Full Text of SB1802 97th General Assembly
SB1802enr 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,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. The Department of Human Services Act is amended | 5 | | by adding Section 10-66 as follows: | 6 | | (20 ILCS 1305/10-66 new) | 7 | | Sec. 10-66. Rate reductions. Rates for medical services | 8 | | purchased by the Divisions of Alcohol and Substance Abuse, | 9 | | Community Health and Prevention, Developmental Disabilities, | 10 | | Mental Health, or Rehabilitation Services within the | 11 | | Department of Human Services shall not be reduced below the | 12 | | rates calculated on April 1, 2011 unless the Department of | 13 | | Human Services promulgates rules and rules are implemented | 14 | | authorizing rate reductions. | 15 | | Section 2. The Civil Administrative Code of Illinois is | 16 | | amended 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 | 19 | | the
following in relation to the prevention and
treatment of | 20 | | acquired immunodeficiency syndrome (AIDS):
| 21 | | (1) Establish a State AIDS Control Unit within the |
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| 1 | | Department as
a
separate administrative subdivision, to | 2 | | coordinate all State
programs and services relating to the | 3 | | prevention, treatment, and
amelioration of AIDS.
| 4 | | (2) Conduct a public information campaign for physicians,
| 5 | | hospitals, health facilities, public health departments, law | 6 | | enforcement
personnel, public employees, laboratories, and the | 7 | | general public on
acquired immunodeficiency syndrome (AIDS) | 8 | | and promote necessary measures
to reduce the incidence of AIDS | 9 | | and the mortality from AIDS. This program
shall include, but | 10 | | not be limited to, the establishment of a statewide
hotline and | 11 | | a State AIDS information clearinghouse that will provide
| 12 | | periodic reports and releases to public officials, health | 13 | | professionals,
community service organizations, and the | 14 | | general public regarding new
developments or procedures | 15 | | concerning prevention and treatment of AIDS.
| 16 | | (3) (Blank).
| 17 | | (4) Establish alternative blood test services that are not
| 18 | | operated by a blood bank, plasma center or hospital. The
| 19 | | Department shall prescribe by rule minimum criteria, standards | 20 | | and
procedures for the establishment and operation of such | 21 | | services, which shall
include, but not be limited to | 22 | | requirements for the provision of
information, counseling and | 23 | | referral services that ensure appropriate
counseling and | 24 | | referral for persons whose blood is tested and shows evidence | 25 | | of
exposure to the human immunodeficiency virus (HIV) or other
| 26 | | identified causative agent of acquired immunodeficiency |
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| 1 | | syndrome (AIDS).
| 2 | | (5) Establish regional and community service networks of | 3 | | public
and
private service providers or health care | 4 | | professionals who may be involved
in AIDS research, prevention | 5 | | and treatment.
| 6 | | (6) Provide grants to individuals, organizations or | 7 | | facilities
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
| 25 | | from private or
public agencies, including federal funds that | 26 | | may be provided for AIDS control
efforts.
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| 1 | | (9) Develop and implement, in consultation with the | 2 | | Long-Term
Care
Facility Advisory Board, standards and | 3 | | procedures for long-term care
facilities that provide care and | 4 | | treatment of persons with AIDS, including
appropriate | 5 | | infection control procedures. The Department shall work
| 6 | | cooperatively with organizations representing those facilities | 7 | | to
develop
adequate numbers and types of placements for persons | 8 | | with AIDS and shall
advise those facilities on proper | 9 | | implementation of its standards
and procedures.
| 10 | | (10) The Department shall create and administer a training
| 11 | | program
for State employees who have a need for understanding | 12 | | matters relating to
AIDS in order to deal with or advise the | 13 | | public. The training
shall
include information on the cause and | 14 | | effects of AIDS, the means of
detecting it and preventing its | 15 | | transmission, the availability of related
counseling and | 16 | | referral, and other matters that may be
appropriate.
