All individuals enrolled as of December 31, 2005, in the
12pharmaceutical assistance program operated pursuant to
13subsection (f) of this Section and all individuals enrolled as
14of December 31, 2005, in the SeniorCare Medicaid waiver program
15operated pursuant to Section 5-5.12a of the Illinois Public Aid
16Code shall be automatically enrolled in the program established
17by this subsection for the first year of operation without the
18need for further application, except that they must apply for
19Medicare Part D and the Low Income Subsidy under Medicare Part
20D. A person enrolled in the pharmaceutical assistance program
21operated pursuant to subsection (f) of this Section as of
22December 31, 2005, shall not lose eligibility in future years
23due only to the fact that they have not reached the age of 65.
24    To the extent permitted by federal law, the Department may
25act as an authorized representative of a beneficiary in order
26to enroll the beneficiary in a Medicare Part D Prescription



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1Drug Plan if the beneficiary has failed to choose a plan and,
2where possible, to enroll beneficiaries in the low-income
3subsidy program under Medicare Part D or assist them in
4enrolling in that program.
5    Beneficiaries under the program established under this
6subsection shall be divided into the following 4 eligibility
8        (A) Eligibility Group 1 shall consist of beneficiaries
9    who are not eligible for Medicare Part D coverage and who
10    are:
11            (i) disabled and under age 65; or
12            (ii) age 65 or older, with incomes over 200% of the
13        Federal Poverty Level; or
14            (iii) age 65 or older, with incomes at or below
15        200% of the Federal Poverty Level and not eligible for
16        federally funded means-tested benefits due to
17        immigration status.
18        (B) Eligibility Group 2 shall consist of beneficiaries
19    who are eligible for Medicare Part D coverage.
20        (C) Eligibility Group 3 shall consist of beneficiaries
21    age 65 or older, with incomes at or below 200% of the
22    Federal Poverty Level, who are not barred from receiving
23    federally funded means-tested benefits due to immigration
24    status and are not eligible for Medicare Part D coverage.
25        If the State applies and receives federal approval for
26    a waiver under Title XIX of the Social Security Act,



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1    persons in Eligibility Group 3 shall continue to receive
2    benefits through the approved waiver, and Eligibility
3    Group 3 may be expanded to include disabled persons under
4    age 65 with incomes under 200% of the Federal Poverty Level
5    who are not eligible for Medicare and who are not barred
6    from receiving federally funded means-tested benefits due
7    to immigration status.
8        (D) Eligibility Group 4 shall consist of beneficiaries
9    who are otherwise described in Eligibility Group 2 who have
10    a diagnosis of HIV or AIDS.
11    The program established under this subsection shall cover
12the cost of covered prescription drugs in excess of the
13beneficiary cost-sharing amounts set forth in this paragraph
14that are not covered by Medicare. The Department of Healthcare
15and Family Services may establish by emergency rule changes in
16cost-sharing necessary to conform the cost of the program to
17the amounts appropriated for State fiscal year 2012 and future
18fiscal years except that the 24-month limitation on the
19adoption of emergency rules and the provisions of Sections
205-115 and 5-125 of the Illinois Administrative Procedure Act
21shall not apply to rules adopted under this subsection (g). The
22adoption of emergency rules authorized by this subsection (g)
23shall be deemed to be necessary for the public interest,
24safety, and welfare. In 2006, beneficiaries shall pay a
25co-payment of $2 for each prescription of a generic drug and $5
26for each prescription of a brand-name drug. In future years,



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1beneficiaries shall pay co-payments equal to the co-payments
2required under Medicare Part D for "other low-income subsidy
3eligible individuals" pursuant to 42 CFR 423.782(b). For
4individuals in Eligibility Groups 1, 2, and 3, once the program
5established under this subsection and Medicare combined have
6paid $1,750 in a year for covered prescription drugs, the
7beneficiary shall pay 20% of the cost of each prescription in
8addition to the co-payments set forth in this paragraph. For
9individuals in Eligibility Group 4, once the program
10established under this subsection and Medicare combined have
11paid $1,750 in a year for covered prescription drugs, the
12beneficiary shall pay 20% of the cost of each prescription in
13addition to the co-payments set forth in this paragraph unless
14the drug is included in the formulary of the Illinois AIDS Drug
15Assistance Program operated by the Illinois Department of
16Public Health and covered by the Medicare Part D Prescription
17Drug Plan in which the beneficiary is enrolled. If the drug is
18included in the formulary of the Illinois AIDS Drug Assistance
19Program and covered by the Medicare Part D Prescription Drug
20Plan in which the beneficiary is enrolled, individuals in
21Eligibility Group 4 shall continue to pay the co-payments set
22forth in this paragraph after the program established under
23this subsection and Medicare combined have paid $1,750 in a
24year for covered prescription drugs.
25    For beneficiaries eligible for Medicare Part D coverage,
26the program established under this subsection shall pay 100% of



