Health Care Availability and Access Committee

Filed: 3/11/2008

 

 


 

 


 
09500HB4449ham001 LRB095 15590 DRJ 47428 a

1
AMENDMENT TO HOUSE BILL 4449

2     AMENDMENT NO. ______. Amend House Bill 4449 by replacing
3 everything after the enacting clause with the following:
 
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

 

 

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1 qualified to receive a grant pursuant to this Section, and any
2 disabled person whose annual household income is less than the
3 income eligibility limitation, as defined in subsection (a-5)
4 and whose household is liable for payment of property taxes
5 accrued or has paid rent constituting property taxes accrued
6 and is domiciled in this State at the time he or she files his
7 or her claim is entitled to claim a grant under this Act. With
8 respect to claims filed by individuals who will become 65 years
9 old during the calendar year in which a claim is filed, the
10 amount of any grant to which that household is entitled shall
11 be an amount equal to 1/12 of the amount to which the claimant
12 would otherwise be entitled as provided in this Section,
13 multiplied by the number of months in which the claimant was 65
14 in the calendar year in which the claim is filed.
15     (a-5) Income eligibility limitation. For purposes of this
16 Section, "income eligibility limitation" means an amount:
17         (i) for grant years before the 1998 grant year, less
18     than $14,000;
19         (ii) for the 1998 and 1999 grant year, less than
20     $16,000;
21         (iii) for grant years 2000 through 2007:
22             (A) less than $21,218 for a household containing
23         one person;
24             (B) less than $28,480 for a household containing 2
25         persons; or
26             (C) less than $35,740 for a household containing 3

 

 

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1         or more persons; or
2         (iv) for grant years 2008 and thereafter:
3             (A) less than $22,218 for a household containing
4         one person;
5             (B) less than $29,480 for a household containing 2
6         persons; or
7             (C) less than $36,740 for a household containing 3
8         or more persons.
9     (b) Limitation. Except as otherwise provided in
10 subsections (a) and (f) of this Section, the maximum amount of
11 grant which a claimant is entitled to claim is the amount by
12 which the property taxes accrued which were paid or payable
13 during the last preceding tax year or rent constituting
14 property taxes accrued upon the claimant's residence for the
15 last preceding taxable year exceeds 3 1/2% of the claimant's
16 household income for that year but in no event is the grant to
17 exceed (i) $700 less 4.5% of household income for that year for
18 those with a household income of $14,000 or less or (ii) $70 if
19 household income for that year is more than $14,000.
20     (c) Public aid recipients. If household income in one or
21 more months during a year includes cash assistance in excess of
22 $55 per month from the Department of Healthcare and Family
23 Services or the Department of Human Services (acting as
24 successor to the Department of Public Aid under the Department
25 of Human Services Act) which was determined under regulations
26 of that Department on a measure of need that included an

 

 

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1 allowance for actual rent or property taxes paid by the
2 recipient of that assistance, the amount of grant to which that
3 household is entitled, except as otherwise provided in
4 subsection (a), shall be the product of (1) the maximum amount
5 computed as specified in subsection (b) of this Section and (2)
6 the ratio of the number of months in which household income did
7 not include such cash assistance over $55 to the number twelve.
8 If household income did not include such cash assistance over
9 $55 for any months during the year, the amount of the grant to
10 which the household is entitled shall be the maximum amount
11 computed as specified in subsection (b) of this Section. For
12 purposes of this paragraph (c), "cash assistance" does not
13 include any amount received under the federal Supplemental
14 Security Income (SSI) program.
15     (d) Joint ownership. If title to the residence is held
16 jointly by the claimant with a person who is not a member of
17 his or her household, the amount of property taxes accrued used
18 in computing the amount of grant to which he or she is entitled
19 shall be the same percentage of property taxes accrued as is
20 the percentage of ownership held by the claimant in the
21 residence.
22     (e) More than one residence. If a claimant has occupied
23 more than one residence in the taxable year, he or she may
24 claim only one residence for any part of a month. In the case
25 of property taxes accrued, he or she shall prorate 1/12 of the
26 total property taxes accrued on his or her residence to each

 

 