The | 17 | | training may also be made available to employees of local
| 18 | | governments,
public service agencies, and private agencies | 19 | | that contract
with the State;
in those cases the Department may | 20 | | charge a reasonable fee to
recover the
cost of the training.
| 21 | | (11) Approve tests or testing procedures used in | 22 | | determining
exposure to HIV or any other identified causative | 23 | | agent of AIDS.
| 24 | | (12) Provide prescription drug benefits counseling for | 25 | | persons with HIV or AIDS.
| 26 | | (13) Continue to administer the AIDS Drug Assistance |
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| 1 | | Program that provides drugs to prolong the lives of low income | 2 | | Persons with Acquired Immunodeficiency Syndrome (AIDS) or | 3 | | Human Immunodeficiency Virus (HIV) infection who are not | 4 | | eligible under Article V of the Illinois Public Aid Code for | 5 | | Medical Assistance, as provided under Title 77, Chapter 1, | 6 | | Subchapter (k), Part 692, Section 692.10 of the Illinois | 7 | | Administrative Code, effective August 1, 2000, except that the | 8 | | financial qualification for that program shall be that the | 9 | | anticipated gross monthly income shall be at or below 500% of | 10 | | the most recent Federal Poverty Guidelines published annually | 11 | | by the United States Department of Health and Human Services | 12 | | for the size of the household. Notwithstanding the preceding | 13 | | sentence, the Department of Public Health may determine the | 14 | | income eligibility standard for the AIDS Drug Assistance | 15 | | Program each year and may set the standard at more than 500% of | 16 | | the Federal Poverty Guidelines for the size of the household, | 17 | | provided that moneys appropriated to the Department for the | 18 | | program are sufficient to cover the increased cost of | 19 | | implementing the higher income eligibility standard. | 20 | | Rulemaking authority to implement this amendatory Act of the | 21 | | 95th General Assembly, if any, is conditioned on the rules | 22 | | being adopted in accordance with all provisions of the Illinois | 23 | | Administrative Procedure Act and all rules and procedures of | 24 | | the Joint Committee on Administrative Rules; any purported rule | 25 | | not so adopted, for whatever reason, is unauthorized. If the | 26 | | Department reduces the financial qualification for new |
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| 1 | | applicants while allowing currently enrolled individuals to | 2 | | remain on the program, the Department shall maintain a waiting | 3 | | list of applicants who would otherwise be eligible except that | 4 | | they do not meet the financial qualifications. Upon | 5 | | determination that program finances are adequate, the | 6 | | Department shall permit qualified individuals who are on the | 7 | | waiting list to enroll in the program. | 8 | | (14) In order to implement the provisions of Public Act | 9 | | 95-7, the Department must expand HIV testing in health care | 10 | | settings where undiagnosed individuals are likely to be | 11 | | identified. The Department must purchase rapid HIV kits and | 12 | | make grants for technical assistance, staff to conduct HIV | 13 | | testing and counseling, and related purposes. The Department | 14 | | must make grants to (i) facilities serving patients that are | 15 | | uninsured at high rates, (ii) facilities located in areas with | 16 | | a high prevalence of HIV or AIDS, (iii) facilities that have a | 17 | | high likelihood of identifying individuals who are undiagnosed | 18 | | with HIV or AIDS, or (iv) any combination of items (i), (ii), | 19 | | and (iii). | 20 | | (Source: P.A. 94-909, eff. 6-23-06; 95-744, eff. 7-18-08; | 21 | | 95-1042, eff. 3-25-09.)
| 22 | | Section 3. The Disabled Persons Rehabilitation Act is | 23 | | amended by adding Section 10a as follows: | 24 | | (20 ILCS 2405/10a new) |
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| 1 | | Sec. 10a. Financial Participation of Students Attending | 2 | | the Illinois School for the Deaf and the Illinois School for | 3 | | the Visually Impaired. | 4 | | (a) General. The Illinois School for the Deaf and the | 5 | | Illinois School for the Visually Impaired are required to | 6 | | provide eligible students with disabilities with a free and | 7 | | appropriate education. As part of the admission process to | 8 | | either school, the Department shall complete a financial | 9 | | analysis on each student attending the Illinois School for the | 10 | | Deaf or the Illinois School for the Visually Impaired and shall | 11 | | ask parents or guardians to participate, if applicable, in the | 12 | | cost of identified services or activities that are not | 13 | | education related. | 14 | | (b) Completion of financial analysis.
