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1 | AN ACT concerning aging.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Senior Citizens and Disabled Persons | ||||||||||||||||||||||||
5 | Property Tax Relief and
Pharmaceutical Assistance Act is | ||||||||||||||||||||||||
6 | amended by changing Section 4 as follows:
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7 | (320 ILCS 25/4) (from Ch. 67 1/2, par. 404)
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8 | Sec. 4. Amount of Grant.
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9 | (a) In general. Any individual 65 years or older or any | ||||||||||||||||||||||||
10 | individual who will
become 65 years old during the calendar | ||||||||||||||||||||||||
11 | year in which a claim is filed, and any
surviving spouse of | ||||||||||||||||||||||||
12 | such a claimant, who at the time of death received or was
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13 | entitled to receive a grant pursuant to this Section, which | ||||||||||||||||||||||||
14 | surviving spouse
will become 65 years of age within the 24 | ||||||||||||||||||||||||
15 | months immediately following the
death of such claimant and | ||||||||||||||||||||||||
16 | which surviving spouse but for his or her age is
otherwise | ||||||||||||||||||||||||
17 | qualified to receive a grant pursuant to this Section, and any
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18 | disabled person whose annual household income is less than | ||||||||||||||||||||||||
19 | $14,000 for grant
years before the 1998 grant year, less than | ||||||||||||||||||||||||
20 | $16,000 for the 1998 and 1999
grant years, and less than (i) | ||||||||||||||||||||||||
21 | $21,218 for a household containing one person,
(ii) $28,480 for | ||||||||||||||||||||||||
22 | a household containing 2 persons, or (iii) $35,740 for a
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23 | household containing 3 or more persons for the 2000 grant year | ||||||||||||||||||||||||
24 | and thereafter
and whose household is liable for payment of | ||||||||||||||||||||||||
25 | property taxes accrued or has
paid rent constituting property | ||||||||||||||||||||||||
26 | taxes accrued and is domiciled in this State
at the time he or | ||||||||||||||||||||||||
27 | she files his or her claim is entitled to claim a
grant under | ||||||||||||||||||||||||
28 | this Act.
With respect to claims filed by individuals who will | ||||||||||||||||||||||||
29 | become 65 years old
during the calendar year in which a claim | ||||||||||||||||||||||||
30 | is filed, the amount of any grant
to which that household is | ||||||||||||||||||||||||
31 | entitled shall be an amount equal to 1/12 of the
amount to | ||||||||||||||||||||||||
32 | which the claimant would otherwise be entitled as provided in
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1 | this Section, multiplied by the number of months in which the | ||||||
2 | claimant was
65 in the calendar year in which the claim is | ||||||
3 | filed.
| ||||||
4 | (b) Limitation. Except as otherwise provided in | ||||||
5 | subsections (a) and (f)
of this Section, the maximum amount of | ||||||
6 | grant which a claimant is
entitled to claim is the amount by | ||||||
7 | which the property taxes accrued which
were paid or payable | ||||||
8 | during the last preceding tax year or rent
constituting | ||||||
9 | property taxes accrued upon the claimant's residence for the
| ||||||
10 | last preceding taxable year exceeds 3 1/2% of the claimant's | ||||||
11 | household
income for that year but in no event is the grant to | ||||||
12 | exceed (i) $700 less
4.5% of household income for that year for | ||||||
13 | those with a household income of
$14,000 or less or (ii) $70 if | ||||||
14 | household income for that year is more than
$14,000.
| ||||||
15 | (c) Public aid recipients. If household income in one or | ||||||
16 | more
months during a year includes cash assistance in excess of | ||||||
17 | $55 per month
from the Department of Healthcare and Family | ||||||
18 | Services
Public Aid or the Department of Human Services (acting
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19 | as successor to the Department of Public Aid under the | ||||||
20 | Department of Human
Services Act) which was determined under | ||||||
21 | regulations of
that Department on a measure of need that | ||||||
22 | included an allowance for actual
rent or property taxes paid by | ||||||
23 | the recipient of that assistance, the amount
of grant to which | ||||||
24 | that household is entitled, except as otherwise provided in
| ||||||
25 | subsection (a), shall be the product of (1) the maximum amount | ||||||
26 | computed as
specified in subsection (b) of this Section and (2) | ||||||
27 | the ratio of the number of
months in which household income did | ||||||
28 | not include such cash assistance over $55
to the number twelve. | ||||||
29 | If household income did not include such cash assistance
over | ||||||
30 | $55 for any months during the year, the amount of the grant to | ||||||
31 | which the
household is entitled shall be the maximum amount | ||||||
32 | computed as specified in
subsection (b) of this Section. For | ||||||
33 | purposes of this paragraph (c), "cash
assistance" does not | ||||||
34 | include any amount received under the federal Supplemental
| ||||||
35 | Security Income (SSI) program.