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1 month that he or she owned and occupied that residence; and, in
2 the case of rent constituting property taxes accrued, shall
3 prorate each month's rent payments to the residence actually
4 occupied during that month.
5     (f) There is hereby established a program of pharmaceutical
6 assistance to the aged and disabled which shall be administered
7 by the Department in accordance with this Act, to consist of
8 payments to authorized pharmacies, on behalf of beneficiaries
9 of the program, for the reasonable costs of covered
10 prescription drugs. Each beneficiary who pays $5 for an
11 identification card shall pay no additional prescription
12 costs. Each beneficiary who pays $25 for an identification card
13 shall pay $3 per prescription. In addition, after a beneficiary
14 receives $2,000 in benefits during a State fiscal year, that
15 beneficiary shall also be charged 20% of the cost of each
16 prescription for which payments are made by the program during
17 the remainder of the fiscal year. To become a beneficiary under
18 this program a person must: (1) be (i) 65 years of age or
19 older, or (ii) the surviving spouse of such a claimant, who at
20 the time of death received or was entitled to receive benefits
21 pursuant to this subsection, which surviving spouse will become
22 65 years of age within the 24 months immediately following the
23 death of such claimant and which surviving spouse but for his
24 or her age is otherwise qualified to receive benefits pursuant
25 to this subsection, or (iii) disabled, and (2) be domiciled in
26 this State at the time he or she files his or her claim, and (3)

 

 

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1 have a maximum household income of less than the income
2 eligibility limitation, as defined in subsection (a-5). In
3 addition, each eligible person must (1) obtain an
4 identification card from the Department, (2) at the time the
5 card is obtained, sign a statement assigning to the State of
6 Illinois benefits which may be otherwise claimed under any
7 private insurance plans, and (3) present the identification
8 card to the dispensing pharmacist.
9     The Department may adopt rules specifying participation
10 requirements for the pharmaceutical assistance program,
11 including copayment amounts, identification card fees,
12 expenditure limits, and the benefit threshold after which a 20%
13 charge is imposed on the cost of each prescription, to be in
14 effect on and after July 1, 2004. Notwithstanding any other
15 provision of this paragraph, however, the Department may not
16 increase the identification card fee above the amount in effect
17 on May 1, 2003 without the express consent of the General
18 Assembly. To the extent practicable, those requirements shall
19 be commensurate with the requirements provided in rules adopted
20 by the Department of Healthcare and Family Services to
21 implement the pharmacy assistance program under Section
22 5-5.12a of the Illinois Public Aid Code.
23     Whenever a generic equivalent for a covered prescription
24 drug is available, the Department shall reimburse only for the
25 reasonable costs of the generic equivalent, less the co-pay
26 established in this Section, unless (i) the covered

 

 

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1 prescription drug contains one or more ingredients defined as a
2 narrow therapeutic index drug at 21 CFR 320.33, (ii) the
3 prescriber indicates on the face of the prescription "brand
4 medically necessary", and (iii) the prescriber specifies that a
5 substitution is not permitted. When issuing an oral
6 prescription for covered prescription medication described in
7 item (i) of this paragraph, the prescriber shall stipulate
8 "brand medically necessary" and that a substitution is not
9 permitted. If the covered prescription drug and its authorizing
10 prescription do not meet the criteria listed above, the
11 beneficiary may purchase the non-generic equivalent of the
12 covered prescription drug by paying the difference between the
13 generic cost and the non-generic cost plus the beneficiary
14 co-pay.
15     Any person otherwise eligible for pharmaceutical
16 assistance under this Act whose covered drugs are covered by
17 any public program for assistance in purchasing any covered
18 prescription drugs shall be ineligible for assistance under
19 this Act to the extent such costs are covered by such other
20 plan.
21     The fee to be charged by the Department for the
22 identification card shall be equal to $5 per coverage year for
23 persons below the official poverty line as defined by the
24 United States Department of Health and Human Services and $25
25 per coverage year for all other persons.
26     In the event that 2 or more persons are eligible for any

 

 

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1 benefit under this Act, and are members of the same household,
2 (1) each such person shall be entitled to participate in the
3 pharmaceutical assistance program, provided that he or she
4 meets all other requirements imposed by this subsection and (2)
5 each participating household member contributes the fee
6 required for that person by the preceding paragraph for the
7 purpose of obtaining an identification card.
8     The provisions of this subsection (f), other than this
9 paragraph, are inoperative after December 31, 2005.
10 Beneficiaries who received benefits under the program
11 established by this subsection (f) are not entitled, at the
12 termination of the program, to any refund of the identification
13 card fee paid under this subsection.
14     (g) Effective January 1, 2006, there is hereby established
15 a program of pharmaceutical assistance to the aged and
16 disabled, entitled the Illinois Seniors and Disabled Drug
17 Coverage Program, which shall be administered by the Department
18 of Healthcare and Family Services and the Department on Aging
19 in accordance with this subsection, to consist of coverage of
20 specified prescription drugs on behalf of beneficiaries of the
21 program as set forth in this subsection. The program under this
22 subsection replaces and supersedes the program established
23 under subsection (f), which shall end at midnight on December
24 31, 2005.
25     To become a beneficiary under the program established under
26 this subsection, a person must:

