Rep. Sara Feigenholtz

Filed: 5/30/2011





09700SB1802ham004LRB097 09314 KTG 56512 a


2    AMENDMENT NO. ______. Amend Senate Bill 1802 by replacing
3everything after the enacting clause with the following:
4    "Section 1. The Department of Human Services Act is amended
5by adding Section 10-66 as follows:
6    (20 ILCS 1305/10-66 new)
7    Sec. 10-66. Rate reductions. Rates for medical services
8purchased by the Divisions of Alcohol and Substance Abuse,
9Community Health and Prevention, Developmentally Disabilities,
10Mental Health, or Rehabilitation Services within the
11Department of Human Services shall not be reduced below the
12rates calculated on April 1, 2011 unless the Department of
13Human Services promulgates rules and rules are implemented
14authorizing rate reductions.
15    Section 2. The Civil Administrative Code of Illinois is



09700SB1802ham004- 2 -LRB097 09314 KTG 56512 a

1amended by changing Section 2310-315 as follows:
2    (20 ILCS 2310/2310-315)  (was 20 ILCS 2310/55.41)
3    Sec. 2310-315. Prevention and treatment of AIDS. To perform
4the following in relation to the prevention and treatment of
5acquired immunodeficiency syndrome (AIDS):
6    (1) Establish a State AIDS Control Unit within the
7Department as a separate administrative subdivision, to
8coordinate all State programs and services relating to the
9prevention, treatment, and amelioration of AIDS.
10    (2) Conduct a public information campaign for physicians,
11hospitals, health facilities, public health departments, law
12enforcement personnel, public employees, laboratories, and the
13general public on acquired immunodeficiency syndrome (AIDS)
14and promote necessary measures to reduce the incidence of AIDS
15and the mortality from AIDS. This program shall include, but
16not be limited to, the establishment of a statewide hotline and
17a State AIDS information clearinghouse that will provide
18periodic reports and releases to public officials, health
19professionals, community service organizations, and the
20general public regarding new developments or procedures
21concerning prevention and treatment of AIDS.
22    (3) (Blank).
23    (4) Establish alternative blood test services that are not
24operated by a blood bank, plasma center or hospital. The
25Department shall prescribe by rule minimum criteria, standards



09700SB1802ham004- 3 -LRB097 09314 KTG 56512 a

1and procedures for the establishment and operation of such
2services, which shall include, but not be limited to
3requirements for the provision of information, counseling and
4referral services that ensure appropriate counseling and
5referral for persons whose blood is tested and shows evidence
6of exposure to the human immunodeficiency virus (HIV) or other
7identified causative agent of acquired immunodeficiency
8syndrome (AIDS).
9    (5) Establish regional and community service networks of
10public and private service providers or health care
11professionals who may be involved in AIDS research, prevention
12and treatment.
13    (6) Provide grants to individuals, organizations or
14facilities to support the following:
15        (A) Information, referral, and treatment services.
16        (B) Interdisciplinary workshops for professionals
17    involved in research and treatment.
18        (C) Establishment and operation of a statewide
19    hotline.
20        (D) Establishment and operation of alternative testing
21    services.
22        (E) Research into detection, prevention, and
23    treatment.
24        (F) Supplementation of other public and private
25    resources.
26        (G) Implementation by long-term care facilities of



09700SB1802ham004- 4 -LRB097 09314 KTG 56512 a

1    Department standards and procedures for the care and
2    treatment of persons with AIDS and the development of
3    adequate numbers and types of placements for those persons.
4    (7) (Blank).
5    (8) Accept any gift, donation, bequest, or grant of funds
6from private or public agencies, including federal funds that
7may be provided for AIDS control efforts.
8    (9) Develop and implement, in consultation with the
9Long-Term Care Facility Advisory Board, standards and
10procedures for long-term care facilities that provide care and
11treatment of persons with AIDS, including appropriate
12infection control procedures. The Department shall work
13cooperatively with organizations representing those facilities
14to develop adequate numbers and types of placements for persons
15with AIDS and shall advise those facilities on proper
16implementation of its standards and procedures.
17    (10) The Department shall create and administer a training
18program for State employees who have a need for understanding
19matters relating to AIDS in order to deal with or advise the
20public. The training shall include information on the cause and
21effects of AIDS, the means of detecting it and preventing its
22transmission, the availability of related counseling and
23referral, and other matters that may be appropriate. The
24training may also be made available to employees of local
25governments, public service agencies, and private agencies
26that contract with the State; in those cases the Department may



09700SB1802ham004- 5 -LRB097 09314 KTG 56512 a

1charge a reasonable fee to recover the cost of the training.
2    (11) Approve tests or testing procedures used in
3determining exposure to HIV or any other identified causative
4agent of AIDS.
5    (12) Provide prescription drug benefits counseling for
6persons with HIV or AIDS.
7    (13) Continue to administer the AIDS Drug Assistance
8Program that provides drugs to prolong the lives of low income
9Persons with Acquired Immunodeficiency Syndrome (AIDS) or
10Human Immunodeficiency Virus (HIV) infection who are not
11eligible under Article V of the Illinois Public Aid Code for
12Medical Assistance, as provided under Title 77, Chapter 1,
13Subchapter (k), Part 692, Section 692.10 of the Illinois
14Administrative Code, effective August 1, 2000, except that the
15financial qualification for that program shall be that the
16anticipated gross monthly income shall be at or below 500% of
17the most recent Federal Poverty Guidelines published annually
18by the United States Department of Health and Human Services
19for the size of the household. Notwithstanding the preceding
20sentence, the Department of Public Health may determine the
21income eligibility standard for the AIDS Drug Assistance
22Program each year and may set the standard at more than 500% of
23the Federal Poverty Guidelines for the size of the household,
24provided that moneys appropriated to the Department for the
25program are sufficient to cover the increased cost of
26implementing the higher income eligibility standard.



09700SB1802ham004- 6 -LRB097 09314 KTG 56512 a

1Rulemaking authority to implement this amendatory Act of the
295th General Assembly, if any, is conditioned on the rules
3being adopted in accordance with all provisions of the Illinois
4Administrative Procedure Act and all rules and procedures of
5the Joint Committee on Administrative Rules; any purported rule
6not so adopted, for whatever reason, is unauthorized. If the
7Department reduces the financial qualification for new
8applicants while allowing currently enrolled individuals to
9remain on the program, the Department shall maintain a waiting
10list of applicants who would otherwise be eligible except that
11they do not meet the financial qualifications. Upon
12determination that program finances are adequate, the
13Department shall permit qualified individuals who are on the
14waiting list to enroll in the program.
15    (14) In order to implement the provisions of Public Act
1695-7, the Department must expand HIV testing in health care
17settings where undiagnosed individuals are likely to be
18identified. The Department must purchase rapid HIV kits and
19make grants for technical assistance, staff to conduct HIV
20testing and counseling, and related purposes. The Department
21must make grants to (i) facilities serving patients that are
22uninsured at high rates, (ii) facilities located in areas with
23a high prevalence of HIV or AIDS, (iii) facilities that have a
24high likelihood of identifying individuals who are undiagnosed
25with HIV or AIDS, or (iv) any combination of items (i), (ii),
26and (iii).



