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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 |
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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.
With respect to claims filed by individuals who will | ||||||
6 | become 65 years old
during the calendar year in which a claim | ||||||
7 | is filed, the amount of any grant
to which that household is | ||||||
8 | entitled shall be an amount equal to 1/12 of the
amount to | ||||||
9 | which the claimant would otherwise be entitled as provided in
| ||||||
10 | this Section, multiplied by the number of months in which the | ||||||
11 | claimant was
65 in the calendar year in which the claim is | ||||||
12 | filed.
| ||||||
13 | (b) Limitation. Except as otherwise provided in | ||||||
14 | subsections (a) and (f)
of this Section, the maximum amount of | ||||||
15 | grant which a claimant is
entitled to claim is the amount by | ||||||
16 | which the property taxes accrued which
were paid or payable | ||||||
17 | during the last preceding tax year or rent
constituting | ||||||
18 | property taxes accrued upon the claimant's residence for the
| ||||||
19 | last preceding taxable year exceeds 3 1/2% of the claimant's | ||||||
20 | household
income for that year but in no event is the grant to | ||||||
21 | exceed (i) $700 less
4.5% of household income for that year for | ||||||
22 | those with a household income of
$14,000 or less or (ii) $70 if | ||||||
23 | household income for that year is more than
$14,000.
| ||||||
24 | (c) Public aid recipients. If household income in one or | ||||||
25 | more
months during a year includes cash assistance in excess of | ||||||
26 | $55 per month
from the Department of Healthcare and Family |
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1 | Services or the Department of Human Services (acting
as | ||||||
2 | successor to the Department of Public Aid under the Department | ||||||
3 | of Human
Services Act) which was determined under regulations | ||||||
4 | of
that Department on a measure of need that included an | ||||||
5 | allowance for actual
rent or property taxes paid by the | ||||||
6 | recipient of that assistance, the amount
of grant to which that | ||||||
7 | household is entitled, except as otherwise provided in
| ||||||
8 | subsection (a), shall be the product of (1) the maximum amount | ||||||
9 | computed as
specified in subsection (b) of this Section and (2) | ||||||
10 | the ratio of the number of
months in which household income did | ||||||
11 | not include such cash assistance over $55
to the number twelve. | ||||||
12 | If household income did not include such cash assistance
over | ||||||
13 | $55 for any months during the year, the amount of the grant to | ||||||
14 | which the
household is entitled shall be the maximum amount | ||||||
15 | computed as specified in
subsection (b) of this Section. For | ||||||
16 | purposes of this paragraph (c), "cash
assistance" does not | ||||||
17 | include any amount received under the federal Supplemental
| ||||||
18 | Security Income (SSI) program.
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19 | (d) Joint ownership. If title to the residence is held | ||||||
20 | jointly by
the claimant with a person who is not a member of | ||||||
21 | his or her household,
the amount of property taxes accrued used | ||||||
22 | in computing the amount of grant
to which he or she is entitled | ||||||
23 | shall be the same percentage of property
taxes accrued as is | ||||||
24 | the percentage of ownership held by the claimant in the
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25 | residence.
| ||||||
26 | (e) More than one residence. If a claimant has occupied |
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| |||||||
1 | more than
one residence in the taxable year, he or she may | ||||||
2 | claim only one residence
for any part of a month. In the case | ||||||
3 | of property taxes accrued, he or she
shall prorate 1/12 of the | ||||||
4 | total property taxes accrued on
his or her residence to each | ||||||
5 | month that he or she owned and occupied
that residence; and, in | ||||||
6 | the case of rent constituting property taxes accrued,
shall | ||||||
7 | prorate each month's rent payments to the residence
actually | ||||||
8 | occupied during that month.