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1the premiums charged by a qualified Medicare Part D
2Prescription Drug Plan for Medicare Part D basic prescription
3drug coverage, not including any late enrollment penalties.
4Qualified Medicare Part D Prescription Drug Plans may be
5limited by the Department of Healthcare and Family Services to
6those plans that sign a coordination agreement with the
8    For Notwithstanding Section 3.15, for purposes of the
9program established under this subsection, the term "covered
10prescription drug" has the following meanings:
11        For Eligibility Group 1, "covered prescription drug"
12    means: (1) any cardiovascular agent or drug; (2) any
13    insulin or other prescription drug used in the treatment of
14    diabetes, including syringe and needles used to administer
15    the insulin; (3) any prescription drug used in the
16    treatment of arthritis; (4) any prescription drug used in
17    the treatment of cancer; (5) any prescription drug used in
18    the treatment of Alzheimer's disease; (6) any prescription
19    drug used in the treatment of Parkinson's disease; (7) any
20    prescription drug used in the treatment of glaucoma; (8)
21    any prescription drug used in the treatment of lung disease
22    and smoking-related illnesses; (9) any prescription drug
23    used in the treatment of osteoporosis; and (10) any
24    prescription drug used in the treatment of multiple
25    sclerosis. The Department may add additional therapeutic
26    classes by rule. The Department may adopt a preferred drug



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1    list within any of the classes of drugs described in items
2    (1) through (10) of this paragraph. The specific drugs or
3    therapeutic classes of covered prescription drugs shall be
4    indicated by rule.
5        For Eligibility Group 2, "covered prescription drug"
6    means those drugs covered by the Medicare Part D
7    Prescription Drug Plan in which the beneficiary is
8    enrolled.
9        For Eligibility Group 3, "covered prescription drug"
10    means those drugs covered by the Medical Assistance Program
11    under Article V of the Illinois Public Aid Code.
12        For Eligibility Group 4, "covered prescription drug"
13    means those drugs covered by the Medicare Part D
14    Prescription Drug Plan in which the beneficiary is
15    enrolled.
16    An individual in Eligibility Group 1, 2, 3, or 4 may opt to
17receive a $25 monthly payment in lieu of the direct coverage
18described in this subsection.
19    Any person otherwise eligible for pharmaceutical
20assistance under this subsection whose covered drugs are
21covered by any public program is ineligible for assistance
22under this subsection to the extent that the cost of those
23drugs is covered by the other program.
24    The Department of Healthcare and Family Services shall
25establish by rule the methods by which it will provide for the
26coverage called for in this subsection. Those methods may



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1include direct reimbursement to pharmacies or the payment of a
2capitated amount to Medicare Part D Prescription Drug Plans.
3    For a pharmacy to be reimbursed under the program
4established under this subsection, it must comply with rules
5adopted by the Department of Healthcare and Family Services
6regarding coordination of benefits with Medicare Part D
7Prescription Drug Plans. A pharmacy may not charge a
8Medicare-enrolled beneficiary of the program established under
9this subsection more for a covered prescription drug than the
10appropriate Medicare cost-sharing less any payment from or on
11behalf of the Department of Healthcare and Family Services.
12    The Department of Healthcare and Family Services or the
13Department on Aging, as appropriate, may adopt rules regarding
14applications, counting of income, proof of Medicare status,
15mandatory generic policies, and pharmacy reimbursement rates
16and any other rules necessary for the cost-efficient operation
17of the program established under this subsection.
18    (h) A qualified individual is not entitled to duplicate
19benefits in a coverage period as a result of the changes made
20by this amendatory Act of the 96th General Assembly.
21(Source: P.A. 95-208, eff. 8-16-07; 95-644, eff. 10-12-07;
2295-876, eff. 8-21-08; 96-804, eff. 1-1-10; revised 9-16-10.)
23    Section 99. Effective date. This Act takes effect upon
24becoming law.