09700SB1802ham004- 7 -LRB097 09314 KTG 56512 a

1(Source: P.A. 94-909, eff. 6-23-06; 95-744, eff. 7-18-08;
295-1042, eff. 3-25-09.)
3    Section 3. The Disabled Persons Rehabilitation Act is
4amended by adding Section 10a as follows:
5    (20 ILCS 2405/10a new)
6    Sec. 10a. Financial Participation of Students Attending
7the Illinois School for the Deaf and the Illinois School for
8the Visually Impaired.
9    (a) General. The Illinois School for the Deaf and the
10Illinois School for the Visually Impaired are required to
11provide eligible students with disabilities with a free and
12appropriate education. As part of the admission process to
13either school, the Department shall complete a financial
14analysis on each student attending the Illinois School for the
15Deaf or the Illinois School for the Visually Impaired and shall
16ask parents or guardians to participate, if applicable, in the
17cost of identified services or activities that are not
18education related.
19    (b) Completion of financial analysis. Prior to admission,
20and annually thereafter, a financial analysis shall be
21completed on each student attending the Illinois School for the
22Deaf or the Illinois School for the Visually Impaired. If at
23any time there is reason to believe there is a change in the
24student's financial situation that will affect their financial



09700SB1802ham004- 8 -LRB097 09314 KTG 56512 a

1participation, a new financial analysis shall be completed.
2        (1) In completing the student's financial analysis,
3    the income of the student's family shall be used. Proof of
4    income must be provided and retained for each parent or
5    guardian.
6        (2) Any funds that have been established on behalf of
7    the student for completion of their primary or secondary
8    education shall be considered when completing the
9    financial analysis.
10        (3) Falsification of information used to complete the
11    financial analysis may result in the Department taking
12    action to recoup monies previously expended by the
13    Department in providing services to the student.
14    (c) Financial Participation. Utilizing a sliding scale
15based on income standards developed by rule by the Department
16with input from the superintendent of each school, parents or
17guardians of students attending the Illinois School for the
18Deaf or the Illinois School for the Visually Impaired may be
19asked to financially participate in the following fees for
20services or activities provided at the schools:
21        (1) Registration.
22        (2) Books, labs, and supplies (fees may vary depending
23    on the classes in which a student participates).
24        (3) Room and board for residential students.
25        (4) Meals for day students.
26        (5) Athletic or extracurricular activities (students



09700SB1802ham004- 9 -LRB097 09314 KTG 56512 a

1    participating in multiple activities will not be required
2    to pay for more than 2 activities).
3        (6) Driver's education (if applicable).
4        (7) Graduation.
5        (8) Yearbook (optional).
6        (9) Activities (field trips or other leisure
7    activities).
8        (10) Other activities or services identified by the
9    Department.
10    Students, parents, or guardians who are receiving Medicaid
11or Temporary Assistance for Needy Families (TANF) shall not be
12required to financially participate in the fees established in
13this subsection (c).
14    Exceptions may be granted to parents or guardians who are
15unable to meet the financial participation obligations due to
16extenuating circumstances. Requests for exceptions must be
17made in writing and must be submitted to the superintendent for
18initial recommendation with a final determination by the
19Director of the Division of Rehabilitation Services.
20    Any fees collected under this subsection (c) shall be held
21locally by the school and used exclusively for the purpose for
22which the fee was assessed.
23    Section 5. The State Prompt Payment Act is amended by
24changing Section 3-2 as follows:



09700SB1802ham004- 10 -LRB097 09314 KTG 56512 a

1    (30 ILCS 540/3-2)
2    Sec. 3-2. Beginning July 1, 1993, in any instance where a
3State official or agency is late in payment of a vendor's bill
4or invoice for goods or services furnished to the State, as
5defined in Section 1, properly approved in accordance with
6rules promulgated under Section 3-3, the State official or
7agency shall pay interest to the vendor in accordance with the
9        (1) Any bill, except a bill submitted under Article V
10    of the Illinois Public Aid Code and except as provided
11    under paragraph (1.05) of this Section, approved for
12    payment under this Section must be paid or the payment
13    issued to the payee within 60 days of receipt of a proper
14    bill or invoice. If payment is not issued to the payee
15    within this 60-day 60 day period, an interest penalty of
16    1.0% of any amount approved and unpaid shall be added for
17    each month or fraction thereof after the end of this 60-day
18    60 day period, until final payment is made. Any bill,
19    except a bill for pharmacy or nursing facility services or
20    goods and except as provided under paragraph (1.05) of this
21    Section, submitted under Article V of the Illinois Public
22    Aid Code approved for payment under this Section must be
23    paid or the payment issued to the payee within 60 days
24    after receipt of a proper bill or invoice, and, if payment
25    is not issued to the payee within this 60-day period, an
26    interest penalty of 2.0% of any amount approved and unpaid



09700SB1802ham004- 11 -LRB097 09314 KTG 56512 a

1    shall be added for each month or fraction thereof after the
2    end of this 60-day period, until final payment is made. Any
3    bill for pharmacy or nursing facility services or goods
4    submitted under Article V of the Illinois Public Aid Code,
5    except as provided under paragraph (1.05) of this Section,
6    , approved for payment under this Section must be paid or
7    the payment issued to the payee within 60 days of receipt
8    of a proper bill or invoice. If payment is not issued to
9    the payee within this 60-day 60 day period, an interest
10    penalty of 1.0% of any amount approved and unpaid shall be
11    added for each month or fraction thereof after the end of
12    this 60-day 60 day period, until final payment is made.
13        (1.05) For State fiscal year 2012 and future fiscal
14    years, any bill approved for payment under this Section
15    must be paid or the payment issued to the payee within 90
16    days of receipt of a proper bill or invoice. If payment is
17    not issued to the payee within this 90-day period, an
18    interest penalty of 1.0% of any amount approved and unpaid
19    shall be added for each month or fraction thereof after the
20    end of this 90-day period, until final payment is made.
21        (1.1) A State agency shall review in a timely manner
22    each bill or invoice after its receipt. If the State agency
23    determines that the bill or invoice contains a defect
24    making it unable to process the payment request, the agency
25    shall notify the vendor requesting payment as soon as
26    possible after discovering the defect pursuant to rules



09700SB1802ham004- 12 -LRB097 09314 KTG 56512 a

1    promulgated under Section 3-3; provided, however, that the
2    notice for construction related bills or invoices must be
3    given not later than 30 days after the bill or invoice was
4    first submitted. The notice shall identify the defect and
5    any additional information necessary to correct the
6    defect. If one or more items on a construction related bill
7    or invoice are disapproved, but not the entire bill or
8    invoice, then the portion that is not disapproved shall be
9    paid.
10        (2) Where a State official or agency is late in payment
11    of a vendor's bill or invoice properly approved in
12    accordance with this Act, and different late payment terms
13    are not reduced to writing as a contractual agreement, the
14    State official or agency shall automatically pay interest
15    penalties required by this Section amounting to $50 or more
16    to the appropriate vendor. Each agency shall be responsible
17    for determining whether an interest penalty is owed and for
18    paying the interest to the vendor. Interest due to a vendor
19    that amounts to less than $50 shall not be paid but shall
20    be accrued until all interest due the vendor for all
21    similar warrants exceeds $50, at which time the accrued
22    interest shall be payable and interest will begin accruing
23    again, except that interest accrued as of the end of the
24    fiscal year that does not exceed $50 shall be payable at
25    that time. In the event an individual has paid a vendor for
26    services in advance, the provisions of this Section shall



