95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB0157

 

Introduced 1/19/2007, by Rep. Elizabeth Coulson

 

SYNOPSIS AS INTRODUCED:
 
320 ILCS 25/4   from Ch. 67 1/2, par. 404

    Amends the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act. Provides for an annual increase in the household income amounts used to determine eligibility for a grant, the increase being equal to the cost-of-living increase designated under the federal Social Security Act.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1     AN ACT concerning aging.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
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:
 
7     (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
8     Sec. 4. Amount of Grant.
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
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
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
23 household containing 3 or more persons for the 2000 grant year

 

 

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1 and thereafter and whose household is liable for payment of
2 property taxes accrued or has paid rent constituting property
3 taxes accrued and is domiciled in this State at the time he or
4 she files his or her claim is entitled to claim a grant under
5 this Act. The annual household income amounts set forth in
6 items (i), (ii), and (iii) of this subsection (a) shall be
7 increased annually by an amount equal to the amount of the
8 annual cost-of-living increase designated under the federal
9 Social Security Act. With respect to claims filed by
10 individuals who will become 65 years old during the calendar
11 year in which a claim is filed, the amount of any grant to
12 which that household is entitled shall be an amount equal to
13 1/12 of the amount to which the claimant would otherwise be
14 entitled as provided in this Section, multiplied by the number
15 of months in which the claimant was 65 in the calendar year in
16 which the claim is filed.
17     (b) Limitation. Except as otherwise provided in
18 subsections (a) and (f) of this Section, the maximum amount of
19 grant which a claimant is entitled to claim is the amount by
20 which the property taxes accrued which were paid or payable
21 during the last preceding tax year or rent constituting
22 property taxes accrued upon the claimant's residence for the
23 last preceding taxable year exceeds 3 1/2% of the claimant's
24 household income for that year but in no event is the grant to
25 exceed (i) $700 less 4.5% of household income for that year for
26 those with a household income of $14,000 or less or (ii) $70 if

 

 

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1 household income for that year is more than $14,000.
2     (c) Public aid recipients. If household income in one or
3 more months during a year includes cash assistance in excess of
4 $55 per month from the Department of Healthcare and Family
5 Services or the Department of Human Services (acting as
6 successor to the Department of Public Aid under the Department
7 of Human Services Act) which was determined under regulations
8 of that Department on a measure of need that included an
9 allowance for actual rent or property taxes paid by the
10 recipient of that assistance, the amount of grant to which that
11 household is entitled, except as otherwise provided in
12 subsection (a), shall be the product of (1) the maximum amount
13 computed as specified in subsection (b) of this Section and (2)
14 the ratio of the number of months in which household income did
15 not include such cash assistance over $55 to the number twelve.
16 If household income did not include such cash assistance over
17 $55 for any months during the year, the amount of the grant to
18 which the household is entitled shall be the maximum amount
19 computed as specified in subsection (b) of this Section. For
20 purposes of this paragraph (c), "cash assistance" does not
21 include any amount received under the federal Supplemental
22 Security Income (SSI) program.
23     (d) Joint ownership. If title to the residence is held
24 jointly by the claimant with a person who is not a member of
25 his or her household, the amount of property taxes accrued used
26 in computing the amount of grant to which he or she is entitled

 

 

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1 shall be the same percentage of property taxes accrued as is
2 the percentage of ownership held by the claimant in the
3 residence.
4     (e) More than one residence. If a claimant has occupied
5 more than one residence in the taxable year, he or she may
6 claim only one residence for any part of a month. In the case
7 of property taxes accrued, he or she shall prorate 1/12 of the
8 total property taxes accrued on his or her residence to each
9 month that he or she owned and occupied that residence; and, in
10 the case of rent constituting property taxes accrued, shall
11 prorate each month's rent payments to the residence actually
12 occupied during that month.
13     (f) There is hereby established a program of pharmaceutical
14 assistance to the aged and disabled which shall be administered
15 by the Department in accordance with this Act, to consist of
16 payments to authorized pharmacies, on behalf of beneficiaries
17 of the program, for the reasonable costs of covered
18 prescription drugs. Each beneficiary who pays $5 for an
19 identification card shall pay no additional prescription
20 costs. Each beneficiary who pays $25 for an identification card
21 shall pay $3 per prescription. In addition, after a beneficiary
22 receives $2,000 in benefits during a State fiscal year, that
23 beneficiary shall also be charged 20% of the cost of each
24 prescription for which payments are made by the program during
25 the remainder of the fiscal year. To become a beneficiary under
26 this program a person must: (1) be (i) 65 years of age or