Prior to admission, | 15 | | and annually thereafter, a financial analysis shall be | 16 | | completed on each student attending the Illinois School for the | 17 | | Deaf or the Illinois School for the Visually Impaired. If at | 18 | | any time there is reason to believe there is a change in the | 19 | | student's financial situation that will affect their financial | 20 | | participation, 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 | 8 | | based on income standards developed by rule by the Department | 9 | | with input from the superintendent of each school, parents or | 10 | | guardians of students attending the Illinois School for the | 11 | | Deaf or the Illinois School for the Visually Impaired may be | 12 | | asked to financially participate in the following fees for | 13 | | services 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 | 4 | | or Temporary Assistance for Needy Families (TANF) shall not be | 5 | | required to financially participate in the fees established in | 6 | | this subsection (c). | 7 | | Exceptions may be granted to parents or guardians who are | 8 | | unable to meet the financial participation obligations due to | 9 | | extenuating circumstances. Requests for exceptions must be | 10 | | made in writing and must be submitted to the superintendent for | 11 | | initial recommendation with a final determination by the | 12 | | Director of the Division of Rehabilitation Services. | 13 | | Any fees collected under this subsection (c) shall be held | 14 | | locally by the school and used exclusively for the purpose for | 15 | | which the fee was assessed. | 16 | | Section 5. The State Prompt Payment Act is amended by | 17 | | changing Section 3-2 as follows:
| 18 | | (30 ILCS 540/3-2)
| 19 | | Sec. 3-2. Beginning July 1, 1993, in any instance where a | 20 | | State official or
agency is late in payment of a vendor's bill | 21 | | or invoice for goods or services
furnished to the State, as | 22 | | defined in Section 1, properly approved in
accordance with | 23 | | rules promulgated under Section 3-3, the State official or
| 24 | | agency shall pay interest to the vendor in accordance with the |
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| 1 | | following:
| 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; | 6 | | 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff. | 7 | | 1-25-11; 96-1530, eff. 2-16-11; revised 2-22-11.)
| 8 | | Section 10. The Children's Health Insurance Program Act is | 9 | | amended 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 | 13 | | to subdivision
(a)(2) of Section 25 and persons enrolled in a | 14 | | health benefits waiver program pursuant to Section 40 shall be | 15 | | subject 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 | 2 | | insurance plan
pursuant to subdivision (a)(1) of Section 25 | 3 | | shall be subject to the cost
sharing provisions as stated in | 4 | | the 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 | 7 | | changing 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 | 10 | | under this
Article shall be available to any of the following | 11 | | classes of persons in
respect to whom a plan for coverage has | 12 | | been submitted to the Governor
by the Illinois Department and | 13 | | approved 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 | 20 | | Department is authorized to adopt only those rules necessary, | 21 | | including emergency rules. Nothing in Public Act 96-20 permits | 22 | | the Department to adopt rules or issue a decision that expands | 23 | | eligibility for the FamilyCare Program to a person whose income | 24 | | exceeds 185% of the Federal Poverty Level as determined from | 25 | | time to time by the U.S. Department of Health and Human | 26 | | Services, unless the Department is provided with express |
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| 1 | | statutory authority. | 2 | | The Illinois Department and the Governor shall provide a | 3 | | plan for
coverage of the persons eligible under paragraph 7 as | 4 | | soon as possible after
July 1, 1984.