09700SB1802ham004- 13 -LRB097 09314 KTG 56512 a

1    apply until payment is made to that individual.
2        (3) The provisions of Public Act 96-1501 this
3    amendatory Act of the 96th General Assembly reducing the
4    interest rate on pharmacy claims under Article V of the
5    Illinois Public Aid Code to 1.0% per month shall apply to
6    any pharmacy bills for services and goods under Article V
7    of the Illinois Public Aid Code received on or after the
8    date 60 days before January 25, 2011 (the effective date of
9    Public Act 96-1501) except as provided under paragraph
10    (1.05) of this Section this amendatory Act of the 96th
11    General Assembly.
12(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10;
1396-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff.
141-25-11; 96-1530, eff. 2-16-11; revised 2-22-11.)
15    Section 10. The Children's Health Insurance Program Act is
16amended by changing Section 30 as follows:
17    (215 ILCS 106/30)
18    Sec. 30. Cost sharing.
19    (a) Children enrolled in a health benefits program pursuant
20to subdivision (a)(2) of Section 25 and persons enrolled in a
21health benefits waiver program pursuant to Section 40 shall be
22subject to the following cost sharing requirements:
23        (1) There shall be no co-payment required for well-baby
24    or well-child care, including age-appropriate



09700SB1802ham004- 14 -LRB097 09314 KTG 56512 a

1    immunizations as required under federal law.
2        (2) Health insurance premiums for family members,
3    either children or adults, in families whose household
4    income is above 150% of the federal poverty level shall be
5    payable monthly, subject to rules promulgated by the
6    Department for grace periods and advance payments, and
7    shall be as follows:
8            (A) $15 per month for one family member.
9            (B) $25 per month for 2 family members.
10            (C) $30 per month for 3 family members.
11            (D) $35 per month for 4 family members.
12            (E) $40 per month for 5 or more family members.
13        (3) Co-payments for children or adults in families
14    whose income is at or below 150% of the federal poverty
15    level, at a minimum and to the extent permitted under
16    federal law, shall be $2 for all medical visits and
17    prescriptions provided under this Act and up to $10 for
18    emergency room use for a non-emergency situation as defined
19    by the Department by rule and subject to federal approval.
20        (4) Co-payments for children or adults in families
21    whose income is above 150% of the federal poverty level, at
22    a minimum and to the extent permitted under federal law
23    shall be as follows:
24            (A) $5 for medical visits.
25            (B) $3 for generic prescriptions and $5 for brand
26        name prescriptions.



09700SB1802ham004- 15 -LRB097 09314 KTG 56512 a

1            (C) $25 for emergency room use for a non-emergency
2        situation as defined by the Department by rule.
3        (5) (Blank) The maximum amount of out-of-pocket
4    expenses for co-payments shall be $100 per family per year.
5        (6) Co-payments shall be maximized to the extent
6    permitted by federal law and are subject to federal
7    approval.
8    (b) Individuals enrolled in a privately sponsored health
9insurance plan pursuant to subdivision (a)(1) of Section 25
10shall be subject to the cost sharing provisions as stated in
11the privately sponsored health insurance plan.
12(Source: P.A. 94-48, eff. 7-1-05.)
13    Section 15. The Illinois Public Aid Code is amended by
14changing Sections 5-2, 5-4.1, 5-5.12, and 5A-10, as follows:
15    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
16    Sec. 5-2. Classes of Persons Eligible. Medical assistance
17under this Article shall be available to any of the following
18classes of persons in respect to whom a plan for coverage has
19been submitted to the Governor by the Illinois Department and
20approved by him:
21        1. Recipients of basic maintenance grants under
22    Articles III and IV.
23        2. Persons otherwise eligible for basic maintenance
24    under Articles III and IV, excluding any eligibility



09700SB1802ham004- 16 -LRB097 09314 KTG 56512 a

1    requirements that are inconsistent with any federal law or
2    federal regulation, as interpreted by the U.S. Department
3    of Health and Human Services, but who fail to qualify
4    thereunder on the basis of need or who qualify but are not
5    receiving basic maintenance under Article IV, and who have
6    insufficient income and resources to meet the costs of
7    necessary medical care, including but not limited to the
8    following:
9            (a) All persons otherwise eligible for basic
10        maintenance under Article III but who fail to qualify
11        under that Article on the basis of need and who meet
12        either of the following requirements:
13                (i) their income, as determined by the
14            Illinois Department in accordance with any federal
15            requirements, is equal to or less than 70% in
16            fiscal year 2001, equal to or less than 85% in
17            fiscal year 2002 and until a date to be determined
18            by the Department by rule, and equal to or less
19            than 100% beginning on the date determined by the
20            Department by rule, of the nonfarm income official
21            poverty line, as defined by the federal Office of
22            Management and Budget and revised annually in
23            accordance with Section 673(2) of the Omnibus
24            Budget Reconciliation Act of 1981, applicable to
25            families of the same size; or
26                (ii) their income, after the deduction of



09700SB1802ham004- 17 -LRB097 09314 KTG 56512 a

1            costs incurred for medical care and for other types
2            of remedial care, is equal to or less than 70% in
3            fiscal year 2001, equal to or less than 85% in
4            fiscal year 2002 and until a date to be determined
5            by the Department by rule, and equal to or less
6            than 100% beginning on the date determined by the
7            Department by rule, of the nonfarm income official
8            poverty line, as defined in item (i) of this
9            subparagraph (a).
10            (b) All persons who, excluding any eligibility
11        requirements that are inconsistent with any federal
12        law or federal regulation, as interpreted by the U.S.
13        Department of Health and Human Services, would be
14        determined eligible for such basic maintenance under
15        Article IV by disregarding the maximum earned income
16        permitted by federal law.
17        3. Persons who would otherwise qualify for Aid to the
18    Medically Indigent under Article VII.
19        4. Persons not eligible under any of the preceding
20    paragraphs who fall sick, are injured, or die, not having
21    sufficient money, property or other resources to meet the
22    costs of necessary medical care or funeral and burial
23    expenses.
24        5.(a) Women during pregnancy, after the fact of
25    pregnancy has been determined by medical diagnosis, and
26    during the 60-day period beginning on the last day of the



