HB6851 93RD GENERAL ASSEMBLY

LRB093 18822 AMC 44557 b

93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB6851

Introduced 02/09/04, by Elizabeth Coulson

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.12a

Amends the Public Aid Code. Provides that, in the event that the current pharmacy assistance program ceases to provide benefits and the federal government creates a Medicare prescription drug benefit, the Department shall develop a new supplemental coverage program to help cover out-of-pocket expenses of individuals enrolled in the Medicare prescription drug benefit program. Provides guidelines for coverage under and eligibility for the program. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by changing Section 5-5.12a as follows:

(305 ILCS 5/5-5.12a)

Sec. 5-5.12a. Title XIX waiver; pharmacy assistance program. The Illinois Department may seek a waiver of otherwise applicable requirements of Title XIX of the federal Social Security Act in order to claim federal financial participation for a pharmacy assistance program for persons aged 65 and over with income levels at or less than 250% of the federal poverty level. The Illinois Department may provide by rule for all other requirements of the program, including cost sharing, as permitted by an approved waiver and without regard to any provision of this Code to the contrary. The benefits may be no more restrictive than the Pharmacy Assistance Program in effect on May 31, 2001. Benefits provided under the waiver are subject to appropriation.

The Illinois Department may not implement the waiver until cost neutrality is demonstrated for the State relative to the final Pharmacy Assistance Program appropriation for the fiscal year beginning July 1, 2001. Implementation of the waiver shall terminate on June 30, 2007.

In the event that the program implemented under this Section ceases to provide benefits and the federal government creates a Medicare prescription drug benefit, the Department shall develop a new supplemental coverage program to help cover out-of-pocket expenses of individuals enrolled in the Medicare prescription drug benefit program. The coverage under this new supplemental program shall include reimbursements for out-of-pocket expenses, including premiums, deductibles, co-payments, and any other payments required by enrollees. The coverage provided under this supplemental program may be capped by the Department, provided that the cap implemented by the Department is not less than the cost of Medicare prescription drug coverage premiums paid by an enrollee or the amount of $420 per person, whichever is greater. In no case shall the reimbursements under this supplemental program be higher than the actual out-of-pocket expenses incurred by the enrollee. Eligibility for the supplemental program shall be set by the Department, but shall include at a minimum persons who would have met income eligibility requirements for the program under this Section as of January 1, 2004. The Department shall adopt any additional rules to implement this new supplemental pharmacy assistance program.

(Source: P.A. 92-10, eff. 6-11-01.)

Section 99. Effective date. This Act takes effect upon becoming law.