Illinois General Assembly - Full Text of HB0135
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Full Text of HB0135  102nd General Assembly

HB0135sam001 102ND GENERAL ASSEMBLY

Sen. Melinda Bush

Filed: 5/14/2021

 

 


 

 


 
10200HB0135sam001LRB102 02749 BMS 26581 a

1
AMENDMENT TO HOUSE BILL 135

2    AMENDMENT NO. ______. Amend House Bill 135 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

 

 

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1356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
2Code. The program of health benefits must comply with Sections
3155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
4XXXIIB of the Illinois Insurance Code. The Department of
5Insurance shall enforce the requirements of this Section with
6respect to Sections 370c and 370c.1 of the Illinois Insurance
7Code; all other requirements of this Section shall be enforced
8by the Department of Central Management Services.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
18eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
19101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
201-1-21.)
 
21    Section 10. The Counties Code is amended by changing
22Section 5-1069.3 as follows:
 
23    (55 ILCS 5/5-1069.3)
24    Sec. 5-1069.3. Required health benefits. If a county,

 

 

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1including a home rule county, is a self-insurer for purposes
2of providing health insurance coverage for its employees, the
3coverage shall include coverage for the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
9356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
10of the Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this Section is an
15exclusive power and function of the State and is a denial and
16limitation under Article VII, Section 6, subsection (h) of the
17Illinois Constitution. A home rule county to which this
18Section applies must comply with every provision of this
19Section.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.
26(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

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1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4101-625, eff. 1-1-21.)
 
5    Section 15. The Illinois Municipal Code is amended by
6changing Section 10-4-2.3 as follows:
 
7    (65 ILCS 5/10-4-2.3)
8    Sec. 10-4-2.3. Required health benefits. If a
9municipality, including a home rule municipality, is a
10self-insurer for purposes of providing health insurance
11coverage for its employees, the coverage shall include
12coverage for the post-mastectomy care benefits required to be
13covered by a policy of accident and health insurance under
14Section 356t and the coverage required under Sections 356g,
15356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
16356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
19Code. The coverage shall comply with Sections 155.22a, 355b,
20356z.19, and 370c of the Illinois Insurance Code. The
21Department of Insurance shall enforce the requirements of this
22Section. The requirement that health benefits be covered as
23provided in this is an exclusive power and function of the
24State and is a denial and limitation under Article VII,

 

 

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1Section 6, subsection (h) of the Illinois Constitution. A home
2rule municipality to which this Section applies must comply
3with every provision of this Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
11100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
121-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
13eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
14101-625, eff. 1-1-21.)
 
15    Section 20. The School Code is amended by changing Section
1610-22.3f as follows:
 
17    (105 ILCS 5/10-22.3f)
18    Sec. 10-22.3f. Required health benefits. Insurance
19protection and benefits for employees shall provide the
20post-mastectomy care benefits required to be covered by a
21policy of accident and health insurance under Section 356t and
22the coverage required under Sections 356g, 356g.5, 356g.5-1,
23356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
24356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

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1356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
2of the Illinois Insurance Code. Insurance policies shall
3comply with Section 356z.19 of the Illinois Insurance Code.
4The coverage shall comply with Sections 155.22a, 355b, and
5370c of the Illinois Insurance Code. The Department of
6Insurance shall enforce the requirements of this Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
14100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
151-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
16eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
17101-625, eff. 1-1-21.)
 
18    Section 25. The Illinois Insurance Code is amended by
19adding Section 356z.43 as follows:
 
20    (215 ILCS 5/356z.43 new)
21    Sec. 356z.43. Coverage for patient care services provided
22by a pharmacist. A group or individual policy of accident and
23health insurance or a managed care plan that is amended,
24delivered, issued, or renewed on or after January 1, 2023

 

 

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1shall provide coverage for health care or patient care
2services provided by a pharmacist if:
3        (1) the pharmacist meets the requirements and scope of
4    practice as set forth in Section 43 of the Pharmacy
5    Practice Act;
6        (2) the health plan provides coverage for the same
7    service provided by a licensed physician, an advanced
8    practice registered nurse, or a physician assistant;
9        (3) the pharmacist is included in the health benefit
10    plan's network of participating providers; and
11        (4) a reimbursement has been successfully negotiated
12    in good faith between the pharmacist and the health plan.
 