09700SB1802ham004- 18 -LRB097 09314 KTG 56512 a

1    pregnancy, together with their infants and children born
2    after September 30, 1983, whose income and resources are
3    insufficient to meet the costs of necessary medical care to
4    the maximum extent possible under Title XIX of the Federal
5    Social Security Act.
6        (b) The Illinois Department and the Governor shall
7    provide a plan for coverage of the persons eligible under
8    paragraph 5(a) by April 1, 1990. Such plan shall provide
9    ambulatory prenatal care to pregnant women during a
10    presumptive eligibility period and establish an income
11    eligibility standard that is equal to 133% of the nonfarm
12    income official poverty line, as defined by the federal
13    Office of Management and Budget and revised annually in
14    accordance with Section 673(2) of the Omnibus Budget
15    Reconciliation Act of 1981, applicable to families of the
16    same size, provided that costs incurred for medical care
17    are not taken into account in determining such income
18    eligibility.
19        (c) The Illinois Department may conduct a
20    demonstration in at least one county that will provide
21    medical assistance to pregnant women, together with their
22    infants and children up to one year of age, where the
23    income eligibility standard is set up to 185% of the
24    nonfarm income official poverty line, as defined by the
25    federal Office of Management and Budget. The Illinois
26    Department shall seek and obtain necessary authorization



09700SB1802ham004- 19 -LRB097 09314 KTG 56512 a

1    provided under federal law to implement such a
2    demonstration. Such demonstration may establish resource
3    standards that are not more restrictive than those
4    established under Article IV of this Code.
5        6. Persons under the age of 18 who fail to qualify as
6    dependent under Article IV and who have insufficient income
7    and resources to meet the costs of necessary medical care
8    to the maximum extent permitted under Title XIX of the
9    Federal Social Security Act.
10        7. Persons who are under 21 years of age and would
11    qualify as disabled as defined under the Federal
12    Supplemental Security Income Program, provided medical
13    service for such persons would be eligible for Federal
14    Financial Participation, and provided the Illinois
15    Department determines that:
16            (a) the person requires a level of care provided by
17        a hospital, skilled nursing facility, or intermediate
18        care facility, as determined by a physician licensed to
19        practice medicine in all its branches;
20            (b) it is appropriate to provide such care outside
21        of an institution, as determined by a physician
22        licensed to practice medicine in all its branches;
23            (c) the estimated amount which would be expended
24        for care outside the institution is not greater than
25        the estimated amount which would be expended in an
26        institution.



09700SB1802ham004- 20 -LRB097 09314 KTG 56512 a

1        8. Persons who become ineligible for basic maintenance
2    assistance under Article IV of this Code in programs
3    administered by the Illinois Department due to employment
4    earnings and persons in assistance units comprised of
5    adults and children who become ineligible for basic
6    maintenance assistance under Article VI of this Code due to
7    employment earnings. The plan for coverage for this class
8    of persons shall:
9            (a) extend the medical assistance coverage for up
10        to 12 months following termination of basic
11        maintenance assistance; and
12            (b) offer persons who have initially received 6
13        months of the coverage provided in paragraph (a) above,
14        the option of receiving an additional 6 months of
15        coverage, subject to the following:
16                (i) such coverage shall be pursuant to
17            provisions of the federal Social Security Act;
18                (ii) such coverage shall include all services
19            covered while the person was eligible for basic
20            maintenance assistance;
21                (iii) no premium shall be charged for such
22            coverage; and
23                (iv) such coverage shall be suspended in the
24            event of a person's failure without good cause to
25            file in a timely fashion reports required for this
26            coverage under the Social Security Act and



09700SB1802ham004- 21 -LRB097 09314 KTG 56512 a

1            coverage shall be reinstated upon the filing of
2            such reports if the person remains otherwise
3            eligible.
4        9. Persons with acquired immunodeficiency syndrome
5    (AIDS) or with AIDS-related conditions with respect to whom
6    there has been a determination that but for home or
7    community-based services such individuals would require
8    the level of care provided in an inpatient hospital,
9    skilled nursing facility or intermediate care facility the
10    cost of which is reimbursed under this Article. Assistance
11    shall be provided to such persons to the maximum extent
12    permitted under Title XIX of the Federal Social Security
13    Act.
14        10. Participants in the long-term care insurance
15    partnership program established under the Illinois
16    Long-Term Care Partnership Program Act who meet the
17    qualifications for protection of resources described in
18    Section 15 of that Act.
19        11. Persons with disabilities who are employed and
20    eligible for Medicaid, pursuant to Section
21    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
22    subject to federal approval, persons with a medically
23    improved disability who are employed and eligible for
24    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
25    the Social Security Act, as provided by the Illinois
26    Department by rule. In establishing eligibility standards



09700SB1802ham004- 22 -LRB097 09314 KTG 56512 a

1    under this paragraph 11, the Department shall, subject to
2    federal approval:
3            (a) set the income eligibility standard at not
4        lower than 350% of the federal poverty level;
5            (b) exempt retirement accounts that the person
6        cannot access without penalty before the age of 59 1/2,
7        and medical savings accounts established pursuant to
8        26 U.S.C. 220;
9            (c) allow non-exempt assets up to $25,000 as to
10        those assets accumulated during periods of eligibility
11        under this paragraph 11; and
12            (d) continue to apply subparagraphs (b) and (c) in
13        determining the eligibility of the person under this
14        Article even if the person loses eligibility under this
15        paragraph 11.
16        12. Subject to federal approval, persons who are
17    eligible for medical assistance coverage under applicable
18    provisions of the federal Social Security Act and the
19    federal Breast and Cervical Cancer Prevention and
20    Treatment Act of 2000. Those eligible persons are defined
21    to include, but not be limited to, the following persons:
22            (1) persons who have been screened for breast or
23        cervical cancer under the U.S. Centers for Disease
24        Control and Prevention Breast and Cervical Cancer
25        Program established under Title XV of the federal
26        Public Health Services Act in accordance with the



09700SB1802ham004- 23 -LRB097 09314 KTG 56512 a

1        requirements of Section 1504 of that Act as
2        administered by the Illinois Department of Public
3        Health; and
4            (2) persons whose screenings under the above
5        program were funded in whole or in part by funds
6        appropriated to the Illinois Department of Public
7        Health for breast or cervical cancer screening.
8        "Medical assistance" under this paragraph 12 shall be
9    identical to the benefits provided under the State's
10    approved plan under Title XIX of the Social Security Act.
11    The Department must request federal approval of the
12    coverage under this paragraph 12 within 30 days after the
13    effective date of this amendatory Act of the 92nd General
14    Assembly.
15        In addition to the persons who are eligible for medical
16    assistance pursuant to subparagraphs (1) and (2) of this
17    paragraph 12, and to be paid from funds appropriated to the
18    Department for its medical programs, any uninsured person
19    as defined by the Department in rules residing in Illinois
20    who is younger than 65 years of age, who has been screened
21    for breast and cervical cancer in accordance with standards
22    and procedures adopted by the Department of Public Health
23    for screening, and who is referred to the Department by the
24    Department of Public Health as being in need of treatment
25    for breast or cervical cancer is eligible for medical
26    assistance benefits that are consistent with the benefits