 

 

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1 older, or (ii) the surviving spouse of such a claimant, who at
2 the time of death received or was entitled to receive benefits
3 pursuant to this subsection, which surviving spouse will become
4 65 years of age within the 24 months immediately following the
5 death of such claimant and which surviving spouse but for his
6 or her age is otherwise qualified to receive benefits pursuant
7 to this subsection, or (iii) disabled, and (2) be domiciled in
8 this State at the time he or she files his or her claim, and (3)
9 have a maximum household income of less than $14,000 for grant
10 years before the 1998 grant year, less than $16,000 for the
11 1998 and 1999 grant years, and less than (i) $21,218 for a
12 household containing one person, (ii) $28,480 for a household
13 containing 2 persons, or (iii) $35,740 for a household
14 containing 3 more persons for the 2000 grant year and
15 thereafter. In addition, each eligible person must (1) obtain
16 an identification card from the Department, (2) at the time the
17 card is obtained, sign a statement assigning to the State of
18 Illinois benefits which may be otherwise claimed under any
19 private insurance plans, and (3) present the identification
20 card to the dispensing pharmacist.
21     The Department may adopt rules specifying participation
22 requirements for the pharmaceutical assistance program,
23 including copayment amounts, identification card fees,
24 expenditure limits, and the benefit threshold after which a 20%
25 charge is imposed on the cost of each prescription, to be in
26 effect on and after July 1, 2004. Notwithstanding any other

 

 

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1 provision of this paragraph, however, the Department may not
2 increase the identification card fee above the amount in effect
3 on May 1, 2003 without the express consent of the General
4 Assembly. To the extent practicable, those requirements shall
5 be commensurate with the requirements provided in rules adopted
6 by the Department of Healthcare and Family Services to
7 implement the pharmacy assistance program under Section
8 5-5.12a of the Illinois Public Aid Code.
9     Whenever a generic equivalent for a covered prescription
10 drug is available, the Department shall reimburse only for the
11 reasonable costs of the generic equivalent, less the co-pay
12 established in this Section, unless (i) the covered
13 prescription drug contains one or more ingredients defined as a
14 narrow therapeutic index drug at 21 CFR 320.33, (ii) the
15 prescriber indicates on the face of the prescription "brand
16 medically necessary", and (iii) the prescriber specifies that a
17 substitution is not permitted. When issuing an oral
18 prescription for covered prescription medication described in
19 item (i) of this paragraph, the prescriber shall stipulate
20 "brand medically necessary" and that a substitution is not
21 permitted. If the covered prescription drug and its authorizing
22 prescription do not meet the criteria listed above, the
23 beneficiary may purchase the non-generic equivalent of the
24 covered prescription drug by paying the difference between the
25 generic cost and the non-generic cost plus the beneficiary
26 co-pay.

 

 

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1     Any person otherwise eligible for pharmaceutical
2 assistance under this Act whose covered drugs are covered by
3 any public program for assistance in purchasing any covered
4 prescription drugs shall be ineligible for assistance under
5 this Act to the extent such costs are covered by such other
6 plan.
7     The fee to be charged by the Department for the
8 identification card shall be equal to $5 per coverage year for
9 persons below the official poverty line as defined by the
10 United States Department of Health and Human Services and $25
11 per coverage year for all other persons.
12     In the event that 2 or more persons are eligible for any
13 benefit under this Act, and are members of the same household,
14 (1) each such person shall be entitled to participate in the
15 pharmaceutical assistance program, provided that he or she
16 meets all other requirements imposed by this subsection and (2)
17 each participating household member contributes the fee
18 required for that person by the preceding paragraph for the
19 purpose of obtaining an identification card.
20     The provisions of this subsection (f), other than this
21 paragraph, are inoperative after December 31, 2005.
22 Beneficiaries who received benefits under the program
23 established by this subsection (f) are not entitled, at the
24 termination of the program, to any refund of the identification
25 card fee paid under this subsection.
26     (g) Effective January 1, 2006, there is hereby established

 

 