 

 

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1         (1) be (i) 65 years of age or older or (ii) disabled;
2     and
3         (2) be domiciled in this State; and
4         (3) enroll with a qualified Medicare Part D
5     Prescription Drug Plan if eligible and apply for all
6     available subsidies under Medicare Part D; and
7         (4) have a maximum household income of (i) less than
8     $21,218 for a household containing one person, (ii) less
9     than $28,480 for a household containing 2 persons, or (iii)
10     less than $35,740 for a household containing 3 or more
11     persons. If any income eligibility limit set forth in items
12     (i) through (iii) is less than 200% of the Federal Poverty
13     Level for any year, the income eligibility limit for that
14     year for households of that size shall be income equal to
15     or less than 250% 200% of the Federal Poverty Level.
16     All individuals enrolled as of December 31, 2005, in the
17 pharmaceutical assistance program operated pursuant to
18 subsection (f) of this Section and all individuals enrolled as
19 of December 31, 2005, in the SeniorCare Medicaid waiver program
20 operated pursuant to Section 5-5.12a of the Illinois Public Aid
21 Code shall be automatically enrolled in the program established
22 by this subsection for the first year of operation without the
23 need for further application, except that they must apply for
24 Medicare Part D and the Low Income Subsidy under Medicare Part
25 D. A person enrolled in the pharmaceutical assistance program
26 operated pursuant to subsection (f) of this Section as of

 

 

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1 December 31, 2005, shall not lose eligibility in future years
2 due only to the fact that they have not reached the age of 65.
3     To the extent permitted by federal law, the Department may
4 act as an authorized representative of a beneficiary in order
5 to enroll the beneficiary in a Medicare Part D Prescription
6 Drug Plan if the beneficiary has failed to choose a plan and,
7 where possible, to enroll beneficiaries in the low-income
8 subsidy program under Medicare Part D or assist them in
9 enrolling in that program.
10     Beneficiaries under the program established under this
11 subsection shall be divided into the following 4 5 eligibility
12 groups:
13         (A) Eligibility Group 1 shall consist of beneficiaries
14     who are not eligible for Medicare Part D coverage and who
15     are:
16             (i) disabled and under age 65; or
17             (ii) age 65 or older, with incomes over 200% of the
18         Federal Poverty Level; or
19             (iii) age 65 or older, with incomes at or below
20         200% of the Federal Poverty Level and not eligible for
21         federally funded means-tested benefits due to
22         immigration status.
23         (B) Eligibility Group 2 shall consist of beneficiaries
24     otherwise described in Eligibility Group 1 but who are
25     eligible for Medicare Part D coverage.
26         (C) Eligibility Group 3 shall consist of beneficiaries

 

 

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1     age 65 or older, with incomes at or below 200% of the
2     Federal Poverty Level, who are not barred from receiving
3     federally funded means-tested benefits due to immigration
4     status and are eligible for Medicare Part D coverage.
5         (C) (D) Eligibility Group 3 4 shall consist of
6     beneficiaries age 65 or older, with incomes at or below
7     200% of the Federal Poverty Level, who are not barred from
8     receiving federally funded means-tested benefits due to
9     immigration status and are not eligible for Medicare Part D
10     coverage.
11         If the State applies and receives federal approval for
12     a waiver under Title XIX of the Social Security Act,
13     persons in Eligibility Group 3 4 shall continue to receive
14     benefits through the approved waiver, and Eligibility
15     Group 3 4 may be expanded to include disabled persons under
16     age 65 with incomes under 200% of the Federal Poverty Level
17     who are not eligible for Medicare and who are not barred
18     from receiving federally funded means-tested benefits due
19     to immigration status.
20         (D) (E) On and after January 1, 2007, Eligibility Group
21     4 5 shall consist of beneficiaries who are otherwise
22     described in Eligibility Group Groups 2 and 3 who have a
23     diagnosis of HIV or AIDS.
24     The program established under this subsection shall cover
25 the cost of covered prescription drugs in excess of the
26 beneficiary cost-sharing amounts set forth in this paragraph

 

 