| 5 | | The eligibility of any such person for medical assistance | 6 | | under this
Article is not affected by the payment of any grant | 7 | | under the Senior
Citizens and Disabled Persons Property Tax | 8 | | Relief and Pharmaceutical
Assistance Act or any distributions | 9 | | or items of income described under
subparagraph (X) of
| 10 | | paragraph (2) of subsection (a) of Section 203 of the Illinois | 11 | | Income Tax
Act. The Department shall by rule establish the | 12 | | amounts of
assets to be disregarded in determining eligibility | 13 | | for medical assistance,
which shall at a minimum equal the | 14 | | amounts to be disregarded under the
Federal Supplemental | 15 | | Security Income Program. The amount of assets of a
single | 16 | | person to be disregarded
shall not be less than $2,000, and the | 17 | | amount of assets of a married couple
to be disregarded shall | 18 | | not be less than $3,000.
| 19 | | To the extent permitted under federal law, any person found | 20 | | guilty of a
second violation of Article VIIIA
shall be | 21 | | ineligible for medical assistance under this Article, as | 22 | | provided
in Section 8A-8.
| 23 | | The eligibility of any person for medical assistance under | 24 | | this Article
shall not be affected by the receipt by the person | 25 | | of donations or benefits
from fundraisers held for the person | 26 | | in cases of serious illness,
as long as neither the person nor |
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| 1 | | members of the person's family
have actual control over the | 2 | | donations or benefits or the disbursement
of the donations or | 3 | | benefits.
| 4 | | (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; | 5 | | 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. | 6 | | 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123, | 7 | | eff. 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 | 10 | | that recipients
under any Article of this Code shall pay a fee | 11 | | as a co-payment for services.
Co-payments shall be maximized to | 12 | | the extent permitted by federal law. Provided, however, that | 13 | | any such rule must provide that no
co-payment requirement can | 14 | | exist
for renal dialysis, radiation therapy, cancer | 15 | | chemotherapy, or insulin, and
other products necessary on a | 16 | | recurring basis, the absence of which would
be life | 17 | | threatening, or where co-payment expenditures for required | 18 | | services
and/or medications for chronic diseases that the | 19 | | Illinois Department shall
by rule designate shall cause an | 20 | | extensive financial burden on the
recipient, and provided no | 21 | | co-payment shall exist for emergency room
encounters which are | 22 | | for medical emergencies. The Department shall seek approval of | 23 | | a State plan amendment that allows pharmacies to refuse to | 24 | | dispense drugs in circumstances where the recipient does not | 25 | | pay the required co-payment. In the event the State plan |
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| 1 | | amendment is rejected, co-payments may not exceed $3 for brand | 2 | | name drugs, $1 for other pharmacy
services other than for | 3 | | generic drugs, and $2 for physician services, dental
services, | 4 | | optical services and supplies, chiropractic services, podiatry
| 5 | | services, and encounter rate clinic services. There shall be no | 6 | | co-payment for
generic drugs. Co-payments may not exceed $10 | 7 | | for emergency room use for a non-emergency situation as defined | 8 | | by the Department by rule and subject to federal approval. | 9 | | Co-payments may not exceed $3 for hospital outpatient and | 10 | | clinic
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 | 15 | | under this
Article for prescription drugs provided to a | 16 | | recipient of aid under this
Article shall include the name of | 17 | | the prescriber or an acceptable
identification number as | 18 | | established by the Department.
| 19 | | (b) Pharmacies providing prescription drugs under
this | 20 | | Article shall be reimbursed at a rate which shall include
a | 21 | | professional dispensing fee as determined by the Illinois
| 22 | | Department, plus the current acquisition cost of the | 23 | | prescription
drug dispensed. The Illinois Department shall | 24 | | update its
information on the acquisition costs of all | 25 | | prescription drugs
no less frequently than every 30 days. |
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| 1 | | However, the Illinois
Department may set the rate of | 2 | | reimbursement for the acquisition
cost, by rule, at a | 3 | | percentage of the current average wholesale
acquisition cost.
| 4 | | (c) (Blank).