13    Section 30. The Pharmacy Practice Act is amended by
14changing Section 3 and by adding Section 43 as follows:
 
15    (225 ILCS 85/3)
16    (Section scheduled to be repealed on January 1, 2023)
17    Sec. 3. Definitions. For the purpose of this Act, except
18where otherwise limited therein:
19    (a) "Pharmacy" or "drugstore" means and includes every
20store, shop, pharmacy department, or other place where
21pharmacist care is provided by a pharmacist (1) where drugs,
22medicines, or poisons are dispensed, sold or offered for sale
23at retail, or displayed for sale at retail; or (2) where
24prescriptions of physicians, dentists, advanced practice

 

 

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1registered nurses, physician assistants, veterinarians,
2podiatric physicians, or optometrists, within the limits of
3their licenses, are compounded, filled, or dispensed; or (3)
4which has upon it or displayed within it, or affixed to or used
5in connection with it, a sign bearing the word or words
6"Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical Care",
7"Apothecary", "Drugstore", "Medicine Store", "Prescriptions",
8"Drugs", "Dispensary", "Medicines", or any word or words of
9similar or like import, either in the English language or any
10other language; or (4) where the characteristic prescription
11sign (Rx) or similar design is exhibited; or (5) any store, or
12shop, or other place with respect to which any of the above
13words, objects, signs or designs are used in any
14advertisement.
15    (b) "Drugs" means and includes (1) articles recognized in
16the official United States Pharmacopoeia/National Formulary
17(USP/NF), or any supplement thereto and being intended for and
18having for their main use the diagnosis, cure, mitigation,
19treatment or prevention of disease in man or other animals, as
20approved by the United States Food and Drug Administration,
21but does not include devices or their components, parts, or
22accessories; and (2) all other articles intended for and
23having for their main use the diagnosis, cure, mitigation,
24treatment or prevention of disease in man or other animals, as
25approved by the United States Food and Drug Administration,
26but does not include devices or their components, parts, or

 

 

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1accessories; and (3) articles (other than food) having for
2their main use and intended to affect the structure or any
3function of the body of man or other animals; and (4) articles
4having for their main use and intended for use as a component
5or any articles specified in clause (1), (2) or (3); but does
6not include devices or their components, parts or accessories.
7    (c) "Medicines" means and includes all drugs intended for
8human or veterinary use approved by the United States Food and
9Drug Administration.
10    (d) "Practice of pharmacy" means:
11        (1) the interpretation and the provision of assistance
12    in the monitoring, evaluation, and implementation of
13    prescription drug orders;
14        (2) the dispensing of prescription drug orders;
15        (3) participation in drug and device selection;
16        (4) drug administration limited to the administration
17    of oral, topical, injectable, and inhalation as follows:
18            (A) in the context of patient education on the
19        proper use or delivery of medications;
20            (B) vaccination of patients 14 years of age and
21        older pursuant to a valid prescription or standing
22        order, by a physician licensed to practice medicine in
23        all its branches, upon completion of appropriate
24        training, including how to address contraindications
25        and adverse reactions set forth by rule, with
26        notification to the patient's physician and

 

 

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1        appropriate record retention, or pursuant to hospital
2        pharmacy and therapeutics committee policies and
3        procedures;
4            (B-5) following the initial administration of
5        long-acting or extended-release extended release form
6        opioid antagonists by a physician licensed to practice
7        medicine in all its branches, administration of
8        injections of long-acting or extended-release form
9        opioid antagonists for the treatment of substance use
10        disorder, pursuant to a valid prescription by a
11        physician licensed to practice medicine in all its
12        branches, upon completion of appropriate training,
13        including how to address contraindications and adverse
14        reactions, including, but not limited to, respiratory
15        depression and the performance of cardiopulmonary
16        resuscitation, set forth by rule, with notification to
17        the patient's physician and appropriate record
18        retention, or pursuant to hospital pharmacy and
19        therapeutics committee policies and procedures;
20            (C) administration of injections of
21        alpha-hydroxyprogesterone caproate, pursuant to a
22        valid prescription, by a physician licensed to
23        practice medicine in all its branches, upon completion
24        of appropriate training, including how to address
25        contraindications and adverse reactions set forth by
26        rule, with notification to the patient's physician and

 

 

