Public Act 095-0208
 
HB1257 Enrolled LRB095 07696 DRJ 27850 b

    AN ACT concerning aging.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act is
amended by changing Section 4 as follows:
 
    (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
    Sec. 4. Amount of Grant.
    (a) In general. Any individual 65 years or older or any
individual who will become 65 years old during the calendar
year in which a claim is filed, and any surviving spouse of
such a claimant, who at the time of death received or was
entitled to receive a grant pursuant to this Section, which
surviving spouse will become 65 years of age within the 24
months immediately following the death of such claimant and
which surviving spouse but for his or her age is otherwise
qualified to receive a grant pursuant to this Section, and any
disabled person whose annual household income is less than
$14,000 for grant years before the 1998 grant year, less than
$16,000 for the 1998 and 1999 grant years, and less than (i)
$21,218 for a household containing one person, (ii) $28,480 for
a household containing 2 persons, or (iii) $35,740 for a
household containing 3 or more persons for the 2000 grant year
and thereafter and whose household is liable for payment of
property taxes accrued or has paid rent constituting property
taxes accrued and is domiciled in this State at the time he or
she files his or her claim is entitled to claim a grant under
this Act. With respect to claims filed by individuals who will
become 65 years old during the calendar year in which a claim
is filed, the amount of any grant to which that household is
entitled shall be an amount equal to 1/12 of the amount to
which the claimant would otherwise be entitled as provided in
this Section, multiplied by the number of months in which the
claimant was 65 in the calendar year in which the claim is
filed.
    (b) Limitation. Except as otherwise provided in
subsections (a) and (f) of this Section, the maximum amount of
grant which a claimant is entitled to claim is the amount by
which the property taxes accrued which were paid or payable
during the last preceding tax year or rent constituting
property taxes accrued upon the claimant's residence for the
last preceding taxable year exceeds 3 1/2% of the claimant's
household income for that year but in no event is the grant to
exceed (i) $700 less 4.5% of household income for that year for
those with a household income of $14,000 or less or (ii) $70 if
household income for that year is more than $14,000.
    (c) Public aid recipients. If household income in one or
more months during a year includes cash assistance in excess of
$55 per month from the Department of Healthcare and Family
Services or the Department of Human Services (acting as
successor to the Department of Public Aid under the Department
of Human Services Act) which was determined under regulations
of that Department on a measure of need that included an
allowance for actual rent or property taxes paid by the
recipient of that assistance, the amount of grant to which that
household is entitled, except as otherwise provided in
subsection (a), shall be the product of (1) the maximum amount
computed as specified in subsection (b) of this Section and (2)
the ratio of the number of months in which household income did
not include such cash assistance over $55 to the number twelve.
If household income did not include such cash assistance over
$55 for any months during the year, the amount of the grant to
which the household is entitled shall be the maximum amount
computed as specified in subsection (b) of this Section. For
purposes of this paragraph (c), "cash assistance" does not
include any amount received under the federal Supplemental
Security Income (SSI) program.
    (d) Joint ownership. If title to the residence is held
jointly by the claimant with a person who is not a member of
his or her household, the amount of property taxes accrued used
in computing the amount of grant to which he or she is entitled
shall be the same percentage of property taxes accrued as is
the percentage of ownership held by the claimant in the
residence.
    (e) More than one residence. If a claimant has occupied
more than one residence in the taxable year, he or she may
claim only one residence for any part of a month. In the case
of property taxes accrued, he or she shall prorate 1/12 of the
total property taxes accrued on his or her residence to each
month that he or she owned and occupied that residence; and, in
the case of rent constituting property taxes accrued, shall
prorate each month's rent payments to the residence actually
occupied during that month.