| 5 | | (d) The Department shall not impose requirements for prior | 6 | | approval
based on a preferred drug list for anti-retroviral, | 7 | | anti-hemophilic factor
concentrates,
or
any atypical | 8 | | antipsychotics, conventional antipsychotics,
or | 9 | | anticonvulsants used for the treatment of serious mental
| 10 | | illnesses
until 30 days after it has conducted a study of the | 11 | | impact of such
requirements on patient care and submitted a | 12 | | report to the Speaker of the
House of Representatives and the | 13 | | President of the Senate. The Department shall review | 14 | | utilization of narcotic medications in the medical assistance | 15 | | program and impose utilization controls that protect against | 16 | | abuse.
| 17 | | (e) When making determinations as to which drugs shall be | 18 | | on a prior approval list, the Department shall include as part | 19 | | of the analysis for this determination, the degree to which a | 20 | | drug may affect individuals in different ways based on factors | 21 | | including the gender of the person taking the medication. | 22 | | (f) The Department shall cooperate with the Department of | 23 | | Public Health and the Department of Human Services Division of | 24 | | Mental Health in identifying psychotropic medications that, | 25 | | when given in a particular form, manner, duration, or frequency | 26 | | (including "as needed") in a dosage, or in conjunction with |
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| 1 | | other psychotropic medications to a nursing home resident, may | 2 | | constitute a chemical restraint or an "unnecessary drug" as | 3 | | defined by the Nursing Home Care Act or Titles XVIII and XIX of | 4 | | the Social Security Act and the implementing rules and | 5 | | regulations. The Department shall require prior approval for | 6 | | any such medication prescribed for a nursing home resident that | 7 | | appears to be a chemical restraint or an unnecessary drug. The | 8 | | Department shall consult with the Department of Human Services | 9 | | Division of Mental Health in developing a protocol and criteria | 10 | | for deciding whether to grant such prior approval. | 11 | | (g) The Department may by rule provide for reimbursement of | 12 | | the dispensing of a 90-day supply of a generic, non-narcotic | 13 | | maintenance medication in circumstances where it is cost | 14 | | effective. | 15 | | (h) Effective July 1, 2011, the Department shall | 16 | | discontinue coverage of select over-the-counter drugs, | 17 | | including analgesics and cough and cold and allergy | 18 | | medications. | 19 | | (i) The Department shall seek any necessary waiver from the | 20 | | federal government in order to establish a program limiting the | 21 | | pharmacies eligible to dispense specialty drugs and shall issue | 22 | | a Request for Proposals in order to maximize savings on these | 23 | | drugs. The Department shall by rule establish the drugs | 24 | | required to be dispensed in this program. | 25 | | (Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; | 26 | | 96-1501, 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 | 4 | | effect or shall
cease to be imposed, and
any moneys
remaining | 5 | | in the Fund shall be refunded to hospital providers
in | 6 | | proportion 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 | 14 | | effect or
shall
cease to be imposed if the assessment is | 15 | | determined to be an impermissible
tax under Title XIX
of the | 16 | | Social Security Act. Moneys in the Hospital Provider Fund | 17 | | derived
from assessments imposed prior thereto shall be
| 18 | | disbursed in accordance with Section 5A-8 to the extent federal | 19 | | financial participation is
not reduced due to the | 20 | | impermissibility of the assessments, and any
remaining
moneys | 21 | | shall be
refunded to hospital providers in proportion to the | 22 | | amounts paid by them.
| 23 | | (Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08; 96-8, | 24 | | eff. 4-28-09; 96-1530, eff. 2-16-11.)
| 25 | | Section 20. The Senior Citizens and Disabled Persons |
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| 1 | | Property Tax Relief and Pharmaceutical Assistance Act is | 2 | | amended 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 | 6 | | individual who will
become 65 years old during the calendar | 7 | | year in which a claim is filed, and any
surviving spouse of | 8 | | such a claimant, who at the time of death received or was
| 9 | | entitled to receive a grant pursuant to this Section, which | 10 | | surviving spouse
will become 65 years of age within the 24 | 11 | | months immediately following the
death of such claimant and | 12 | | which surviving spouse but for his or her age is
otherwise | 13 | | qualified to receive a grant pursuant to this Section, and any
| 14 | | disabled person whose annual household income is less than the | 15 | | income eligibility limitation, as defined in subsection (a-5)
| 16 | | and whose household is liable for payment of property taxes | 17 | | accrued or has
paid rent constituting property taxes accrued | 18 | | and is domiciled in this State
at the time he or she files his | 19 | | or her claim is entitled to claim a
grant under this Act.
