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Rep. La Shawn K. Ford
Filed: 3/16/2017
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| 1 | | AMENDMENT TO HOUSE BILL 236
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| 2 | | AMENDMENT NO. ______. Amend House Bill 236 by replacing |
| 3 | | everything after the enacting clause with the following:
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| 4 | | "Section 5. The Illinois Public Aid Code is amended by
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| 5 | | changing Sections 5-2b and 5-4.1 as follows:
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| 6 | | (305 ILCS 5/5-2b) |
| 7 | | Sec. 5-2b. Medically fragile and technology dependent |
| 8 | | children eligibility and program. Notwithstanding any other |
| 9 | | provision of law, on and after September 1, 2012, subject to |
| 10 | | federal approval, medical assistance under this Article shall |
| 11 | | be available to children who qualify as persons with a |
| 12 | | disability, as defined under the federal Supplemental Security |
| 13 | | Income program and who are medically fragile and technology |
| 14 | | dependent. The program shall allow eligible children to receive |
| 15 | | the medical assistance provided under this Article in the |
| 16 | | community and must maximize, to the fullest extent permissible |
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| 1 | | under federal law, federal reimbursement and family |
| 2 | | cost-sharing, including co-pays for brand name prescription |
| 3 | | drugs, premiums, or any other family contributions, except that |
| 4 | | the Department shall be permitted to incentivize the |
| 5 | | utilization of selected services through the use of |
| 6 | | cost-sharing adjustments. The Department shall establish the |
| 7 | | policies, procedures, standards, services, and criteria for |
| 8 | | this program by rule.
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| 9 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
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| 10 | | (305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
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| 11 | | Sec. 5-4.1. Co-payments; limitations. The Department may |
| 12 | | not require recipients of benefits under any Article of this |
| 13 | | Code to pay a fee as a co-payment for any service or generic |
| 14 | | drug or prescribed over-the-counter drug covered under the fee |
| 15 | | for service or managed care medical assistance programs. The |
| 16 | | Department may by rule provide that recipients
under any |
| 17 | | Article of this Code shall pay a fee as a co-payment for brand |
| 18 | | name prescription drugs. services.
Co-payments shall be |
| 19 | | maximized to the extent permitted by federal law, except that |
| 20 | | the Department shall impose a co-pay of $2 on generic drugs. |
| 21 | | Provided, however, that any such rule must provide that no
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| 22 | | co-payment requirement can exist
for renal dialysis, radiation |
| 23 | | therapy, cancer chemotherapy, or insulin, and
other products |
| 24 | | necessary on a recurring basis, the absence of which would
be |
| 25 | | life threatening, or where co-payment expenditures for |
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| 1 | | required services
and/or medications for chronic diseases that |
| 2 | | the Illinois Department shall
by rule designate shall cause an |
| 3 | | extensive financial burden on the
recipient, and provided no |
| 4 | | co-payment shall exist for emergency room
encounters which are |
| 5 | | for medical emergencies. The Department shall seek approval of |
| 6 | | a State plan amendment that allows pharmacies to refuse to |
| 7 | | dispense brand name prescription drugs in circumstances where |
| 8 | | the recipient does not pay the required co-payment for a brand |
| 9 | | name prescription drug. Co-payments may not exceed $10 for |
| 10 | | emergency room use for a non-emergency situation as defined by |
| 11 | | the Department by rule and subject to federal approval.
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| 12 | | (Source: P.A. 96-1501, eff. 1-25-11; 97-74, eff. 6-30-11; |
| 13 | | 97-689, eff. 6-14-12.)".
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