    (f) There is hereby established a program of pharmaceutical
assistance to the aged and disabled which shall be administered
by the Department in accordance with this Act, to consist of
payments to authorized pharmacies, on behalf of beneficiaries
of the program, for the reasonable costs of covered
prescription drugs. Each beneficiary who pays $5 for an
identification card shall pay no additional prescription
costs. Each beneficiary who pays $25 for an identification card
shall pay $3 per prescription. In addition, after a beneficiary
receives $2,000 in benefits during a State fiscal year, that
beneficiary shall also be charged 20% of the cost of each
prescription for which payments are made by the program during
the remainder of the fiscal year. To become a beneficiary under
this program a person must: (1) be (i) 65 years of age or
older, or (ii) the surviving spouse of such a claimant, who at
the time of death received or was entitled to receive benefits
pursuant to this subsection, which surviving spouse will become
65 years of age within the 24 months immediately following the
death of such claimant and which surviving spouse but for his
or her age is otherwise qualified to receive benefits pursuant
to this subsection, or (iii) disabled, and (2) be domiciled in
this State at the time he or she files his or her claim, and (3)
have a maximum household income of less than $14,000 for grant
years before the 1998 grant year, less than $16,000 for the
1998 and 1999 grant years, and less than (i) $21,218 for a
household containing one person, (ii) $28,480 for a household
containing 2 persons, or (iii) $35,740 for a household
containing 3 more persons for the 2000 grant year and
thereafter. In addition, each eligible person must (1) obtain
an identification card from the Department, (2) at the time the
card is obtained, sign a statement assigning to the State of
Illinois benefits which may be otherwise claimed under any
private insurance plans, and (3) present the identification
card to the dispensing pharmacist.
    The Department may adopt rules specifying participation
requirements for the pharmaceutical assistance program,
including copayment amounts, identification card fees,
expenditure limits, and the benefit threshold after which a 20%
charge is imposed on the cost of each prescription, to be in
effect on and after July 1, 2004. Notwithstanding any other
provision of this paragraph, however, the Department may not
increase the identification card fee above the amount in effect
on May 1, 2003 without the express consent of the General
Assembly. To the extent practicable, those requirements shall
be commensurate with the requirements provided in rules adopted
by the Department of Healthcare and Family Services to
implement the pharmacy assistance program under Section
5-5.12a of the Illinois Public Aid Code.
    Whenever a generic equivalent for a covered prescription
drug is available, the Department shall reimburse only for the
reasonable costs of the generic equivalent, less the co-pay
established in this Section, unless (i) the covered
prescription drug contains one or more ingredients defined as a
narrow therapeutic index drug at 21 CFR 320.33, (ii) the
prescriber indicates on the face of the prescription "brand
medically necessary", and (iii) the prescriber specifies that a
substitution is not permitted. When issuing an oral
prescription for covered prescription medication described in
item (i) of this paragraph, the prescriber shall stipulate
"brand medically necessary" and that a substitution is not
permitted. If the covered prescription drug and its authorizing
prescription do not meet the criteria listed above, the
beneficiary may purchase the non-generic equivalent of the
covered prescription drug by paying the difference between the
generic cost and the non-generic cost plus the beneficiary
co-pay.
    Any person otherwise eligible for pharmaceutical
assistance under this Act whose covered drugs are covered by
any public program for assistance in purchasing any covered
prescription drugs shall be ineligible for assistance under
this Act to the extent such costs are covered by such other
plan.
    The fee to be charged by the Department for the
identification card shall be equal to $5 per coverage year for
persons below the official poverty line as defined by the
United States Department of Health and Human Services and $25
per coverage year for all other persons.
    In the event that 2 or more persons are eligible for any
benefit under this Act, and are members of the same household,
(1) each such person shall be entitled to participate in the
pharmaceutical assistance program, provided that he or she
meets all other requirements imposed by this subsection and (2)
each participating household member contributes the fee
required for that person by the preceding paragraph for the
purpose of obtaining an identification card.
    The provisions of this subsection (f), other than this
paragraph, are inoperative after December 31, 2005.
Beneficiaries who received benefits under the program
established by this subsection (f) are not entitled, at the
termination of the program, to any refund of the identification
card fee paid under this subsection.
    (g) Effective January 1, 2006, there is hereby established
a program of pharmaceutical assistance to the aged and
disabled, entitled the Illinois Seniors and Disabled Drug
Coverage Program, which shall be administered by the Department
of Healthcare and Family Services and the Department on Aging
in accordance with this subsection, to consist of coverage of
specified prescription drugs on behalf of beneficiaries of the
program as set forth in this subsection. The program under this
subsection replaces and supersedes the program established
under subsection (f), which shall end at midnight on December
31, 2005.
    To become a beneficiary under the program established under
this subsection, a person must:
        (1) be (i) 65 years of age or older or (ii) disabled;
    and
        (2) be domiciled in this State; and
        (3) enroll with a qualified Medicare Part D
    Prescription Drug Plan if eligible and apply for all
    available subsidies under Medicare Part D; and
        (4) have a maximum household income of (i) less than
    $21,218 for a household containing one person, (ii) less
    than $28,480 for a household containing 2 persons, or (iii)
    less than $35,740 for a household containing 3 or more
    persons. If any income eligibility limit set forth in items
    (i) through (iii) is less than 200% of the Federal Poverty
    Level for any year, the income eligibility limit for that
    year for households of that size shall be income equal to
    or less than 200% of the Federal Poverty Level.