09700SB1802ham004- 24 -LRB097 09314 KTG 56512 a

1    provided to those persons described in subparagraphs (1)
2    and (2). Medical assistance coverage for the persons who
3    are eligible under the preceding sentence is not dependent
4    on federal approval, but federal moneys may be used to pay
5    for services provided under that coverage upon federal
6    approval.
7        13. Subject to appropriation and to federal approval,
8    persons living with HIV/AIDS who are not otherwise eligible
9    under this Article and who qualify for services covered
10    under Section 5-5.04 as provided by the Illinois Department
11    by rule.
12        14. Subject to the availability of funds for this
13    purpose, the Department may provide coverage under this
14    Article to persons who reside in Illinois who are not
15    eligible under any of the preceding paragraphs and who meet
16    the income guidelines of paragraph 2(a) of this Section and
17    (i) have an application for asylum pending before the
18    federal Department of Homeland Security or on appeal before
19    a court of competent jurisdiction and are represented
20    either by counsel or by an advocate accredited by the
21    federal Department of Homeland Security and employed by a
22    not-for-profit organization in regard to that application
23    or appeal, or (ii) are receiving services through a
24    federally funded torture treatment center. Medical
25    coverage under this paragraph 14 may be provided for up to
26    24 continuous months from the initial eligibility date so



09700SB1802ham004- 25 -LRB097 09314 KTG 56512 a

1    long as an individual continues to satisfy the criteria of
2    this paragraph 14. If an individual has an appeal pending
3    regarding an application for asylum before the Department
4    of Homeland Security, eligibility under this paragraph 14
5    may be extended until a final decision is rendered on the
6    appeal. The Department may adopt rules governing the
7    implementation of this paragraph 14.
8        15. Family Care Eligibility.
9            (a) Through December 31, 2013, a A caretaker
10        relative who is 19 years of age or older when countable
11        income is at or below 185% of the Federal Poverty Level
12        Guidelines, as published annually in the Federal
13        Register, for the appropriate family size. Beginning
14        January 1, 2014, a caretaker relative who is 19 years
15        of age or older when countable income is at or below
16        133% of the Federal Poverty Level Guidelines, as
17        published annually in the Federal Register, for the
18        appropriate family size. A person may not spend down to
19        become eligible under this paragraph 15.
20            (b) Eligibility shall be reviewed annually.
21            (c) Caretaker relatives enrolled under this
22        paragraph 15 in families with countable income above
23        150% and at or below 185% of the Federal Poverty Level
24        Guidelines shall be counted as family members and pay
25        premiums as established under the Children's Health
26        Insurance Program Act.



09700SB1802ham004- 26 -LRB097 09314 KTG 56512 a

1            (d) Premiums shall be billed by and payable to the
2        Department or its authorized agent, on a monthly basis.
3            (e) The premium due date is the last day of the
4        month preceding the month of coverage.
5            (f) Individuals shall have a grace period through
6        30 days of coverage to pay the premium.
7            (g) Failure to pay the full monthly premium by the
8        last day of the grace period shall result in
9        termination of coverage.
10            (h) Partial premium payments shall not be
11        refunded.
12            (i) Following termination of an individual's
13        coverage under this paragraph 15, the following action
14        is required before the individual can be re-enrolled:
15                (1) A new application must be completed and the
16            individual must be determined otherwise eligible.
17                (2) There must be full payment of premiums due
18            under this Code, the Children's Health Insurance
19            Program Act, the Covering ALL KIDS Health
20            Insurance Act, or any other healthcare program
21            administered by the Department for periods in
22            which a premium was owed and not paid for the
23            individual.
24                (3) The first month's premium must be paid if
25            there was an unpaid premium on the date the
26            individual's previous coverage was canceled.



09700SB1802ham004- 27 -LRB097 09314 KTG 56512 a

1        The Department is authorized to implement the
2    provisions of this amendatory Act of the 95th General
3    Assembly by adopting the medical assistance rules in effect
4    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
5    89 Ill. Admin. Code 120.32 along with only those changes
6    necessary to conform to federal Medicaid requirements,
7    federal laws, and federal regulations, including but not
8    limited to Section 1931 of the Social Security Act (42
9    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
10    of Health and Human Services, and the countable income
11    eligibility standard authorized by this paragraph 15. The
12    Department may not otherwise adopt any rule to implement
13    this increase except as authorized by law, to meet the
14    eligibility standards authorized by the federal government
15    in the Medicaid State Plan or the Title XXI Plan, or to
16    meet an order from the federal government or any court.
17        16. Subject to appropriation, uninsured persons who
18    are not otherwise eligible under this Section who have been
19    certified and referred by the Department of Public Health
20    as having been screened and found to need diagnostic
21    evaluation or treatment, or both diagnostic evaluation and
22    treatment, for prostate or testicular cancer. For the
23    purposes of this paragraph 16, uninsured persons are those
24    who do not have creditable coverage, as defined under the
25    Health Insurance Portability and Accountability Act, or
26    have otherwise exhausted any insurance benefits they may



09700SB1802ham004- 28 -LRB097 09314 KTG 56512 a

1    have had, for prostate or testicular cancer diagnostic
2    evaluation or treatment, or both diagnostic evaluation and
3    treatment. To be eligible, a person must furnish a Social
4    Security number. A person's assets are exempt from
5    consideration in determining eligibility under this
6    paragraph 16. Such persons shall be eligible for medical
7    assistance under this paragraph 16 for so long as they need
8    treatment for the cancer. A person shall be considered to
9    need treatment if, in the opinion of the person's treating
10    physician, the person requires therapy directed toward
11    cure or palliation of prostate or testicular cancer,
12    including recurrent metastatic cancer that is a known or
13    presumed complication of prostate or testicular cancer and
14    complications resulting from the treatment modalities
15    themselves. Persons who require only routine monitoring
16    services are not considered to need treatment. "Medical
17    assistance" under this paragraph 16 shall be identical to
18    the benefits provided under the State's approved plan under
19    Title XIX of the Social Security Act. Notwithstanding any
20    other provision of law, the Department (i) does not have a
21    claim against the estate of a deceased recipient of
22    services under this paragraph 16 and (ii) does not have a
23    lien against any homestead property or other legal or
24    equitable real property interest owned by a recipient of
25    services under this paragraph 16.
26    In implementing the provisions of Public Act 96-20, the



09700SB1802ham004- 29 -LRB097 09314 KTG 56512 a

1Department is authorized to adopt only those rules necessary,
2including emergency rules. Nothing in Public Act 96-20 permits
3the Department to adopt rules or issue a decision that expands
4eligibility for the FamilyCare Program to a person whose income
5exceeds 185% of the Federal Poverty Level as determined from
6time to time by the U.S. Department of Health and Human
7Services, unless the Department is provided with express
8statutory authority.
9    The Illinois Department and the Governor shall provide a
10plan for coverage of the persons eligible under paragraph 7 as
11soon as possible after July 1, 1984.
12    The eligibility of any such person for medical assistance
13under this Article is not affected by the payment of any grant
14under the Senior Citizens and Disabled Persons Property Tax
15Relief and Pharmaceutical Assistance Act or any distributions
16or items of income described under subparagraph (X) of
17paragraph (2) of subsection (a) of Section 203 of the Illinois
18Income Tax Act. The Department shall by rule establish the
19amounts of assets to be disregarded in determining eligibility
20for medical assistance, which shall at a minimum equal the
21amounts to be disregarded under the Federal Supplemental
22Security Income Program. The amount of assets of a single
23person to be disregarded shall not be less than $2,000, and the
24amount of assets of a married couple to be disregarded shall
25not be less than $3,000.
26    To the extent permitted under federal law, any person found