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1 a program of pharmaceutical assistance to the aged and
2 disabled, entitled the Illinois Seniors and Disabled Drug
3 Coverage Program, which shall be administered by the Department
4 of Healthcare and Family Services and the Department on Aging
5 in accordance with this subsection, to consist of coverage of
6 specified prescription drugs on behalf of beneficiaries of the
7 program as set forth in this subsection. The program under this
8 subsection replaces and supersedes the program established
9 under subsection (f), which shall end at midnight on December
10 31, 2005.
11     To become a beneficiary under the program established under
12 this subsection, a person must:
13         (1) be (i) 65 years of age or older or (ii) disabled;
14     and
15         (2) be domiciled in this State; and
16         (3) enroll with a qualified Medicare Part D
17     Prescription Drug Plan if eligible and apply for all
18     available subsidies under Medicare Part D; and
19         (4) have a maximum household income of (i) less than
20     $21,218 for a household containing one person, (ii) less
21     than $28,480 for a household containing 2 persons, or (iii)
22     less than $35,740 for a household containing 3 or more
23     persons. If any income eligibility limit set forth in items
24     (i) through (iii) is less than 200% of the Federal Poverty
25     Level for any year, the income eligibility limit for that
26     year for households of that size shall be income equal to

 

 

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1     or less than 200% of the Federal Poverty Level.
2     All individuals enrolled as of December 31, 2005, in the
3 pharmaceutical assistance program operated pursuant to
4 subsection (f) of this Section and all individuals enrolled as
5 of December 31, 2005, in the SeniorCare Medicaid waiver program
6 operated pursuant to Section 5-5.12a of the Illinois Public Aid
7 Code shall be automatically enrolled in the program established
8 by this subsection for the first year of operation without the
9 need for further application, except that they must apply for
10 Medicare Part D and the Low Income Subsidy under Medicare Part
11 D. A person enrolled in the pharmaceutical assistance program
12 operated pursuant to subsection (f) of this Section as of
13 December 31, 2005, shall not lose eligibility in future years
14 due only to the fact that they have not reached the age of 65.
15     To the extent permitted by federal law, the Department may
16 act as an authorized representative of a beneficiary in order
17 to enroll the beneficiary in a Medicare Part D Prescription
18 Drug Plan if the beneficiary has failed to choose a plan and,
19 where possible, to enroll beneficiaries in the low-income
20 subsidy program under Medicare Part D or assist them in
21 enrolling in that program.
22     Beneficiaries under the program established under this
23 subsection shall be divided into the following 5 eligibility
24 groups:
25         (A) Eligibility Group 1 shall consist of beneficiaries
26     who are not eligible for Medicare Part D coverage and who

 

 

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1     are:
2             (i) disabled and under age 65; or
3             (ii) age 65 or older, with incomes over 200% of the
4         Federal Poverty Level; or
5             (iii) age 65 or older, with incomes at or below
6         200% of the Federal Poverty Level and not eligible for
7         federally funded means-tested benefits due to
8         immigration status.
9         (B) Eligibility Group 2 shall consist of beneficiaries
10     otherwise described in Eligibility Group 1 but who are
11     eligible for Medicare Part D coverage.
12         (C) Eligibility Group 3 shall consist of beneficiaries
13     age 65 or older, with incomes at or below 200% of the
14     Federal Poverty Level, who are not barred from receiving
15     federally funded means-tested benefits due to immigration
16     status and are eligible for Medicare Part D coverage.
17         (D) Eligibility Group 4 shall consist of beneficiaries
18     age 65 or older, with incomes at or below 200% of the
19     Federal Poverty Level, who are not barred from receiving
20     federally funded means-tested benefits due to immigration
21     status and are not eligible for Medicare Part D coverage.
22         If the State applies and receives federal approval for
23     a waiver under Title XIX of the Social Security Act,
24     persons in Eligibility Group 4 shall continue to receive
25     benefits through the approved waiver, and Eligibility
26     Group 4 may be expanded to include disabled persons under

 

 

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1     age 65 with incomes under 200% of the Federal Poverty Level
2     who are not eligible for Medicare and who are not barred
3     from receiving federally funded means-tested benefits due
4     to immigration status.
5         (E) On and after January 1, 2007, Eligibility Group 5
6     shall consist of beneficiaries who are otherwise described
7     in Eligibility Group 1 but are eligible for Medicare Part D
8     and have a diagnosis of HIV or AIDS.
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). For individuals in Eligibility Groups 1, 2, 3, and
19 4, once the program established under this subsection and
20 Medicare combined have paid $1,750 in a year for covered
21 prescription drugs, the beneficiary shall pay 20% of the cost
22 of each prescription in addition to the co-payments set forth
23 in this paragraph. For individuals in Eligibility Group 5, once
24 the program established under this subsection and Medicare
25 combined have paid $1,750 in a year for covered prescription
26 drugs, the beneficiary shall pay 20% of the cost of each

 

 