With | 20 | | respect to claims filed by individuals who will become 65 years | 21 | | old
during the calendar year in which a claim is filed, the | 22 | | amount of any grant
to which that household is entitled shall | 23 | | be an amount equal to 1/12 of the
amount to which the claimant | 24 | | would otherwise be entitled as provided in
this Section, | 25 | | multiplied by the number of months in which the claimant was
65 |
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| 1 | | in the calendar year in which the claim is filed.
| 2 | | (a-5) Income eligibility limitation. For purposes of this | 3 | | Section, "income eligibility limitation" means an amount for | 4 | | grant 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 | 12 | | year 2010, a household must have annual household income of | 13 | | less than $27,610 for a household containing one person; less | 14 | | than $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 | 17 | | January 1, 2011, and thereafter, the foregoing household income | 18 | | eligibility limits may be changed to reflect the annual cost of | 19 | | living adjustment in Social Security and Supplemental Security | 20 | | Income benefits that are applicable to the year for which those | 21 | | benefits are being reported as income on an application. | 22 | | If a person files as a surviving spouse, then only his or | 23 | | her income shall be counted in determining his or her household | 24 | | income. | 25 | | (b) Limitation. Except as otherwise provided in | 26 | | subsections (a) and (f)
of this Section, the maximum amount of |
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| 1 | | grant which a claimant is
entitled to claim is the amount by | 2 | | which the property taxes accrued which
were paid or payable | 3 | | during the last preceding tax year or rent
constituting | 4 | | property taxes accrued upon the claimant's residence for the
| 5 | | last preceding taxable year exceeds 3 1/2% of the claimant's | 6 | | household
income for that year but in no event is the grant to | 7 | | exceed (i) $700 less
4.5% of household income for that year for | 8 | | those with a household income of
$14,000 or less or (ii) $70 if | 9 | | household income for that year is more than
$14,000.
| 10 | | (c) Public aid recipients. If household income in one or | 11 | | more
months during a year includes cash assistance in excess of | 12 | | $55 per month
from the Department of Healthcare and Family | 13 | | Services or the Department of Human Services (acting
as | 14 | | successor to the Department of Public Aid under the Department | 15 | | of Human
Services Act) which was determined under regulations | 16 | | of
that Department on a measure of need that included an | 17 | | allowance for actual
rent or property taxes paid by the | 18 | | recipient of that assistance, the amount
of grant to which that | 19 | | household is entitled, except as otherwise provided in
| 20 | | subsection (a), shall be the product of (1) the maximum amount | 21 | | computed as
specified in subsection (b) of this Section and (2) | 22 | | the ratio of the number of
months in which household income did | 23 | | not include such cash assistance over $55
to the number twelve. | 24 | | If household income did not include such cash assistance
over | 25 | | $55 for any months during the year, the amount of the grant to | 26 | | which the
household is entitled shall be the maximum amount |
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| 1 | | computed as specified in
subsection (b) of this Section. For | 2 | | purposes of this paragraph (c), "cash
assistance" does not | 3 | | include any amount received under the federal Supplemental
| 4 | | Security Income (SSI) program.
| 5 | | (d) Joint ownership. If title to the residence is held | 6 | | jointly by
the claimant with a person who is not a member of | 7 | | his or her household,
the amount of property taxes accrued used | 8 | | in computing the amount of grant
to which he or she is entitled | 9 | | shall be the same percentage of property
taxes accrued as is | 10 | | the percentage of ownership held by the claimant in the
| 11 | | residence.