09700SB1802ham004- 30 -LRB097 09314 KTG 56512 a

1guilty of a second violation of Article VIIIA shall be
2ineligible for medical assistance under this Article, as
3provided in Section 8A-8.
4    The eligibility of any person for medical assistance under
5this Article shall not be affected by the receipt by the person
6of donations or benefits from fundraisers held for the person
7in cases of serious illness, as long as neither the person nor
8members of the person's family have actual control over the
9donations or benefits or the disbursement of the donations or
11(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
1296-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.
138-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123,
14eff. 1-1-11; 96-1270, eff. 7-26-10; revised 9-16-10.)
15    (305 ILCS 5/5-4.1)  (from Ch. 23, par. 5-4.1)
16    Sec. 5-4.1. Co-payments. The Department may by rule provide
17that recipients under any Article of this Code shall pay a fee
18as a co-payment for services. Co-payments shall be maximized to
19the extent permitted by federal law. Provided, however, that
20any such rule must provide that no co-payment requirement can
21exist for renal dialysis, radiation therapy, cancer
22chemotherapy, or insulin, and other products necessary on a
23recurring basis, the absence of which would be life
24threatening, or where co-payment expenditures for required
25services and/or medications for chronic diseases that the



09700SB1802ham004- 31 -LRB097 09314 KTG 56512 a

1Illinois Department shall by rule designate shall cause an
2extensive financial burden on the recipient, and provided no
3co-payment shall exist for emergency room encounters which are
4for medical emergencies. The Department shall seek approval of
5a State plan amendment that allows pharmacies to refuse to
6dispense drugs in circumstances where the recipient does not
7pay the required co-payment. In the event the State plan
8amendment is rejected, co-payments may not exceed $3 for brand
9name drugs, $1 for other pharmacy services other than for
10generic drugs, and $2 for physician services, dental services,
11optical services and supplies, chiropractic services, podiatry
12services, and encounter rate clinic services. There shall be no
13co-payment for generic drugs. Co-payments may not exceed $10
14for emergency room use for a non-emergency situation as defined
15by the Department by rule and subject to federal approval.
16Co-payments may not exceed $3 for hospital outpatient and
17clinic services.
18(Source: P.A. 96-1501, eff. 1-25-11.)
19    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
20    Sec. 5-5.12. Pharmacy payments.
21    (a) Every request submitted by a pharmacy for reimbursement
22under this Article for prescription drugs provided to a
23recipient of aid under this Article shall include the name of
24the prescriber or an acceptable identification number as
25established by the Department.



09700SB1802ham004- 32 -LRB097 09314 KTG 56512 a

1    (b) Pharmacies providing prescription drugs under this
2Article shall be reimbursed at a rate which shall include a
3professional dispensing fee as determined by the Illinois
4Department, plus the current acquisition cost of the
5prescription drug dispensed. The Illinois Department shall
6update its information on the acquisition costs of all
7prescription drugs no less frequently than every 30 days.
8However, the Illinois Department may set the rate of
9reimbursement for the acquisition cost, by rule, at a
10percentage of the current average wholesale acquisition cost.
11    (c) (Blank).
12    (d) The Department shall not impose requirements for prior
13approval based on a preferred drug list for anti-retroviral,
14anti-hemophilic factor concentrates, or any atypical
15antipsychotics, conventional antipsychotics, or
16anticonvulsants used for the treatment of serious mental
17illnesses until 30 days after it has conducted a study of the
18impact of such requirements on patient care and submitted a
19report to the Speaker of the House of Representatives and the
20President of the Senate. The Department shall review
21utilization of narcotic medications in the medical assistance
22program and impose utilization controls that protect against
24    (e) When making determinations as to which drugs shall be
25on a prior approval list, the Department shall include as part
26of the analysis for this determination, the degree to which a



09700SB1802ham004- 33 -LRB097 09314 KTG 56512 a

1drug may affect individuals in different ways based on factors
2including the gender of the person taking the medication.
3    (f) The Department shall cooperate with the Department of
4Public Health and the Department of Human Services Division of
5Mental Health in identifying psychotropic medications that,
6when given in a particular form, manner, duration, or frequency
7(including "as needed") in a dosage, or in conjunction with
8other psychotropic medications to a nursing home resident, may
9constitute a chemical restraint or an "unnecessary drug" as
10defined by the Nursing Home Care Act or Titles XVIII and XIX of
11the Social Security Act and the implementing rules and
12regulations. The Department shall require prior approval for
13any such medication prescribed for a nursing home resident that
14appears to be a chemical restraint or an unnecessary drug. The
15Department shall consult with the Department of Human Services
16Division of Mental Health in developing a protocol and criteria
17for deciding whether to grant such prior approval.
18    (g) The Department may by rule provide for reimbursement of
19the dispensing of a 90-day supply of a generic, non-narcotic
20maintenance medication in circumstances where it is cost
22    (h) Effective July 1, 2011, the Department shall
23discontinue coverage of select over-the-counter drugs,
24including analgesics and cough and cold and allergy
26    (i) The Department shall seek any necessary waiver from the



09700SB1802ham004- 34 -LRB097 09314 KTG 56512 a

1federal government in order to establish a program limiting the
2pharmacies eligible to dispense specialty drugs and shall issue
3a Request for Proposals in order to maximize savings on these
4drugs. The Department shall by rule establish the drugs
5required to be dispensed in this program.
6(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
796-1501, eff. 1-25-11.)
8    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
9    Sec. 5A-10. Applicability.
10    (a) The assessment imposed by Section 5A-2 shall not take
11effect or shall cease to be imposed, and any moneys remaining
12in the Fund shall be refunded to hospital providers in
13proportion to the amounts paid by them, if:
14        (1) The sum of the appropriations for State fiscal
15    years 2004 and 2005 from the General Revenue Fund for
16    hospital payments under the medical assistance program is
17    less than $4,500,000,000 or the appropriation for each of
18    State fiscal years 2006, 2007 and 2008 from the General
19    Revenue Fund for hospital payments under the medical
20    assistance program is less than $2,500,000,000 increased
21    annually to reflect any increase in the number of
22    recipients, or the annual appropriation for State fiscal
23    years 2009, 2010, 2011, 2013, and 2014 through 2014, from
24    the General Revenue Fund combined with the Hospital
25    Provider Fund as authorized in Section 5A-8 for hospital