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1        appropriate record retention, or pursuant to hospital
2        pharmacy and therapeutics committee policies and
3        procedures; and
4            (D) administration of injections of long-term
5        antipsychotic medications pursuant to a valid
6        prescription by a physician licensed to practice
7        medicine in all its branches, upon completion of
8        appropriate training conducted by an Accreditation
9        Council of Pharmaceutical Education accredited
10        provider, including how to address contraindications
11        and adverse reactions set forth by rule, with
12        notification to the patient's physician and
13        appropriate record retention, or pursuant to hospital
14        pharmacy and therapeutics committee policies and
15        procedures.
16        (5) vaccination of patients ages 10 through 13 limited
17    to the Influenza (inactivated influenza vaccine and live
18    attenuated influenza intranasal vaccine) and Tdap (defined
19    as tetanus, diphtheria, acellular pertussis) vaccines,
20    pursuant to a valid prescription or standing order, by a
21    physician licensed to practice medicine in all its
22    branches, upon completion of appropriate training,
23    including how to address contraindications and adverse
24    reactions set forth by rule, with notification to the
25    patient's physician and appropriate record retention, or
26    pursuant to hospital pharmacy and therapeutics committee

 

 

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1    policies and procedures;
2        (6) drug regimen review;
3        (7) drug or drug-related research;
4        (8) the provision of patient counseling;
5        (9) the practice of telepharmacy;
6        (10) the provision of those acts or services necessary
7    to provide pharmacist care;
8        (11) medication therapy management; and
9        (12) the responsibility for compounding and labeling
10    of drugs and devices (except labeling by a manufacturer,
11    repackager, or distributor of non-prescription drugs and
12    commercially packaged legend drugs and devices), proper
13    and safe storage of drugs and devices, and maintenance of
14    required records; and .
15        (13) the assessment and consultation of patients and
16    dispensing of hormonal contraceptives.
17    A pharmacist who performs any of the acts defined as the
18practice of pharmacy in this State must be actively licensed
19as a pharmacist under this Act.
20    (e) "Prescription" means and includes any written, oral,
21facsimile, or electronically transmitted order for drugs or
22medical devices, issued by a physician licensed to practice
23medicine in all its branches, dentist, veterinarian, podiatric
24physician, or optometrist, within the limits of his or her
25license, by a physician assistant in accordance with
26subsection (f) of Section 4, or by an advanced practice

 

 

10200HB0135sam001- 13 -LRB102 02749 BMS 26581 a

1registered nurse in accordance with subsection (g) of Section
24, containing the following: (1) name of the patient; (2) date
3when prescription was issued; (3) name and strength of drug or
4description of the medical device prescribed; and (4)
5quantity; (5) directions for use; (6) prescriber's name,
6address, and signature; and (7) DEA registration number where
7required, for controlled substances. The prescription may, but
8is not required to, list the illness, disease, or condition
9for which the drug or device is being prescribed. DEA
10registration numbers shall not be required on inpatient drug
11orders. A prescription for medication other than controlled
12substances shall be valid for up to 15 months from the date
13issued for the purpose of refills, unless the prescription
14states otherwise.
15    (f) "Person" means and includes a natural person,
16partnership, association, corporation, government entity, or
17any other legal entity.
18    (g) "Department" means the Department of Financial and
19Professional Regulation.
20    (h) "Board of Pharmacy" or "Board" means the State Board
21of Pharmacy of the Department of Financial and Professional
22Regulation.
23    (i) "Secretary" means the Secretary of Financial and
24Professional Regulation.
25    (j) "Drug product selection" means the interchange for a
26prescribed pharmaceutical product in accordance with Section

 

 

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125 of this Act and Section 3.14 of the Illinois Food, Drug and
2Cosmetic Act.
3    (k) "Inpatient drug order" means an order issued by an
4authorized prescriber for a resident or patient of a facility
5licensed under the Nursing Home Care Act, the ID/DD Community
6Care Act, the MC/DD Act, the Specialized Mental Health
7Rehabilitation Act of 2013, the Hospital Licensing Act, or the
8University of Illinois Hospital Act, or a facility which is
9operated by the Department of Human Services (as successor to
10the Department of Mental Health and Developmental
11Disabilities) or the Department of Corrections.
12    (k-5) "Pharmacist" means an individual health care
13professional and provider currently licensed by this State to
14engage in the practice of pharmacy.
15    (l) "Pharmacist in charge" means the licensed pharmacist
16whose name appears on a pharmacy license and who is
17responsible for all aspects of the operation related to the
18practice of pharmacy.
19    (m) "Dispense" or "dispensing" means the interpretation,
20evaluation, and implementation of a prescription drug order,
21including the preparation and delivery of a drug or device to a
22patient or patient's agent in a suitable container
23appropriately labeled for subsequent administration to or use
24by a patient in accordance with applicable State and federal
25laws and regulations. "Dispense" or "dispensing" does not mean
26the physical delivery to a patient or a patient's