| ||||||
36 | (d) Joint ownership. If title to the residence is held |
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1 | jointly by
the claimant with a person who is not a member of | ||||||
2 | his or her household,
the amount of property taxes accrued used | ||||||
3 | in computing the amount of grant
to which he or she is entitled | ||||||
4 | shall be the same percentage of property
taxes accrued as is | ||||||
5 | the percentage of ownership held by the claimant in the
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6 | residence.
| ||||||
7 | (e) More than one residence. If a claimant has occupied | ||||||
8 | more than
one residence in the taxable year, he or she may | ||||||
9 | claim only one residence
for any part of a month. In the case | ||||||
10 | of property taxes accrued, he or she
shall prorate 1/12 of the | ||||||
11 | total property taxes accrued on
his or her residence to each | ||||||
12 | month that he or she owned and occupied
that residence; and, in | ||||||
13 | the case of rent constituting property taxes accrued,
shall | ||||||
14 | prorate each month's rent payments to the residence
actually | ||||||
15 | occupied during that month.
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16 | (f) There is hereby established a program of pharmaceutical | ||||||
17 | assistance
to the aged and disabled which shall be administered | ||||||
18 | by the Department in
accordance with this Act, to consist of | ||||||
19 | payments to authorized pharmacies, on
behalf of beneficiaries | ||||||
20 | of the program, for the reasonable costs of covered
| ||||||
21 | prescription drugs. Each beneficiary who pays $5 for an | ||||||
22 | identification card
shall pay no additional prescription | ||||||
23 | costs. Each beneficiary who pays $25 for
an identification card | ||||||
24 | shall pay $3 per prescription. In addition, after a
beneficiary | ||||||
25 | receives $2,000 in benefits during a State fiscal year, that
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26 | beneficiary shall also be charged 20% of the cost of each | ||||||
27 | prescription for
which payments are made by the program during | ||||||
28 | the remainder of the fiscal
year. To become a beneficiary under | ||||||
29 | this program a person must: (1)
be (i) 65 years of age or | ||||||
30 | older, or (ii) the surviving spouse of such
a claimant, who at | ||||||
31 | the time of death received or was entitled to receive
benefits | ||||||
32 | pursuant to this subsection, which surviving spouse will become | ||||||
33 | 65
years of age within the 24 months immediately following the | ||||||
34 | death of such
claimant and which surviving spouse but for his | ||||||
35 | or her age is otherwise
qualified to receive benefits pursuant | ||||||
36 | to this subsection, or (iii) disabled,
and (2) be domiciled in |
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1 | this State at the time he or she files
his or her claim, and (3) | ||||||
2 | have a maximum household income of less
than $14,000 for grant | ||||||
3 | years before the 1998 grant year, less than $16,000
for the | ||||||
4 | 1998 and 1999 grant years, and less than (i) $21,218 for a | ||||||
5 | household
containing one person, (ii) $28,480 for a household | ||||||
6 | containing 2 persons, or
(iii) $35,740 for a household | ||||||
7 | containing 3 more persons for the 2000 grant
year
and | ||||||
8 | thereafter. In addition, each eligible person must (1) obtain | ||||||
9 | an
identification card from the Department, (2) at the time the | ||||||
10 | card is obtained,
sign a statement assigning to the State of | ||||||
11 | Illinois benefits which may be
otherwise claimed under any | ||||||
12 | private insurance plans, and (3) present the
identification | ||||||
13 | card to the dispensing pharmacist.