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9 | (f) There is hereby established a program of pharmaceutical | ||||||
10 | assistance
to the aged and disabled which shall be administered | ||||||
11 | by the Department in
accordance with this Act, to consist of | ||||||
12 | payments to authorized pharmacies, on
behalf of beneficiaries | ||||||
13 | of the program, for the reasonable costs of covered
| ||||||
14 | prescription drugs. Each beneficiary who pays $5 for an | ||||||
15 | identification card
shall pay no additional prescription | ||||||
16 | costs. Each beneficiary who pays $25 for
an identification card | ||||||
17 | shall pay $3 per prescription. In addition, after a
beneficiary | ||||||
18 | receives $2,000 in benefits during a State fiscal year, that
| ||||||
19 | beneficiary shall also be charged 20% of the cost of each | ||||||
20 | prescription for
which payments are made by the program during | ||||||
21 | the remainder of the fiscal
year. To become a beneficiary under | ||||||
22 | this program a person must: (1)
be (i) 65 years of age or | ||||||
23 | older, or (ii) the surviving spouse of such
a claimant, who at | ||||||
24 | the time of death received or was entitled to receive
benefits | ||||||
25 | pursuant to this subsection, which surviving spouse will become | ||||||
26 | 65
years of age within the 24 months immediately following the |
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| |||||||
1 | death of such
claimant and which surviving spouse but for his | ||||||
2 | or her age is otherwise
qualified to receive benefits pursuant | ||||||
3 | to this subsection, or (iii) disabled,
and (2) be domiciled in | ||||||
4 | this State at the time he or she files
his or her claim, and (3) | ||||||
5 | have a maximum household income of less
than $14,000 for grant | ||||||
6 | years before the 1998 grant year, less than $16,000
for the | ||||||
7 | 1998 and 1999 grant years, and less than (i) $21,218 for a | ||||||
8 | household
containing one person, (ii) $28,480 for a household | ||||||
9 | containing 2 persons, or
(iii) $35,740 for a household | ||||||
10 | containing 3 more persons for the 2000 grant
year
and | ||||||
11 | thereafter. In addition, each eligible person must (1) obtain | ||||||
12 | an
identification card from the Department, (2) at the time the | ||||||
13 | card is obtained,
sign a statement assigning to the State of | ||||||
14 | Illinois benefits which may be
otherwise claimed under any | ||||||
15 | private insurance plans, and (3) present the
identification | ||||||
16 | card to the dispensing pharmacist.
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17 | The Department may adopt rules specifying
participation
| ||||||
18 | requirements for the pharmaceutical assistance program, | ||||||
19 | including copayment
amounts,
identification card fees, | ||||||
20 | expenditure limits, and the benefit threshold after
which a 20% | ||||||
21 | charge is imposed on the cost of each prescription, to be in
| ||||||
22 | effect on and
after July 1, 2004.
Notwithstanding any other | ||||||
23 | provision of this paragraph, however, the Department
may not
| ||||||
24 | increase the identification card fee above the amount in effect | ||||||
25 | on May 1, 2003
without
the express consent of the General | ||||||
26 | Assembly.
To the extent practicable, those requirements shall |
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1 | be
commensurate
with the requirements provided in rules adopted | ||||||
2 | by the Department of Healthcare and Family Services
to
| ||||||
3 | implement the pharmacy assistance program under Section | ||||||
4 | 5-5.12a of the Illinois
Public
Aid Code.
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5 | Whenever a generic equivalent for a covered prescription | ||||||
6 | drug is available,
the Department shall reimburse only for the | ||||||
7 | reasonable costs of the generic
equivalent, less the co-pay | ||||||
8 | established in this Section, unless (i) the covered
| ||||||
9 | prescription drug contains one or more ingredients defined as a | ||||||
10 | narrow
therapeutic index drug at 21 CFR 320.33, (ii) the | ||||||
11 | prescriber indicates on the
face of the prescription "brand | ||||||
12 | medically necessary", and (iii) the prescriber
specifies that a | ||||||
13 | substitution is not permitted. When issuing an oral
| ||||||
14 | prescription for covered prescription medication described in | ||||||
15 | item (i) of this
paragraph, the prescriber shall stipulate | ||||||
16 | "brand medically necessary" and
that a substitution is not | ||||||
17 | permitted. If the covered prescription drug and its
authorizing | ||||||
18 | prescription do not meet the criteria listed above, the | ||||||
19 | beneficiary
may purchase the non-generic equivalent of the | ||||||
20 | covered prescription drug by
paying the difference between the | ||||||
21 | generic cost and the non-generic cost plus
the beneficiary | ||||||
22 | co-pay.
| ||||||
23 | Any person otherwise eligible for pharmaceutical | ||||||
24 | assistance under this
Act whose covered drugs are covered by | ||||||
25 | any public program for assistance in
purchasing any covered | ||||||
26 | prescription drugs shall be ineligible for assistance
under |
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1 | this Act to the extent such costs are covered by such other | ||||||
2 | plan.
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3 | The fee to be charged by the Department for the | ||||||
4 | identification card shall
be equal to $5 per coverage year for | ||||||
5 | persons below the official poverty line
as defined by the | ||||||
6 | United States Department of Health and Human Services and
$25 | ||||||
7 | per coverage year for all other persons.