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1 prescription in addition to the co-payments set forth in this
2 paragraph unless the drug is included in the formulary of the
3 Illinois AIDS Drug Assistance Program operated by the Illinois
4 Department of Public Health. If the drug is included in the
5 formulary of the Illinois AIDS Drug Assistance Program,
6 individuals in Eligibility Group 5 shall continue to pay the
7 co-payments set forth in this paragraph after the program
8 established under this subsection and Medicare combined have
9 paid $1,750 in a year for covered prescription drugs.
10     For beneficiaries eligible for Medicare Part D coverage,
11 the program established under this subsection shall pay 100% of
12 the premiums charged by a qualified Medicare Part D
13 Prescription Drug Plan for Medicare Part D basic prescription
14 drug coverage, not including any late enrollment penalties.
15 Qualified Medicare Part D Prescription Drug Plans may be
16 limited by the Department of Healthcare and Family Services to
17 those plans that sign a coordination agreement with the
18 Department.
19     Notwithstanding Section 3.15, for purposes of the program
20 established under this subsection, the term "covered
21 prescription drug" has the following meanings:
22         For Eligibility Group 1, "covered prescription drug"
23     means: (1) any cardiovascular agent or drug; (2) any
24     insulin or other prescription drug used in the treatment of
25     diabetes, including syringe and needles used to administer
26     the insulin; (3) any prescription drug used in the

 

 

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1     treatment of arthritis; (4) any prescription drug used in
2     the treatment of cancer; (5) any prescription drug used in
3     the treatment of Alzheimer's disease; (6) any prescription
4     drug used in the treatment of Parkinson's disease; (7) any
5     prescription drug used in the treatment of glaucoma; (8)
6     any prescription drug used in the treatment of lung disease
7     and smoking-related illnesses; (9) any prescription drug
8     used in the treatment of osteoporosis; and (10) any
9     prescription drug used in the treatment of multiple
10     sclerosis. The Department may add additional therapeutic
11     classes by rule. The Department may adopt a preferred drug
12     list within any of the classes of drugs described in items
13     (1) through (10) of this paragraph. The specific drugs or
14     therapeutic classes of covered prescription drugs shall be
15     indicated by rule.
16         For Eligibility Group 2, "covered prescription drug"
17     means those drugs covered for Eligibility Group 1 that are
18     also covered by the Medicare Part D Prescription Drug Plan
19     in which the beneficiary is enrolled.
20         For Eligibility Group 3, "covered prescription drug"
21     means those drugs covered by the Medicare Part D
22     Prescription Drug Plan in which the beneficiary is
23     enrolled.
24         For Eligibility Group 4, "covered prescription drug"
25     means those drugs covered by the Medical Assistance Program
26     under Article V of the Illinois Public Aid Code.

 

 

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1         For Eligibility Group 5, "covered prescription drug"
2     means: (1) those drugs covered for Eligibility Group 1 that
3     are also covered by the Medicare Part D Prescription Drug
4     Plan in which the beneficiary is enrolled; and (2) those
5     drugs included in the formulary of the Illinois AIDS Drug
6     Assistance Program operated by the Illinois Department of
7     Public Health that are also covered by the Medicare Part D
8     Prescription Drug Plan in which the beneficiary is
9     enrolled.
10     An individual in Eligibility Group 3 or 4 may opt to
11 receive a $25 monthly payment in lieu of the direct coverage
12 described in this subsection.
13     Any person otherwise eligible for pharmaceutical
14 assistance under this subsection whose covered drugs are
15 covered by any public program is ineligible for assistance
16 under this subsection to the extent that the cost of those
17 drugs is covered by the other program.
18     The Department of Healthcare and Family Services shall
19 establish by rule the methods by which it will provide for the
20 coverage called for in this subsection. Those methods may
21 include direct reimbursement to pharmacies or the payment of a
22 capitated amount to Medicare Part D Prescription Drug Plans.
23     For a pharmacy to be reimbursed under the program
24 established under this subsection, it must comply with rules
25 adopted by the Department of Healthcare and Family Services
26 regarding coordination of benefits with Medicare Part D

 

 

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1 Prescription Drug Plans. A pharmacy may not charge a
2 Medicare-enrolled beneficiary of the program established under
3 this subsection more for a covered prescription drug than the
4 appropriate Medicare cost-sharing less any payment from or on
5 behalf of the Department of Healthcare and Family Services.
6     The Department of Healthcare and Family Services or the
7 Department on Aging, as appropriate, may adopt rules regarding
8 applications, counting of income, proof of Medicare status,
9 mandatory generic policies, and pharmacy reimbursement rates
10 and any other rules necessary for the cost-efficient operation
11 of the program established under this subsection.
12 (Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; 94-909,
13 eff. 6-23-06.)