 

 

10200HB0135sam001- 15 -LRB102 02749 BMS 26581 a

1representative in a home or institution by a designee of a
2pharmacist or by common carrier. "Dispense" or "dispensing"
3also does not mean the physical delivery of a drug or medical
4device to a patient or patient's representative by a
5pharmacist's designee within a pharmacy or drugstore while the
6pharmacist is on duty and the pharmacy is open.
7    (n) "Nonresident pharmacy" means a pharmacy that is
8located in a state, commonwealth, or territory of the United
9States, other than Illinois, that delivers, dispenses, or
10distributes, through the United States Postal Service,
11commercially acceptable parcel delivery service, or other
12common carrier, to Illinois residents, any substance which
13requires a prescription.
14    (o) "Compounding" means the preparation and mixing of
15components, excluding flavorings, (1) as the result of a
16prescriber's prescription drug order or initiative based on
17the prescriber-patient-pharmacist relationship in the course
18of professional practice or (2) for the purpose of, or
19incident to, research, teaching, or chemical analysis and not
20for sale or dispensing. "Compounding" includes the preparation
21of drugs or devices in anticipation of receiving prescription
22drug orders based on routine, regularly observed dispensing
23patterns. Commercially available products may be compounded
24for dispensing to individual patients only if all of the
25following conditions are met: (i) the commercial product is
26not reasonably available from normal distribution channels in

 

 

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1a timely manner to meet the patient's needs and (ii) the
2prescribing practitioner has requested that the drug be
3compounded.
4    (p) (Blank).
5    (q) (Blank).
6    (r) "Patient counseling" means the communication between a
7pharmacist or a student pharmacist under the supervision of a
8pharmacist and a patient or the patient's representative about
9the patient's medication or device for the purpose of
10optimizing proper use of prescription medications or devices.
11"Patient counseling" may include without limitation (1)
12obtaining a medication history; (2) acquiring a patient's
13allergies and health conditions; (3) facilitation of the
14patient's understanding of the intended use of the medication;
15(4) proper directions for use; (5) significant potential
16adverse events; (6) potential food-drug interactions; and (7)
17the need to be compliant with the medication therapy. A
18pharmacy technician may only participate in the following
19aspects of patient counseling under the supervision of a
20pharmacist: (1) obtaining medication history; (2) providing
21the offer for counseling by a pharmacist or student
22pharmacist; and (3) acquiring a patient's allergies and health
23conditions.
24    (s) "Patient profiles" or "patient drug therapy record"
25means the obtaining, recording, and maintenance of patient
26prescription information, including prescriptions for

 

 

10200HB0135sam001- 17 -LRB102 02749 BMS 26581 a

1controlled substances, and personal information.
2    (t) (Blank).
3    (u) "Medical device" or "device" means an instrument,
4apparatus, implement, machine, contrivance, implant, in vitro
5reagent, or other similar or related article, including any
6component part or accessory, required under federal law to
7bear the label "Caution: Federal law requires dispensing by or
8on the order of a physician". A seller of goods and services
9who, only for the purpose of retail sales, compounds, sells,
10rents, or leases medical devices shall not, by reasons
11thereof, be required to be a licensed pharmacy.
12    (v) "Unique identifier" means an electronic signature,
13handwritten signature or initials, thumb print, or other
14acceptable biometric or electronic identification process as
15approved by the Department.
16    (w) "Current usual and customary retail price" means the
17price that a pharmacy charges to a non-third-party payor.
18    (x) "Automated pharmacy system" means a mechanical system
19located within the confines of the pharmacy or remote location
20that performs operations or activities, other than compounding
21or administration, relative to storage, packaging, dispensing,
22or distribution of medication, and which collects, controls,
23and maintains all transaction information.
24    (y) "Drug regimen review" means and includes the
25evaluation of prescription drug orders and patient records for
26(1) known allergies; (2) drug or potential therapy