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8 | In the event that 2 or more persons are eligible for any | ||||||
9 | benefit under
this Act, and are members of the same household, | ||||||
10 | (1) each such person shall
be entitled to participate in the | ||||||
11 | pharmaceutical assistance program, provided
that he or she | ||||||
12 | meets all other requirements imposed by this subsection
and (2) | ||||||
13 | each participating household member contributes the fee | ||||||
14 | required
for that person by the preceding paragraph for the | ||||||
15 | purpose
of obtaining an identification card. | ||||||
16 | The provisions of this subsection (f), other than this | ||||||
17 | paragraph, are inoperative after December 31, 2005. | ||||||
18 | Beneficiaries who received benefits under the program | ||||||
19 | established by this subsection (f) are not entitled, at the | ||||||
20 | termination of the program, to any refund of the identification | ||||||
21 | card fee paid under this subsection. | ||||||
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. The program under this | ||||||
4 | subsection replaces and supersedes the program established | ||||||
5 | under subsection (f), which shall end at midnight on December | ||||||
6 | 31, 2005. | ||||||
7 | To become a beneficiary under the program established under | ||||||
8 | this subsection, a person must: | ||||||
9 | (1) be (i) 65 years of age or older or (ii) disabled; | ||||||
10 | and | ||||||
11 | (2) be domiciled in this State; and | ||||||
12 | (3) enroll with a qualified Medicare Part D | ||||||
13 | Prescription Drug Plan if eligible and apply for all | ||||||
14 | available subsidies under Medicare Part D; and | ||||||
15 | (4) have a maximum household income not exceeding 350%
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16 | of (i) less than $21,218 for a household containing one | ||||||
17 | person, (ii) less than $28,480 for a household containing 2 | ||||||
18 | persons, or (iii) less than $35,740 for a household | ||||||
19 | containing 3 or more persons. If any income eligibility | ||||||
20 | limit set forth in items (i) through (iii) is less than | ||||||
21 | 200% of the Federal Poverty Level for any year, the income | ||||||
22 | eligibility limit for that year for households of that size | ||||||
23 | shall be income equal to or less than 200% of the Federal | ||||||
24 | Poverty Level. | ||||||
25 | All individuals enrolled as of December 31, 2005, in the | ||||||
26 | pharmaceutical assistance program operated pursuant to |
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1 | subsection (f) of this Section and all individuals enrolled as | ||||||
2 | of December 31, 2005, in the SeniorCare Medicaid waiver program | ||||||
3 | operated pursuant to Section 5-5.12a of the Illinois Public Aid | ||||||
4 | Code shall be automatically enrolled in the program established | ||||||
5 | by this subsection for the first year of operation without the | ||||||
6 | need for further application, except that they must apply for | ||||||
7 | Medicare Part D and the Low Income Subsidy under Medicare Part | ||||||
8 | D. A person enrolled in the pharmaceutical assistance program | ||||||
9 | operated pursuant to subsection (f) of this Section as of | ||||||
10 | December 31, 2005, shall not lose eligibility in future years | ||||||
11 | due only to the fact that they have not reached the age of 65. | ||||||
12 | To the extent permitted by federal law, the Department may | ||||||
13 | act as an authorized representative of a beneficiary in order | ||||||
14 | to enroll the beneficiary in a Medicare Part D Prescription | ||||||
15 | Drug Plan if the beneficiary has failed to choose a plan and, | ||||||
16 | where possible, to enroll beneficiaries in the low-income | ||||||
17 | subsidy program under Medicare Part D or assist them in | ||||||
18 | enrolling in that program. | ||||||
19 | Beneficiaries under the program established under this | ||||||
20 | subsection shall be divided into the following 5 eligibility | ||||||
21 | groups: | ||||||
22 | (A) Eligibility Group 1 shall consist of beneficiaries | ||||||
23 | who are not eligible for Medicare Part D coverage and who
| ||||||
24 | are: | ||||||