09700SB1802ham004- 35 -LRB097 09314 KTG 56512 a

1    payments under the medical assistance program, is less than
2    the amount appropriated for State fiscal year 2009,
3    adjusted annually to reflect any change in the number of
4    recipients, excluding State fiscal year 2009 supplemental
5    appropriations made necessary by the enactment of the
6    American Recovery and Reinvestment Act of 2009; or
7        (2) For State fiscal years prior to State fiscal year
8    2009, the Department of Healthcare and Family Services
9    (formerly Department of Public Aid) makes changes in its
10    rules that reduce the hospital inpatient or outpatient
11    payment rates, including adjustment payment rates, in
12    effect on October 1, 2004, except for hospitals described
13    in subsection (b) of Section 5A-3 and except for changes in
14    the methodology for calculating outlier payments to
15    hospitals for exceptionally costly stays, so long as those
16    changes do not reduce aggregate expenditures below the
17    amount expended in State fiscal year 2005 for such
18    services; or
19        (2.1) For State fiscal years 2009 through 2014, the
20    Department of Healthcare and Family Services adopts any
21    administrative rule change to reduce payment rates or
22    alters any payment methodology that reduces any payment
23    rates made to operating hospitals under the approved Title
24    XIX or Title XXI State plan in effect January 1, 2008
25    except for:
26            (A) any changes for hospitals described in



09700SB1802ham004- 36 -LRB097 09314 KTG 56512 a

1        subsection (b) of Section 5A-3; or
2            (B) any rates for payments made under this Article
3        V-A; or
4            (C) any changes proposed in State plan amendment
5        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
6        08-07; or
7            (D) in relation to any admissions on or after
8        January 1, 2011, a modification in the methodology for
9        calculating outlier payments to hospitals for
10        exceptionally costly stays, for hospitals reimbursed
11        under the diagnosis-related grouping methodology;
12        provided that the Department shall be limited to one
13        such modification during the 36-month period after the
14        effective date of this amendatory Act of the 96th
15        General Assembly; or
16        (3) The payments to hospitals required under Section
17    5A-12 or Section 5A-12.2 are changed or are not eligible
18    for federal matching funds under Title XIX or XXI of the
19    Social Security Act.
20    (b) The assessment imposed by Section 5A-2 shall not take
21effect or shall cease to be imposed if the assessment is
22determined to be an impermissible tax under Title XIX of the
23Social Security Act. Moneys in the Hospital Provider Fund
24derived from assessments imposed prior thereto shall be
25disbursed in accordance with Section 5A-8 to the extent federal
26financial participation is not reduced due to the



09700SB1802ham004- 37 -LRB097 09314 KTG 56512 a

1impermissibility of the assessments, and any remaining moneys
2shall be refunded to hospital providers in proportion to the
3amounts paid by them.
4(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08; 96-8,
5eff. 4-28-09; 96-1530, eff. 2-16-11.)
6    Section 20. The Senior Citizens and Disabled Persons
7Property Tax Relief and Pharmaceutical Assistance Act is
8amended by changing Section 4 as follows:
9    (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
10    Sec. 4. Amount of Grant.
11    (a) In general. Any individual 65 years or older or any
12individual who will become 65 years old during the calendar
13year in which a claim is filed, and any surviving spouse of
14such a claimant, who at the time of death received or was
15entitled to receive a grant pursuant to this Section, which
16surviving spouse will become 65 years of age within the 24
17months immediately following the death of such claimant and
18which surviving spouse but for his or her age is otherwise
19qualified to receive a grant pursuant to this Section, and any
20disabled person whose annual household income is less than the
21income eligibility limitation, as defined in subsection (a-5)
22and whose household is liable for payment of property taxes
23accrued or has paid rent constituting property taxes accrued
24and is domiciled in this State at the time he or she files his



09700SB1802ham004- 38 -LRB097 09314 KTG 56512 a

1or her claim is entitled to claim a grant under this Act. With
2respect to claims filed by individuals who will become 65 years
3old during the calendar year in which a claim is filed, the
4amount of any grant to which that household is entitled shall
5be an amount equal to 1/12 of the amount to which the claimant
6would otherwise be entitled as provided in this Section,
7multiplied by the number of months in which the claimant was 65
8in the calendar year in which the claim is filed.
9    (a-5) Income eligibility limitation. For purposes of this
10Section, "income eligibility limitation" means an amount for
11grant years 2008 and thereafter:
12        (1) less than $22,218 for a household containing one
13    person;
14        (2) less than $29,480 for a household containing 2
15    persons; or
16        (3) less than $36,740 for a household containing 3 or
17    more persons.
18    For 2009 claim year applications submitted during calendar
19year 2010, a household must have annual household income of
20less than $27,610 for a household containing one person; less
21than $36,635 for a household containing 2 persons; or less than
22$45,657 for a household containing 3 or more persons.
23    The Department on Aging may adopt rules such that on
24January 1, 2011, and thereafter, the foregoing household income
25eligibility limits may be changed to reflect the annual cost of
26living adjustment in Social Security and Supplemental Security



09700SB1802ham004- 39 -LRB097 09314 KTG 56512 a

1Income benefits that are applicable to the year for which those
2benefits are being reported as income on an application.
3    If a person files as a surviving spouse, then only his or
4her income shall be counted in determining his or her household
6    (b) Limitation. Except as otherwise provided in
7subsections (a) and (f) of this Section, the maximum amount of
8grant which a claimant is entitled to claim is the amount by
9which the property taxes accrued which were paid or payable
10during the last preceding tax year or rent constituting
11property taxes accrued upon the claimant's residence for the
12last preceding taxable year exceeds 3 1/2% of the claimant's
13household income for that year but in no event is the grant to
14exceed (i) $700 less 4.5% of household income for that year for
15those with a household income of $14,000 or less or (ii) $70 if
16household income for that year is more than $14,000.
17    (c) Public aid recipients. If household income in one or
18more months during a year includes cash assistance in excess of
19$55 per month from the Department of Healthcare and Family
20Services or the Department of Human Services (acting as
21successor to the Department of Public Aid under the Department
22of Human Services Act) which was determined under regulations
23of that Department on a measure of need that included an
24allowance for actual rent or property taxes paid by the
25recipient of that assistance, the amount of grant to which that
26household is entitled, except as otherwise provided in



09700SB1802ham004- 40 -LRB097 09314 KTG 56512 a

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



09700SB1802ham004- 41 -LRB097 09314 KTG 56512 a

1occupied during that month.
2    (f) (Blank).
3    (g) Effective January 1, 2006, there is hereby established
4a program of pharmaceutical assistance to the aged and
5disabled, entitled the Illinois Seniors and Disabled Drug
6Coverage Program, which shall be administered by the Department
7of Healthcare and Family Services and the Department on Aging
8in accordance with this subsection, to consist of coverage of
9specified prescription drugs on behalf of beneficiaries of the
10program as set forth in this subsection.
11    To become a beneficiary under the program established under
12this 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) for the 2006 and 2007 claim years, have a maximum
20    household income of (i) less than $21,218 for a household
21    containing one person, (ii) less than $28,480 for a
22    household containing 2 persons, or (iii) less than $35,740
23    for a household containing 3 or more persons; and
24        (5) for the 2008 claim year, have a maximum household
25    income of (i) less than $22,218 for a household containing
26    one person, (ii) $29,480 for a household containing 2