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14 | The Department may adopt rules specifying
participation
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15 | requirements for the pharmaceutical assistance program, | ||||||
16 | including copayment
amounts,
identification card fees, | ||||||
17 | expenditure limits, and the benefit threshold after
which a 20% | ||||||
18 | charge is imposed on the cost of each prescription, to be in
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19 | effect on and
after July 1, 2004.
Notwithstanding any other | ||||||
20 | provision of this paragraph, however, the Department
may not
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21 | increase the identification card fee above the amount in effect | ||||||
22 | on May 1, 2003
without
the express consent of the General | ||||||
23 | Assembly.
To the extent practicable, those requirements shall | ||||||
24 | be
commensurate
with the requirements provided in rules adopted | ||||||
25 | by the Department of Healthcare and Family Services
Public Aid
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26 | to
implement the pharmacy assistance program under Section | ||||||
27 | 5-5.12a of the Illinois
Public
Aid Code.
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28 | Whenever a generic equivalent for a covered prescription | ||||||
29 | drug is available,
the Department shall reimburse only for the | ||||||
30 | reasonable costs of the generic
equivalent, less the co-pay | ||||||
31 | established in this Section, unless (i) the covered
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32 | prescription drug contains one or more ingredients defined as a | ||||||
33 | narrow
therapeutic index drug at 21 CFR 320.33, (ii) the | ||||||
34 | prescriber indicates on the
face of the prescription "brand | ||||||
35 | medically necessary", and (iii) the prescriber
specifies that a | ||||||
36 | substitution is not permitted. When issuing an oral
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1 | prescription for covered prescription medication described in | ||||||
2 | item (i) of this
paragraph, the prescriber shall stipulate | ||||||
3 | "brand medically necessary" and
that a substitution is not | ||||||
4 | permitted. If the covered prescription drug and its
authorizing | ||||||
5 | prescription do not meet the criteria listed above, the | ||||||
6 | beneficiary
may purchase the non-generic equivalent of the | ||||||
7 | covered prescription drug by
paying the difference between the | ||||||
8 | generic cost and the non-generic cost plus
the beneficiary | ||||||
9 | co-pay.
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10 | Any person otherwise eligible for pharmaceutical | ||||||
11 | assistance under this
Act whose covered drugs are covered by | ||||||
12 | any public program for assistance in
purchasing any covered | ||||||
13 | prescription drugs shall be ineligible for assistance
under | ||||||
14 | this Act to the extent such costs are covered by such other | ||||||
15 | plan.
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16 | The fee to be charged by the Department for the | ||||||
17 | identification card shall
be equal to $5 per coverage year for | ||||||
18 | persons below the official poverty line
as defined by the | ||||||
19 | United States Department of Health and Human Services and
$25 | ||||||
20 | per coverage year for all other persons.
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21 | In the event that 2 or more persons are eligible for any | ||||||
22 | benefit under
this Act, and are members of the same household, | ||||||
23 | (1) each such person shall
be entitled to participate in the | ||||||
24 | pharmaceutical assistance program, provided
that he or she | ||||||
25 | meets all other requirements imposed by this subsection
and (2) | ||||||
26 | each participating household member contributes the fee | ||||||
27 | required
for that person by the preceding paragraph for the | ||||||
28 | purpose
of obtaining an identification card. | ||||||
29 | The provisions of this subsection (f), other than this | ||||||
30 | paragraph, are inoperative after December 31, 2005. | ||||||
31 | Beneficiaries who received benefits under the program | ||||||
32 | established by this subsection (f) are not entitled, at the | ||||||
33 | termination of the program, to any refund of the identification | ||||||
34 | card fee paid under this subsection. | ||||||
35 | (g) Effective January 1, 2006, there is hereby established | ||||||