25 | (i) disabled and under age 65; or | ||||||
26 | (ii) age 65 or older, with incomes over 200% of the |
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1 | Federal Poverty Level; or | ||||||
2 | (iii) age 65 or older, with incomes at or below | ||||||
3 | 200% of the Federal Poverty Level and not eligible for | ||||||
4 | federally funded means-tested benefits due to | ||||||
5 | immigration status. | ||||||
6 | (B) Eligibility Group 2 shall consist of beneficiaries | ||||||
7 | otherwise described in Eligibility Group 1 but who are | ||||||
8 | eligible for Medicare Part D coverage. | ||||||
9 | (C) Eligibility Group 3 shall consist of beneficiaries | ||||||
10 | age 65 or older, with incomes at or below 200% of the | ||||||
11 | Federal Poverty Level, who are not barred from receiving | ||||||
12 | federally funded means-tested benefits due to immigration | ||||||
13 | status and are eligible for Medicare Part D coverage. | ||||||
14 | (D) Eligibility Group 4 shall consist of beneficiaries | ||||||
15 | age 65 or older, with incomes at or below 200% of the | ||||||
16 | Federal Poverty Level, who are not barred from receiving | ||||||
17 | federally funded means-tested benefits due to immigration | ||||||
18 | status and are not eligible for Medicare Part D coverage. | ||||||
19 | If the State applies and receives federal approval for | ||||||
20 | a waiver under Title XIX of the Social Security Act, | ||||||
21 | persons in Eligibility Group 4 shall continue to receive | ||||||
22 | benefits through the approved waiver, and Eligibility | ||||||
23 | Group 4 may be expanded to include disabled persons under | ||||||
24 | age 65 with incomes under 200% of the Federal Poverty Level | ||||||
25 | who are not eligible for Medicare and who are not barred | ||||||
26 | from receiving federally funded means-tested benefits due |
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1 | to immigration status. | ||||||
2 | (E) On and after January 1, 2007, Eligibility Group 5 | ||||||
3 | shall consist of beneficiaries who are otherwise described | ||||||
4 | in Eligibility Group 1 but are eligible for Medicare Part D | ||||||
5 | and have a diagnosis of HIV or AIDS.
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6 | The program established under this subsection shall cover | ||||||
7 | the cost of covered prescription drugs in excess of the | ||||||
8 | beneficiary cost-sharing amounts set forth in this paragraph | ||||||
9 | that are not covered by Medicare. In 2006, beneficiaries shall | ||||||
10 | pay a co-payment of $2 for each prescription of a generic drug | ||||||
11 | and $5 for each prescription of a brand-name drug. In future | ||||||
12 | years, beneficiaries shall pay co-payments equal to the | ||||||
13 | co-payments required under Medicare Part D for "other | ||||||
14 | low-income subsidy eligible individuals" pursuant to 42 CFR | ||||||
15 | 423.782(b). For individuals in Eligibility Groups 1, 2, 3, and | ||||||
16 | 4, once the program established under this subsection and | ||||||
17 | Medicare combined have paid $1,750 in a year for covered | ||||||
18 | prescription drugs, the beneficiary shall pay 20% of the cost | ||||||
19 | of each prescription in addition to the co-payments set forth | ||||||
20 | in this paragraph. For individuals in Eligibility Group 5, once | ||||||
21 | the program established under this subsection and Medicare | ||||||
22 | combined have paid $1,750 in a year for covered prescription | ||||||
23 | drugs, the beneficiary shall pay 20% of the cost of each | ||||||
24 | prescription in addition to the co-payments set forth in this | ||||||
25 | paragraph unless the drug is included in the formulary of the | ||||||
26 | Illinois AIDS Drug Assistance Program operated by the Illinois |
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1 | Department of Public Health. If the drug is included in the | ||||||
2 | formulary of the Illinois AIDS Drug Assistance Program, | ||||||
3 | individuals in Eligibility Group 5 shall continue to pay the | ||||||
4 | co-payments set forth in this paragraph after the program | ||||||
5 | established under this subsection and Medicare combined have | ||||||
6 | paid $1,750 in a year for covered prescription drugs.