09700SB1802ham004- 42 -LRB097 09314 KTG 56512 a

1    persons, or (iii) $36,740 for a household containing 3 or
2    more persons; and
3        (6) for 2009 claim year applications submitted during
4    calendar year 2010, have annual household income of less
5    than (i) $27,610 for a household containing one person;
6    (ii) less than $36,635 for a household containing 2
7    persons; or (iii) less than $45,657 for a household
8    containing 3 or more persons; and .
9        (7) as of September 1, 2011, have a maximum household
10    income at or below 200% of the federal poverty level.
11    The Department of Healthcare and Family Services may adopt
12rules such that on January 1, 2011, and thereafter, the
13foregoing household income eligibility limits may be changed to
14reflect the annual cost of living adjustment in Social Security
15and Supplemental Security Income benefits that are applicable
16to the year for which those benefits are being reported as
17income on an application.
18    All individuals enrolled as of December 31, 2005, in the
19pharmaceutical assistance program operated pursuant to
20subsection (f) of this Section and all individuals enrolled as
21of December 31, 2005, in the SeniorCare Medicaid waiver program
22operated pursuant to Section 5-5.12a of the Illinois Public Aid
23Code shall be automatically enrolled in the program established
24by this subsection for the first year of operation without the
25need for further application, except that they must apply for
26Medicare Part D and the Low Income Subsidy under Medicare Part



09700SB1802ham004- 43 -LRB097 09314 KTG 56512 a

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



09700SB1802ham004- 44 -LRB097 09314 KTG 56512 a

1        (C) Eligibility Group 3 shall consist of beneficiaries
2    age 65 or older, with incomes at or below 200% of the
3    Federal Poverty Level, who are not barred from receiving
4    federally funded means-tested benefits due to immigration
5    status and are not eligible for Medicare Part D coverage.
6        If the State applies and receives federal approval for
7    a waiver under Title XIX of the Social Security Act,
8    persons in Eligibility Group 3 shall continue to receive
9    benefits through the approved waiver, and Eligibility
10    Group 3 may be expanded to include disabled persons under
11    age 65 with incomes under 200% of the Federal Poverty Level
12    who are not eligible for Medicare and who are not barred
13    from receiving federally funded means-tested benefits due
14    to immigration status.
15        (D) Eligibility Group 4 shall consist of beneficiaries
16    who are otherwise described in Eligibility Group 2 who have
17    a diagnosis of HIV or AIDS.
18    The program established under this subsection shall cover
19the cost of covered prescription drugs in excess of the
20beneficiary cost-sharing amounts set forth in this paragraph
21that are not covered by Medicare. The Department of Healthcare
22and Family Services may establish by emergency rule changes in
23cost-sharing necessary to conform the cost of the program to
24the amounts appropriated for State fiscal year 2012 and future
25fiscal years except that the 24-month limitation on the
26adoption of emergency rules and the provisions of Sections



09700SB1802ham004- 45 -LRB097 09314 KTG 56512 a

15-115 and 5-125 of the Illinois Administrative Procedure Act
2shall not apply to rules adopted under this subsection (g). The
3adoption of emergency rules authorized by this subsection (g)
4shall be deemed to be necessary for the public interest,
5safety, and welfare. In 2006, beneficiaries shall pay a
6co-payment of $2 for each prescription of a generic drug and $5
7for each prescription of a brand-name drug. In future years,
8beneficiaries shall pay co-payments equal to the co-payments
9required under Medicare Part D for "other low-income subsidy
10eligible individuals" pursuant to 42 CFR 423.782(b). For
11individuals in Eligibility Groups 1, 2, and 3, once the program
12established under this subsection and Medicare combined have
13paid $1,750 in a year for covered prescription drugs, the
14beneficiary shall pay 20% of the cost of each prescription in
15addition to the co-payments set forth in this paragraph. For
16individuals in Eligibility Group 4, once the program
17established under this subsection and Medicare combined have
18paid $1,750 in a year for covered prescription drugs, the
19beneficiary shall pay 20% of the cost of each prescription in
20addition to the co-payments set forth in this paragraph unless
21the drug is included in the formulary of the Illinois AIDS Drug
22Assistance Program operated by the Illinois Department of
23Public Health and covered by the Medicare Part D Prescription
24Drug Plan in which the beneficiary is enrolled. If the drug is
25included in the formulary of the Illinois AIDS Drug Assistance
26Program and covered by the Medicare Part D Prescription Drug



09700SB1802ham004- 46 -LRB097 09314 KTG 56512 a

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



09700SB1802ham004- 47 -LRB097 09314 KTG 56512 a

1    prescription drug used in the treatment of glaucoma; (8)
2    any prescription drug used in the treatment of lung disease
3    and smoking-related illnesses; (9) any prescription drug
4    used in the treatment of osteoporosis; and (10) any
5    prescription drug used in the treatment of multiple
6    sclerosis. The Department may add additional therapeutic
7    classes by rule. The Department may adopt a preferred drug
8    list within any of the classes of drugs described in items
9    (1) through (10) of this paragraph. The specific drugs or
10    therapeutic classes of covered prescription drugs shall be
11    indicated by rule.
12        For Eligibility Group 2, "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, "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, "covered prescription drug"
20    means those drugs covered by the Medicare Part D
21    Prescription Drug Plan in which the beneficiary is
22    enrolled.
23    An individual in Eligibility Group 1, 2, 3, or 4 may opt to
24receive a $25 monthly payment in lieu of the direct coverage
25described in this subsection.
26    Any person otherwise eligible for pharmaceutical



09700SB1802ham004- 48 -LRB097 09314 KTG 56512 a

1assistance under this subsection whose covered drugs are
2covered by any public program is ineligible for assistance
3under this subsection to the extent that the cost of those
4drugs is covered by the other program.
5    The Department of Healthcare and Family Services shall
6establish by rule the methods by which it will provide for the
7coverage called for in this subsection. Those methods may
8include direct reimbursement to pharmacies or the payment of a
9capitated amount to Medicare Part D Prescription Drug Plans.
10    For a pharmacy to be reimbursed under the program
11established under this subsection, it must comply with rules
12adopted by the Department of Healthcare and Family Services
13regarding coordination of benefits with Medicare Part D
14Prescription Drug Plans. A pharmacy may not charge a
15Medicare-enrolled beneficiary of the program established under
16this subsection more for a covered prescription drug than the
17appropriate Medicare cost-sharing less any payment from or on
18behalf of the Department of Healthcare and Family Services.
19    The Department of Healthcare and Family Services or the
20Department on Aging, as appropriate, may adopt rules regarding
21applications, counting of income, proof of Medicare status,
22mandatory generic policies, and pharmacy reimbursement rates
23and any other rules necessary for the cost-efficient operation
24of the program established under this subsection.
25    (h) A qualified individual is not entitled to duplicate
26benefits in a coverage period as a result of the changes made



09700SB1802ham004- 49 -LRB097 09314 KTG 56512 a

1by this amendatory Act of the 96th General Assembly.
2(Source: P.A. 95-208, eff. 8-16-07; 95-644, eff. 10-12-07;
395-876, eff. 8-21-08; 96-804, eff. 1-1-10; revised 9-16-10.)
4    Section 99. Effective date. This Act takes effect upon
5becoming law.".