36 | a program of pharmaceutical assistance to the aged and |
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1 | disabled, entitled the Illinois Seniors and Disabled Drug | ||||||
2 | Coverage Program, which shall be administered by the Department | ||||||
3 | of Healthcare and Family Services and the Department on Aging | ||||||
4 | in accordance with this subsection, to consist of coverage of | ||||||
5 | specified prescription drugs on behalf of beneficiaries of the | ||||||
6 | program as set forth in this subsection. The program under this | ||||||
7 | subsection replaces and supersedes the program established | ||||||
8 | under subsection (f), which shall end at midnight on December | ||||||
9 | 31, 2005. | ||||||
10 | To become a beneficiary under the program established under | ||||||
11 | this subsection, a person must: | ||||||
12 | (1) be (i) 65 years of age or older or (ii) disabled; | ||||||
13 | and | ||||||
14 | (2) be domiciled in this State; and | ||||||
15 | (3) enroll with a qualified Medicare Part D | ||||||
16 | Prescription Drug Plan if eligible and apply for all | ||||||
17 | available subsidies under Medicare Part D; and | ||||||
18 | (4) have a maximum household income of (i) less than | ||||||
19 | $21,218 for a household containing one person, (ii) less | ||||||
20 | than $28,480 for a household containing 2 persons, or (iii) | ||||||
21 | less than $35,740 for a household containing 3 or more | ||||||
22 | persons. If any income eligibility limit set forth in items | ||||||
23 | (i) through (iii) is less than 200% of the Federal Poverty | ||||||
24 | Level for any year, the income eligibility limit for that | ||||||
25 | year for households of that size shall be income equal to | ||||||
26 | or less than 200% of the Federal Poverty Level. | ||||||
27 | All individuals enrolled as of December 31, 2005, in the | ||||||
28 | pharmaceutical assistance program operated pursuant to | ||||||
29 | subsection (f) of this Section and all individuals enrolled as | ||||||
30 | of December 31, 2005, in the SeniorCare Medicaid waiver program | ||||||
31 | operated pursuant to Section 5-5.12a of the Illinois Public Aid | ||||||
32 | Code shall be automatically enrolled in the program established | ||||||
33 | by this subsection for the first year of operation without the | ||||||
34 | need for further application, except that they must apply for | ||||||
35 | Medicare Part D and the Low Income Subsidy under Medicare Part | ||||||
36 | D. A person enrolled in the pharmaceutical assistance program |
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1 | operated pursuant to subsection (f) of this Section as of | ||||||
2 | December 31, 2005, shall not lose eligibility in future years | ||||||
3 | due only to the fact that they have not reached the age of 65. | ||||||
4 | To the extent permitted by federal law, the Department may | ||||||
5 | act as an authorized representative of a beneficiary in order | ||||||
6 | to enroll the beneficiary in a Medicare Part D Prescription | ||||||
7 | Drug Plan if the beneficiary has failed to choose a plan and, | ||||||
8 | where possible, to enroll beneficiaries in the low-income | ||||||
9 | subsidy program under Medicare Part D or assist them in | ||||||
10 | enrolling in that program. | ||||||
11 | Beneficiaries under the program established under this | ||||||
12 | subsection shall be divided into the following 4 eligibility | ||||||
13 | groups: | ||||||
14 | (A) Eligibility Group 1 shall consist of beneficiaries | ||||||
15 | who are not eligible for Medicare Part D coverage and who
| ||||||
16 | are: | ||||||
17 | (i) disabled and under age 65; or | ||||||
18 | (ii) age 65 or older, with incomes over 200% of the | ||||||
19 | Federal Poverty Level; or | ||||||
20 | (iii) age 65 or older, with incomes at or below | ||||||
21 | 200% of the Federal Poverty Level and not eligible for | ||||||
22 | federally funded means-tested benefits due to | ||||||
23 | immigration status. | ||||||
24 | (B) Eligibility Group 2 shall consist of beneficiaries | ||||||
25 | otherwise described in Eligibility Group 1 but who are | ||||||
26 | eligible for Medicare Part D coverage. | ||||||
27 | (C) Eligibility Group 3 shall consist of beneficiaries | ||||||
28 | age 65 or older, with incomes at or below 200% of the | ||||||
29 | Federal Poverty Level, who are not barred from receiving | ||||||
30 | federally funded means-tested benefits due to immigration | ||||||
31 | status and are eligible for Medicare Part D coverage. | ||||||
32 | (D) Eligibility Group 4 shall consist of beneficiaries | ||||||