| 12 | | (e) More than one residence. If a claimant has occupied | 13 | | more than
one residence in the taxable year, he or she may | 14 | | claim only one residence
for any part of a month. In the case | 15 | | of property taxes accrued, he or she
shall prorate 1/12 of the | 16 | | total property taxes accrued on
his or her residence to each | 17 | | month that he or she owned and occupied
that residence; and, in | 18 | | the case of rent constituting property taxes accrued,
shall | 19 | | prorate each month's rent payments to the residence
actually | 20 | | occupied during that month.
| 21 | | (f) (Blank).
| 22 | | (g) Effective January 1, 2006, there is hereby established | 23 | | a program of pharmaceutical assistance to the aged and | 24 | | disabled, entitled the Illinois Seniors and Disabled Drug | 25 | | Coverage Program, which shall be administered by the Department | 26 | | of Healthcare and Family Services and the Department on Aging |
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| 1 | | in accordance with this subsection, to consist of coverage of | 2 | | specified prescription drugs on behalf of beneficiaries of the | 3 | | program as set forth in this subsection. | 4 | | To become a beneficiary under the program established under | 5 | | this 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 | 5 | | rules such that on January 1, 2011, and thereafter, the | 6 | | foregoing household income eligibility limits may be changed to | 7 | | reflect the annual cost of living adjustment in Social Security | 8 | | and Supplemental Security Income benefits that are applicable | 9 | | to the year for which those benefits are being reported as | 10 | | income on an application. | 11 | | All individuals enrolled as of December 31, 2005, in the | 12 | | pharmaceutical assistance program operated pursuant to | 13 | | subsection (f) of this Section and all individuals enrolled as | 14 | | of December 31, 2005, in the SeniorCare Medicaid waiver program | 15 | | operated pursuant to Section 5-5.12a of the Illinois Public Aid | 16 | | Code shall be automatically enrolled in the program established | 17 | | by this subsection for the first year of operation without the | 18 | | need for further application, except that they must apply for | 19 | | Medicare Part D and the Low Income Subsidy under Medicare Part | 20 | | D. A person enrolled in the pharmaceutical assistance program | 21 | | operated pursuant to subsection (f) of this Section as of | 22 | | December 31, 2005, shall not lose eligibility in future years | 23 | | due only to the fact that they have not reached the age of 65. | 24 | | To the extent permitted by federal law, the Department may | 25 | | act as an authorized representative of a beneficiary in order | 26 | | to enroll the beneficiary in a Medicare Part D Prescription |
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| 1 | | Drug Plan if the beneficiary has failed to choose a plan and, | 2 | | where possible, to enroll beneficiaries in the low-income | 3 | | subsidy program under Medicare Part D or assist them in | 4 | | enrolling in that program. | 5 | | Beneficiaries under the program established under this | 6 | | subsection shall be divided into the following 4 eligibility | 7 | | groups: | 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 | 12 | | the cost of covered prescription drugs in excess of the | 13 | | beneficiary cost-sharing amounts set forth in this paragraph | 14 | | that are not covered by Medicare. The Department of Healthcare | 15 | | and Family Services may establish by emergency rule changes in | 16 | | cost-sharing necessary to conform the cost of the program to | 17 | | the amounts appropriated for State fiscal year 2012 and future | 18 | | fiscal years except that the 24-month limitation on the | 19 | | adoption of emergency rules and the provisions of Sections | 20 | | 5-115 and 5-125 of the Illinois Administrative Procedure Act | 21 | | shall not apply to rules adopted under this subsection (g). The | 22 | | adoption of emergency rules authorized by this subsection (g) | 23 | | shall be deemed to be necessary for the public interest, | 24 | | safety, and welfare. In 2006, beneficiaries shall pay a | 25 | | co-payment of $2 for each prescription of a generic drug and $5 | 26 | | for each prescription of a brand-name drug. In future years, |