| ||||||
7 | For beneficiaries eligible for Medicare Part D coverage, | ||||||
8 | the program established under this subsection shall pay 100% of | ||||||
9 | the premiums charged by a qualified Medicare Part D | ||||||
10 | Prescription Drug Plan for Medicare Part D basic prescription | ||||||
11 | drug coverage, not including any late enrollment penalties. | ||||||
12 | Qualified Medicare Part D Prescription Drug Plans may be | ||||||
13 | limited by the Department of Healthcare and Family Services to | ||||||
14 | those plans that sign a coordination agreement with the | ||||||
15 | Department. | ||||||
16 | Notwithstanding Section 3.15, for purposes of the program | ||||||
17 | established under this subsection, the term "covered | ||||||
18 | prescription drug" has the following meanings: | ||||||
19 | For Eligibility Group 1, "covered prescription drug" | ||||||
20 | means: (1) any cardiovascular agent or drug; (2) any | ||||||
21 | insulin or other prescription drug used in the treatment of | ||||||
22 | diabetes, including syringe and needles used to administer | ||||||
23 | the insulin; (3) any prescription drug used in the | ||||||
24 | treatment of arthritis; (4) any prescription drug used in | ||||||
25 | the treatment of cancer; (5) any prescription drug used in | ||||||
26 | the treatment of Alzheimer's disease; (6) any prescription |
| |||||||
| |||||||
1 | drug used in the treatment of Parkinson's disease; (7) any | ||||||
2 | prescription drug used in the treatment of glaucoma; (8) | ||||||
3 | any prescription drug used in the treatment of lung disease | ||||||
4 | and smoking-related illnesses; (9) any prescription drug | ||||||
5 | used in the treatment of osteoporosis; and (10) any | ||||||
6 | prescription drug used in the treatment of multiple | ||||||
7 | sclerosis. The Department may add additional therapeutic | ||||||
8 | classes by rule. The Department may adopt a preferred drug | ||||||
9 | list within any of the classes of drugs described in items | ||||||
10 | (1) through (10) of this paragraph. The specific drugs or | ||||||
11 | therapeutic classes of covered prescription drugs shall be | ||||||
12 | indicated by rule. | ||||||
13 | For Eligibility Group 2, "covered prescription drug" | ||||||
14 | means those drugs covered for Eligibility Group 1 that are | ||||||
15 | also covered by the Medicare Part D Prescription Drug Plan | ||||||
16 | in which the beneficiary is enrolled. | ||||||
17 | For Eligibility Group 3, "covered prescription drug" | ||||||
18 | means those drugs covered by the Medicare Part D | ||||||
19 | Prescription Drug Plan in which the beneficiary is | ||||||
20 | enrolled. | ||||||
21 | For Eligibility Group 4, "covered prescription drug" | ||||||
22 | means those drugs covered by the Medical Assistance Program | ||||||
23 | under Article V of the Illinois Public Aid Code. | ||||||
24 | For Eligibility Group 5, "covered prescription drug" | ||||||
25 | means:
(1) those drugs covered for Eligibility Group 1 that | ||||||
26 | are also covered by the Medicare Part D Prescription Drug |
| |||||||
| |||||||
1 | Plan in which the beneficiary is enrolled; and
(2) those | ||||||
2 | drugs included in the formulary of the Illinois AIDS Drug | ||||||
3 | Assistance Program operated by the Illinois Department of | ||||||
4 | Public Health that are also covered by the Medicare Part D | ||||||
5 | Prescription Drug Plan in which the beneficiary is | ||||||
6 | enrolled.
| ||||||
7 | An individual in Eligibility Group 3 or 4 may opt to | ||||||
8 | receive a $25 monthly payment in lieu of the direct coverage | ||||||
9 | described in this subsection. | ||||||
10 | Any person otherwise eligible for pharmaceutical | ||||||
11 | assistance under this subsection whose covered drugs are | ||||||
12 | covered by any public program is ineligible for assistance | ||||||
13 | under this subsection to the extent that the cost of those | ||||||
14 | drugs is covered by the other program. | ||||||
15 | The Department of Healthcare and Family Services shall | ||||||
16 | establish by rule the methods by which it will provide for the | ||||||
17 | coverage called for in this subsection. Those methods may | ||||||
18 | include direct reimbursement to pharmacies or the payment of a | ||||||
19 | capitated amount to Medicare Part D Prescription Drug Plans. | ||||||
20 | For a pharmacy to be reimbursed under the program | ||||||
21 | established under this subsection, it must comply with rules | ||||||
22 | adopted by the Department of Healthcare and Family Services | ||||||
23 | regarding coordination of benefits with Medicare Part D | ||||||
24 | Prescription Drug Plans. A pharmacy may not charge a | ||||||
25 | Medicare-enrolled beneficiary of the program established under | ||||||
26 | this subsection more for a covered prescription drug than the |
| |||||||
| |||||||
1 | appropriate Medicare cost-sharing less any payment from or on | ||||||
2 | behalf of the Department of Healthcare and Family Services. | ||||||
3 | The Department of Healthcare and Family Services or the | ||||||
4 | Department on Aging, as appropriate, may adopt rules regarding | ||||||
5 | applications, counting of income, proof of Medicare status, | ||||||
6 | mandatory generic policies, and pharmacy reimbursement rates | ||||||
7 | and any other rules necessary for the cost-efficient operation | ||||||
8 | of the program established under this subsection.
| ||||||
9 | (Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; 94-909, | ||||||
10 | eff. 6-23-06.)
| ||||||
11 | Section 99. Effective date. This Act takes effect January | ||||||
12 | 1, 2008.
|