33 | age 65 or older, with incomes at or below 200% of the | ||||||
34 | Federal Poverty Level, who are not barred from receiving | ||||||
35 | federally funded means-tested benefits due to immigration | ||||||
36 | status and are not eligible for Medicare Part D coverage. |
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1 | If the State applies and receives federal approval for a | ||||||
2 | waiver under Title XIX of the Social Security Act, persons in | ||||||
3 | Eligibility Group 4 shall continue to receive benefits through | ||||||
4 | the approved waiver, and Eligibility Group 4 may be expanded to | ||||||
5 | include disabled persons under age 65 with incomes under 200% | ||||||
6 | of the Federal Poverty Level who are not eligible for Medicare | ||||||
7 | and who are not barred from receiving federally funded | ||||||
8 | means-tested benefits due to immigration status. | ||||||
9 | The program established under this subsection shall cover | ||||||
10 | the cost of covered prescription drugs in excess of the | ||||||
11 | beneficiary cost-sharing amounts set forth in this paragraph | ||||||
12 | that are not covered by Medicare. In 2006, beneficiaries shall | ||||||
13 | pay a co-payment of $2 for each prescription of a generic drug | ||||||
14 | and $5 for each prescription of a brand-name drug. In future | ||||||
15 | years, beneficiaries shall pay co-payments equal to the | ||||||
16 | co-payments required under Medicare Part D for "other | ||||||
17 | low-income subsidy eligible individuals" pursuant to 42 CFR | ||||||
18 | 423.782(b). Once the program established under this subsection | ||||||
19 | and Medicare combined have paid $1,750 in a year for covered | ||||||
20 | prescription drugs, the beneficiary shall pay 20% of the cost | ||||||
21 | of each prescription in addition to the co-payments set forth | ||||||
22 | in this paragraph. | ||||||
23 | For beneficiaries eligible for Medicare Part D coverage, | ||||||
24 | the program established under this subsection shall pay 100% of | ||||||
25 | the premiums charged by a qualified Medicare Part D | ||||||
26 | Prescription Drug Plan for Medicare Part D basic prescription | ||||||
27 | drug coverage, not including any late enrollment penalties. | ||||||
28 | Qualified Medicare Part D Prescription Drug Plans may be | ||||||
29 | limited by the Department of Healthcare and Family Services to | ||||||
30 | those plans that sign a coordination agreement with the | ||||||
31 | Department. | ||||||
32 | Notwithstanding Section 3.15, for purposes of the program | ||||||
33 | established under this subsection, the term "covered | ||||||
34 | prescription drug" has the following meanings: | ||||||
35 | For Eligibility Group 1, "covered prescription drug" | ||||||
36 | means: (1) any cardiovascular agent or drug; (2) any |
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1 | insulin or other prescription drug used in the treatment of | ||||||
2 | diabetes, including syringe and needles used to administer | ||||||
3 | the insulin; (3) any prescription drug used in the | ||||||
4 | treatment of arthritis; (4) any prescription drug used in | ||||||
5 | the treatment of cancer; (5) any prescription drug used in | ||||||
6 | the treatment of Alzheimer's disease; (6) any prescription | ||||||
7 | drug used in the treatment of Parkinson's disease; (7) any | ||||||
8 | prescription drug used in the treatment of glaucoma; (8) | ||||||
9 | any prescription drug used in the treatment of lung disease | ||||||
10 | and smoking-related illnesses; (9) any prescription drug | ||||||
11 | used in the treatment of osteoporosis; and (10) any | ||||||
12 | prescription drug used in the treatment of multiple | ||||||
13 | sclerosis. The Department may add additional therapeutic | ||||||
14 | classes by rule. The Department may adopt a preferred drug | ||||||
15 | list within any of the classes of drugs described in items | ||||||
16 | (1) through (10) of this paragraph. The specific drugs or | ||||||
17 | therapeutic classes of covered prescription drugs shall be | ||||||
18 | indicated by rule. | ||||||
19 | For Eligibility Group 2, "covered prescription drug" | ||||||
20 | means those drugs covered for Eligibility Group 1 that are | ||||||
21 | also covered by the Medicare Part D Prescription Drug Plan | ||||||
22 | in which the beneficiary is enrolled. | ||||||
23 | For Eligibility Group 3, "covered prescription drug" | ||||||
24 | means those drugs covered by the Medicare Part D | ||||||