 

 

10200HB0135sam001- 18 -LRB102 02749 BMS 26581 a

1contraindications; (3) reasonable dose, duration of use, and
2route of administration, taking into consideration factors
3such as age, gender, and contraindications; (4) reasonable
4directions for use; (5) potential or actual adverse drug
5reactions; (6) drug-drug interactions; (7) drug-food
6interactions; (8) drug-disease contraindications; (9)
7therapeutic duplication; (10) patient laboratory values when
8authorized and available; (11) proper utilization (including
9over or under utilization) and optimum therapeutic outcomes;
10and (12) abuse and misuse.
11    (z) "Electronically transmitted prescription" means a
12prescription that is created, recorded, or stored by
13electronic means; issued and validated with an electronic
14signature; and transmitted by electronic means directly from
15the prescriber to a pharmacy. An electronic prescription is
16not an image of a physical prescription that is transferred by
17electronic means from computer to computer, facsimile to
18facsimile, or facsimile to computer.
19    (aa) "Medication therapy management services" means a
20distinct service or group of services offered by licensed
21pharmacists, physicians licensed to practice medicine in all
22its branches, advanced practice registered nurses authorized
23in a written agreement with a physician licensed to practice
24medicine in all its branches, or physician assistants
25authorized in guidelines by a supervising physician that
26optimize therapeutic outcomes for individual patients through

 

 

10200HB0135sam001- 19 -LRB102 02749 BMS 26581 a

1improved medication use. In a retail or other non-hospital
2pharmacy, medication therapy management services shall consist
3of the evaluation of prescription drug orders and patient
4medication records to resolve conflicts with the following:
5        (1) known allergies;
6        (2) drug or potential therapy contraindications;
7        (3) reasonable dose, duration of use, and route of
8    administration, taking into consideration factors such as
9    age, gender, and contraindications;
10        (4) reasonable directions for use;
11        (5) potential or actual adverse drug reactions;
12        (6) drug-drug interactions;
13        (7) drug-food interactions;
14        (8) drug-disease contraindications;
15        (9) identification of therapeutic duplication;
16        (10) patient laboratory values when authorized and
17    available;
18        (11) proper utilization (including over or under
19    utilization) and optimum therapeutic outcomes; and
20        (12) drug abuse and misuse.
21    "Medication therapy management services" includes the
22following:
23        (1) documenting the services delivered and
24    communicating the information provided to patients'
25    prescribers within an appropriate time frame, not to
26    exceed 48 hours;

 

 

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1        (2) providing patient counseling designed to enhance a
2    patient's understanding and the appropriate use of his or
3    her medications; and
4        (3) providing information, support services, and
5    resources designed to enhance a patient's adherence with
6    his or her prescribed therapeutic regimens.
7    "Medication therapy management services" may also include
8patient care functions authorized by a physician licensed to
9practice medicine in all its branches for his or her
10identified patient or groups of patients under specified
11conditions or limitations in a standing order from the
12physician.
13    "Medication therapy management services" in a licensed
14hospital may also include the following:
15        (1) reviewing assessments of the patient's health
16    status; and
17        (2) following protocols of a hospital pharmacy and
18    therapeutics committee with respect to the fulfillment of
19    medication orders.
20    (bb) "Pharmacist care" means the provision by a pharmacist
21of medication therapy management services, with or without the
22dispensing of drugs or devices, intended to achieve outcomes
23that improve patient health, quality of life, and comfort and
24enhance patient safety.
25    (cc) "Protected health information" means individually
26identifiable health information that, except as otherwise

 

 

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1provided, is:
2        (1) transmitted by electronic media;
3        (2) maintained in any medium set forth in the
4    definition of "electronic media" in the federal Health
5    Insurance Portability and Accountability Act; or
6        (3) transmitted or maintained in any other form or
7    medium.
8    "Protected health information" does not include
9individually identifiable health information found in:
10        (1) education records covered by the federal Family
11    Educational Right and Privacy Act; or
12        (2) employment records held by a licensee in its role
13    as an employer.
14    (dd) "Standing order" means a specific order for a patient
15or group of patients issued by a physician licensed to
16practice medicine in all its branches in Illinois.
17    (ee) "Address of record" means the designated address
18recorded by the Department in the applicant's application file
19or licensee's license file maintained by the Department's
20licensure maintenance unit.
21    (ff) "Home pharmacy" means the location of a pharmacy's
22primary operations.
23    (gg) "Email address of record" means the designated email
24address recorded by the Department in the applicant's
25application file or the licensee's license file, as maintained
26by the Department's licensure maintenance unit.