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| 1 | | beneficiaries shall pay co-payments equal to the co-payments | 2 | | required under Medicare Part D for "other low-income subsidy | 3 | | eligible individuals" pursuant to 42 CFR 423.782(b). For | 4 | | individuals in Eligibility Groups 1, 2, and 3, once the program | 5 | | established under this subsection and Medicare combined have | 6 | | paid $1,750 in a year for covered prescription drugs, the | 7 | | beneficiary shall pay 20% of the cost of each prescription in | 8 | | addition to the co-payments set forth in this paragraph. For | 9 | | individuals in Eligibility Group 4, once the program | 10 | | established under this subsection and Medicare combined have | 11 | | paid $1,750 in a year for covered prescription drugs, the | 12 | | beneficiary shall pay 20% of the cost of each prescription in | 13 | | addition to the co-payments set forth in this paragraph unless | 14 | | the drug is included in the formulary of the Illinois AIDS Drug | 15 | | Assistance Program operated by the Illinois Department of | 16 | | Public Health and covered by the Medicare Part D Prescription | 17 | | Drug Plan in which the beneficiary is enrolled. If the drug is | 18 | | included in the formulary of the Illinois AIDS Drug Assistance | 19 | | Program and covered by the Medicare Part D Prescription Drug | 20 | | Plan in which the beneficiary is enrolled, individuals in | 21 | | Eligibility Group 4 shall continue to pay the co-payments set | 22 | | forth in this paragraph after the program established under | 23 | | this subsection and Medicare combined have paid $1,750 in a | 24 | | year for covered prescription drugs.
| 25 | | For beneficiaries eligible for Medicare Part D coverage, | 26 | | the program established under this subsection shall pay 100% of |
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| 1 | | the premiums charged by a qualified Medicare Part D | 2 | | Prescription Drug Plan for Medicare Part D basic prescription | 3 | | drug coverage, not including any late enrollment penalties. | 4 | | Qualified Medicare Part D Prescription Drug Plans may be | 5 | | limited by the Department of Healthcare and Family Services to | 6 | | those plans that sign a coordination agreement with the | 7 | | Department. | 8 | | For Notwithstanding Section 3.15, for purposes of the | 9 | | program established under this subsection, the term "covered | 10 | | prescription 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 | 17 | | receive a $25 monthly payment in lieu of the direct coverage | 18 | | described in this subsection. | 19 | | Any person otherwise eligible for pharmaceutical | 20 | | assistance under this subsection whose covered drugs are | 21 | | covered by any public program is ineligible for assistance | 22 | | under this subsection to the extent that the cost of those | 23 | | drugs is covered by the other program. | 24 | | The Department of Healthcare and Family Services shall | 25 | | establish by rule the methods by which it will provide for the | 26 | | coverage called for in this subsection. Those methods may |
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| 1 | | include direct reimbursement to pharmacies or the payment of a | 2 | | capitated amount to Medicare Part D Prescription Drug Plans. | 3 | | For a pharmacy to be reimbursed under the program | 4 | | established under this subsection, it must comply with rules | 5 | | adopted by the Department of Healthcare and Family Services | 6 | | regarding coordination of benefits with Medicare Part D | 7 | | Prescription Drug Plans. A pharmacy may not charge a | 8 | | Medicare-enrolled beneficiary of the program established under | 9 | | this subsection more for a covered prescription drug than the | 10 | | appropriate Medicare cost-sharing less any payment from or on | 11 | | behalf of the Department of Healthcare and Family Services. | 12 | | The Department of Healthcare and Family Services or the | 13 | | Department on Aging, as appropriate, may adopt rules regarding | 14 | | applications, counting of income, proof of Medicare status, | 15 | | mandatory generic policies, and pharmacy reimbursement rates | 16 | | and any other rules necessary for the cost-efficient operation | 17 | | of the program established under this subsection. | 18 | | (h) A qualified individual is not entitled to duplicate
| 19 | | benefits in a coverage period as a result of the changes made
| 20 | | by this amendatory Act of the 96th General Assembly.
| 21 | | (Source: P.A. 95-208, eff. 8-16-07; 95-644, eff. 10-12-07; | 22 | | 95-876, eff. 8-21-08; 96-804, eff. 1-1-10; revised 9-16-10.)
| 23 | | Section 99. Effective date. This Act takes effect upon | 24 | | becoming law.
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