    All individuals enrolled as of December 31, 2005, in the
pharmaceutical assistance program operated pursuant to
subsection (f) of this Section and all individuals enrolled as
of December 31, 2005, in the SeniorCare Medicaid waiver program
operated pursuant to Section 5-5.12a of the Illinois Public Aid
Code shall be automatically enrolled in the program established
by this subsection for the first year of operation without the
need for further application, except that they must apply for
Medicare Part D and the Low Income Subsidy under Medicare Part
D. A person enrolled in the pharmaceutical assistance program
operated pursuant to subsection (f) of this Section as of
December 31, 2005, shall not lose eligibility in future years
due only to the fact that they have not reached the age of 65.
    To the extent permitted by federal law, the Department may
act as an authorized representative of a beneficiary in order
to enroll the beneficiary in a Medicare Part D Prescription
Drug Plan if the beneficiary has failed to choose a plan and,
where possible, to enroll beneficiaries in the low-income
subsidy program under Medicare Part D or assist them in
enrolling in that program.
    Beneficiaries under the program established under this
subsection shall be divided into the following 5 eligibility
groups:
        (A) Eligibility Group 1 shall consist of beneficiaries
    who are not eligible for Medicare Part D coverage and who
    are:
            (i) disabled and under age 65; or
            (ii) age 65 or older, with incomes over 200% of the
        Federal Poverty Level; or
            (iii) age 65 or older, with incomes at or below
        200% of the Federal Poverty Level and not eligible for
        federally funded means-tested benefits due to
        immigration status.
        (B) Eligibility Group 2 shall consist of beneficiaries
    otherwise described in Eligibility Group 1 but who are
    eligible for Medicare Part D coverage.
        (C) Eligibility Group 3 shall consist of beneficiaries
    age 65 or older, with incomes at or below 200% of the
    Federal Poverty Level, who are not barred from receiving
    federally funded means-tested benefits due to immigration
    status and are eligible for Medicare Part D coverage.
        (D) Eligibility Group 4 shall consist of beneficiaries
    age 65 or older, with incomes at or below 200% of the
    Federal Poverty Level, who are not barred from receiving
    federally funded means-tested benefits due to immigration
    status and are not eligible for Medicare Part D coverage.
        If the State applies and receives federal approval for
    a waiver under Title XIX of the Social Security Act,
    persons in Eligibility Group 4 shall continue to receive
    benefits through the approved waiver, and Eligibility
    Group 4 may be expanded to include disabled persons under
    age 65 with incomes under 200% of the Federal Poverty Level
    who are not eligible for Medicare and who are not barred
    from receiving federally funded means-tested benefits due
    to immigration status.
        (E) On and after January 1, 2007, Eligibility Group 5
    shall consist of beneficiaries who are otherwise described
    in Eligibility Groups 2 and 3 who Group 1 but are eligible
    for Medicare Part D and have a diagnosis of HIV or AIDS.
    The program established under this subsection shall cover
the cost of covered prescription drugs in excess of the
beneficiary cost-sharing amounts set forth in this paragraph
that are not covered by Medicare. In 2006, beneficiaries shall
pay a co-payment of $2 for each prescription of a generic drug
and $5 for each prescription of a brand-name drug. In future
years, beneficiaries shall pay co-payments equal to the
co-payments required under Medicare Part D for "other
low-income subsidy eligible individuals" pursuant to 42 CFR
423.782(b). For individuals in Eligibility Groups 1, 2, 3, and
4, once the program established under this subsection and
Medicare combined have paid $1,750 in a year for covered
prescription drugs, the beneficiary shall pay 20% of the cost
of each prescription in addition to the co-payments set forth
in this paragraph. For individuals in Eligibility Group 5, once
the program established under this subsection and Medicare
combined have paid $1,750 in a year for covered prescription
drugs, the beneficiary shall pay 20% of the cost of each
prescription in addition to the co-payments set forth in this
paragraph unless the drug is included in the formulary of the
Illinois AIDS Drug Assistance Program operated by the Illinois
Department of Public Health. If the drug is included in the
formulary of the Illinois AIDS Drug Assistance Program,
individuals in Eligibility Group 5 shall continue to pay the
co-payments set forth in this paragraph after the program
established under this subsection and Medicare combined have
paid $1,750 in a year for covered prescription drugs.