 

 

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1(Source: P.A. 100-208, eff. 1-1-18; 100-497, eff. 9-8-17;
2100-513, eff. 1-1-18; 100-804, eff. 1-1-19; 100-863, eff.
38-14-18; 101-349, eff. 1-1-20; revised 8-21-20.)
 
4    (225 ILCS 85/43 new)
5    Sec. 43. Dispensation of hormonal contraceptives.
6    (a) The dispensing of hormonal contraceptives to a patient
7shall be pursuant to a valid prescription or standing order by
8a physician licensed to practice medicine in all its branches
9or the medical director of a local health department, pursuant
10to the following:
11        (1) a pharmacist may dispense no more than a 12-month
12    supply of hormonal contraceptives to a patient;
13        (2) a pharmacist must complete an educational training
14    program accredited by the Accreditation Council for
15    Pharmacy Education and approved by the Department that is
16    related to the patient self-screening risk assessment,
17    patient assessment contraceptive counseling and education,
18    and dispensation of hormonal contraceptives;
19        (3) a pharmacist shall have the patient complete the
20    self-screening risk assessment tool; the self-screening
21    risk assessment tool is to be based on the most current
22    version of the United States Medical Eligibility Criteria
23    for Contraceptive Use published by the federal Centers for
24    Disease Control and Prevention;
25        (4) based upon the results of the self-screening risk

 

 

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1    assessment and the patient assessment, the pharmacist
2    shall use his or her professional and clinical judgment as
3    to when a patient should be referred to the patient's
4    physician or another health care provider;
5        (5) a pharmacist shall provide, during the patient
6    assessment and consultation, counseling and education
7    about all methods of contraception, including methods not
8    covered under the standing order, and their proper use and
9    effectiveness;
10        (6) the patient consultation shall take place in a
11    private manner; and
12        (7) a pharmacist and pharmacy must maintain
13    appropriate records.
14    (b) The Department may adopt rules to implement this
15Section.
16    (c) Nothing in this Section shall be interpreted to
17require a pharmacist to dispense hormonal contraception under
18a standing order issued by a physician licensed to practice
19medicine in all its branches or the medical director of a local
20health department.
 
21    Section 35. The Illinois Public Aid Code is amended by
22adding Section 5-5.12d as follows:
 
23    (305 ILCS 5/5-5.12d new)
24    Sec. 5-5.12d. Coverage for patient care services for

 

 

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1hormonal contraceptives provided by a pharmacist.
2    (a) Subject to approval by the federal Centers for
3Medicare and Medicaid Services, the medical assistance
4program, including both the fee-for-service and managed care
5medical assistance programs established under this Article,
6shall cover patient care services provided by a pharmacist for
7hormonal contraceptives assessment and consultation.
8    (b) The Department shall establish a fee schedule for
9patient care services provided by a pharmacist for hormonal
10contraceptives assessment and consultation.
11    (c) The rate of reimbursement for patient care services
12provided by a pharmacist for hormonal contraceptives
13assessment and consultation shall be at 85% of the fee
14schedule for physician services by the medical assistance
15program.
16    (d) A pharmacist must be enrolled in the medical
17assistance program as an ordering and referring provider prior
18to providing hormonal contraceptives assessment and
19consultation that is submitted by a pharmacy or pharmacist
20provider for reimbursement pursuant to this Section.
21    (e) The Department shall apply for any necessary federal
22waivers or approvals to implement this Section by January 1,
232022.
24    (f) This Section does not restrict or prohibit any
25services currently provided by pharmacists as authorized by
26law, including, but not limited to, pharmacist services

 

 

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1provided under this Code or authorized under the Illinois
2Title XIX State Plan.
3    (g) The Department shall submit to the Joint Committee on
4Administrative Rules administrative rules for this Section as
5soon as practicable but no later than 6 months after federal
6approval is received.
 
7    Section 99. Effective date. This Act takes effect January
81, 2023.".