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1 that are not covered by Medicare. In 2006, beneficiaries shall
2 pay a co-payment of $2 for each prescription of a generic drug
3 and $5 for each prescription of a brand-name drug. In future
4 years, beneficiaries shall pay co-payments equal to the
5 co-payments required under Medicare Part D for "other
6 low-income subsidy eligible individuals" pursuant to 42 CFR
7 423.782(b). For individuals in Eligibility Groups 1, 2, and 3,
8 and 4, once the program established under this subsection and
9 Medicare combined have paid $1,750 in a year for covered
10 prescription drugs, the beneficiary shall pay 20% of the cost
11 of each prescription in addition to the co-payments set forth
12 in this paragraph. For individuals in Eligibility Group 4 5,
13 once the program established under this subsection and Medicare
14 combined have paid $1,750 in a year for covered prescription
15 drugs, the beneficiary shall pay 20% of the cost of each
16 prescription in addition to the co-payments set forth in this
17 paragraph unless the drug is included in the formulary of the
18 Illinois AIDS Drug Assistance Program operated by the Illinois
19 Department of Public Health and covered by the Medicare Part D
20 Prescription Drug Plan in which the beneficiary is enrolled. If
21 the drug is included in the formulary of the Illinois AIDS Drug
22 Assistance Program and covered by the Medicare Part D
23 Prescription Drug Plan in which the beneficiary is enrolled,
24 individuals in Eligibility Group 4 5 shall continue to pay the
25 co-payments set forth in this paragraph after the program
26 established under this subsection and Medicare combined have

 

 

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1 paid $1,750 in a year for covered prescription drugs.
2     For beneficiaries eligible for Medicare Part D coverage,
3 the program established under this subsection shall pay 100% of
4 the premiums charged by a qualified Medicare Part D
5 Prescription Drug Plan for Medicare Part D basic prescription
6 drug coverage, not including any late enrollment penalties.
7 Qualified Medicare Part D Prescription Drug Plans may be
8 limited by the Department of Healthcare and Family Services to
9 those plans that sign a coordination agreement with the
10 Department.
11     Notwithstanding Section 3.15, for purposes of the program
12 established under this subsection, the term "covered
13 prescription drug" has the following meanings:
14         For Eligibility Group 1, "covered prescription drug"
15     means: (1) any cardiovascular agent or drug; (2) any
16     insulin or other prescription drug used in the treatment of
17     diabetes, including syringe and needles used to administer
18     the insulin; (3) any prescription drug used in the
19     treatment of arthritis; (4) any prescription drug used in
20     the treatment of cancer; (5) any prescription drug used in
21     the treatment of Alzheimer's disease; (6) any prescription
22     drug used in the treatment of Parkinson's disease; (7) any
23     prescription drug used in the treatment of glaucoma; (8)
24     any prescription drug used in the treatment of lung disease
25     and smoking-related illnesses; (9) any prescription drug
26     used in the treatment of osteoporosis; and (10) any

 

 

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

 

 

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1     Medicare Part D Prescription Drug Plan in which the
2     beneficiary is enrolled. For Eligibility Group 5, for
3     individuals otherwise described in Eligibility Group 3,
4     "covered prescription drug" means those drugs covered by
5     the Medicare Part D Prescription Drug Plan in which the
6     beneficiary is enrolled.
7     An individual in Eligibility Group 1, 2, 3, or 4, or 5 may
8 opt to receive a $25 monthly payment in lieu of the direct
9 coverage 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

 

 

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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     (h) Notwithstanding any other rulemaking authority that
10 may exist, neither the Governor nor any agency or agency head
11 under the jurisdiction of the Governor has any authority to
12 make or promulgate rules to implement or enforce the provisions
13 of this amendatory Act of the 95th General Assembly. If,
14 however, the Governor believes that rules are necessary to
15 implement or enforce the provisions of this amendatory Act of
16 the 95th General Assembly, the Governor may suggest rules to
17 the General Assembly by filing them with the Clerk of the House
18 and Secretary of the Senate and by requesting that the General
19 Assembly authorize such rulemaking by law, enact those
20 suggested rules into law, or take any other appropriate action
21 in the General Assembly's discretion. Nothing contained in this
22 amendatory Act of the 95th General Assembly shall be
23 interpreted to grant rulemaking authority under any other
24 Illinois statute where such authority is not otherwise
25 explicitly given. For the purposes of this amendatory Act of
26 the 95th General Assembly, "rules" is given the meaning

 

 

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1 contained in Section 1-70 of the Illinois Administrative
2 Procedure Act, and "agency" and "agency head" are given the
3 meanings contained in Sections 1-20 and 1-25 of the Illinois
4 Administrative Procedure Act to the extent that such
5 definitions apply to agencies or agency heads under the
6 jurisdiction of the Governor.
7 (Source: P.A. 94-86, eff. 1-1-06; 94-909, eff. 6-23-06; 95-208,
8 eff. 8-16-07; 95-644, eff. 10-12-07; revised 10-25-07.)".
 
9     Section 99. Effective date. This Act takes effect upon
10 becoming law.".