25 | Prescription Drug Plan in which the beneficiary is | ||||||
26 | enrolled. | ||||||
27 | For Eligibility Group 4, "covered prescription drug" | ||||||
28 | means those drugs covered by the Medical Assistance Program | ||||||
29 | under Article V of the Illinois Public Aid Code. | ||||||
30 | An individual in Eligibility Group 3 or 4 may opt to | ||||||
31 | receive a $25 monthly payment in lieu of the direct coverage | ||||||
32 | described in this subsection. | ||||||
33 | Any person otherwise eligible for pharmaceutical | ||||||
34 | assistance under this subsection whose covered drugs are | ||||||
35 | covered by any public program is ineligible for assistance | ||||||
36 | under this subsection to the extent that the cost of those |
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1 | drugs is covered by the other program. | ||||||
2 | The Department of Healthcare and Family Services shall | ||||||
3 | establish by rule the methods by which it will provide for the | ||||||
4 | coverage called for in this subsection. Those methods may | ||||||
5 | include direct reimbursement to pharmacies or the payment of a | ||||||
6 | capitated amount to Medicare Part D Prescription Drug Plans. | ||||||
7 | For a pharmacy to be reimbursed under the program | ||||||
8 | established under this subsection, it must comply with rules | ||||||
9 | adopted by the Department of Healthcare and Family Services | ||||||
10 | regarding coordination of benefits with Medicare Part D | ||||||
11 | Prescription Drug Plans. A pharmacy may not charge a | ||||||
12 | Medicare-enrolled beneficiary of the program established under | ||||||
13 | this subsection more for a covered prescription drug than the | ||||||
14 | appropriate Medicare cost-sharing less any payment from or on | ||||||
15 | behalf of the Department of Healthcare and Family Services. | ||||||
16 | The Department of Healthcare and Family Services or the | ||||||
17 | Department on Aging, as appropriate, may adopt rules regarding | ||||||
18 | applications, counting of income, proof of Medicare status, | ||||||
19 | mandatory generic policies, and pharmacy reimbursement rates | ||||||
20 | and any other rules necessary for the cost-efficient operation | ||||||
21 | of the program established under this subsection.
| ||||||
22 | (h) There is established a program of hearing aid | ||||||
23 | assistance
to the aged and disabled that shall be administered | ||||||
24 | by the Department in
accordance with this Act, to consist of | ||||||
25 | payments to eligible claimants to offset the costs of hearing | ||||||
26 | aids. | ||||||
27 | To offset the cost of the hearing aids, a person entitled | ||||||
28 | to claim a grant under subsection (a) of this Section is | ||||||
29 | entitled to receive a payment of up to $100 each calendar year | ||||||
30 | in which he or she purchases a hearing aid for his or her | ||||||
31 | personal use. | ||||||
32 | For purposes of this subsection (g), "hearing aid" means an | ||||||
33 | ear-level or body-worn electroacoustic instrument that is used | ||||||
34 | for the purpose of amplifying sound and the basic components of | ||||||
35 | which are a microphone, amplifier, and receiver. "Hearing aid" | ||||||
36 | also includes prosthetic devices that produce perception of |
| |||||||
| |||||||
1 | sound by replacing the function of the middle ear, cochlea, or | ||||||
2 | auditory nerve, such as auditory osseointegrated devices and | ||||||
3 | auditory brainstem devices.
| ||||||
4 | (i) There is established a program of dental services | ||||||
5 | assistance
to the aged and disabled that shall be administered | ||||||
6 | by the Department in
accordance with this Act, to consist of | ||||||
7 | payments to eligible claimants to offset the costs of dental | ||||||
8 | services.
| ||||||
9 | To offset the cost of the dental services, a person | ||||||
10 | entitled to claim a grant under subsection (a) of this Section | ||||||
11 | is entitled to receive a payment of up to $500 each calendar | ||||||
12 | year in which he or she purchases dental services for his or | ||||||
13 | her personal use. | ||||||
14 | For the purposes of this subsection (i), "dental services" | ||||||
15 | means dental care, dental surgery, dental treatment, any other | ||||||
16 | dental procedure involving the teeth or periodontium or any | ||||||
17 | dental appliances, including crowns, bridges, implants, or | ||||||
18 | partial or complete dentures. | ||||||
19 | (Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; revised | ||||||
20 | 12-15-05.)
|