    For beneficiaries eligible for Medicare Part D coverage,
the program established under this subsection shall pay 100% of
the premiums charged by a qualified Medicare Part D
Prescription Drug Plan for Medicare Part D basic prescription
drug coverage, not including any late enrollment penalties.
Qualified Medicare Part D Prescription Drug Plans may be
limited by the Department of Healthcare and Family Services to
those plans that sign a coordination agreement with the
Department.
    Notwithstanding Section 3.15, for purposes of the program
established under this subsection, the term "covered
prescription drug" has the following meanings:
        For Eligibility Group 1, "covered prescription drug"
    means: (1) any cardiovascular agent or drug; (2) any
    insulin or other prescription drug used in the treatment of
    diabetes, including syringe and needles used to administer
    the insulin; (3) any prescription drug used in the
    treatment of arthritis; (4) any prescription drug used in
    the treatment of cancer; (5) any prescription drug used in
    the treatment of Alzheimer's disease; (6) any prescription
    drug used in the treatment of Parkinson's disease; (7) any
    prescription drug used in the treatment of glaucoma; (8)
    any prescription drug used in the treatment of lung disease
    and smoking-related illnesses; (9) any prescription drug
    used in the treatment of osteoporosis; and (10) any
    prescription drug used in the treatment of multiple
    sclerosis. The Department may add additional therapeutic
    classes by rule. The Department may adopt a preferred drug
    list within any of the classes of drugs described in items
    (1) through (10) of this paragraph. The specific drugs or
    therapeutic classes of covered prescription drugs shall be
    indicated by rule.
        For Eligibility Group 2, "covered prescription drug"
    means those drugs covered for Eligibility Group 1 that are
    also covered by the Medicare Part D Prescription Drug Plan
    in which the beneficiary is enrolled.
        For Eligibility Group 3, "covered prescription drug"
    means those drugs covered by the Medicare Part D
    Prescription Drug Plan in which the beneficiary is
    enrolled.
        For Eligibility Group 4, "covered prescription drug"
    means those drugs covered by the Medical Assistance Program
    under Article V of the Illinois Public Aid Code.
        For Eligibility Group 5, for individuals otherwise
    described in Eligibility Group 2, "covered prescription
    drug" means: (1) those drugs covered for Eligibility Group
    2 1 that are also covered by the Medicare Part D
    Prescription Drug Plan in which the beneficiary is
    enrolled; and (2) those drugs included in the formulary of
    the Illinois AIDS Drug Assistance Program operated by the
    Illinois Department of Public Health that are also covered
    by the Medicare Part D Prescription Drug Plan in which the
    beneficiary is enrolled. For Eligibility Group 5, for
    individuals otherwise described in Eligibility Group 3,
    "covered prescription drug" means those drugs covered by
    the Medicare Part D Prescription Drug Plan in which the
    beneficiary is enrolled.
    An individual in Eligibility Group 1, 2, 3, or 4, or 5 may
opt to receive a $25 monthly payment in lieu of the direct
coverage described in this subsection.
    Any person otherwise eligible for pharmaceutical
assistance under this subsection whose covered drugs are
covered by any public program is ineligible for assistance
under this subsection to the extent that the cost of those
drugs is covered by the other program.
    The Department of Healthcare and Family Services shall
establish by rule the methods by which it will provide for the
coverage called for in this subsection. Those methods may
include direct reimbursement to pharmacies or the payment of a
capitated amount to Medicare Part D Prescription Drug Plans.
    For a pharmacy to be reimbursed under the program
established under this subsection, it must comply with rules
adopted by the Department of Healthcare and Family Services
regarding coordination of benefits with Medicare Part D
Prescription Drug Plans. A pharmacy may not charge a
Medicare-enrolled beneficiary of the program established under
this subsection more for a covered prescription drug than the
appropriate Medicare cost-sharing less any payment from or on
behalf of the Department of Healthcare and Family Services.
    The Department of Healthcare and Family Services or the
Department on Aging, as appropriate, may adopt rules regarding
applications, counting of income, proof of Medicare status,
mandatory generic policies, and pharmacy reimbursement rates
and any other rules necessary for the cost-efficient operation
of the program established under this subsection.
(Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; 94-909,
eff. 6-23-06.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.