Full Text of SB2242 94th General Assembly
SB2242eng 94TH GENERAL ASSEMBLY
|
|
|
SB2242 Engrossed |
|
LRB094 17727 RCE 53026 b |
|
| 1 |
| AN ACT concerning aging.
| 2 |
| Be it enacted by the People of the State of Illinois,
| 3 |
| represented in the General Assembly:
| 4 |
| Section 5. The Senior Citizens and Disabled Persons | 5 |
| Property Tax Relief and
Pharmaceutical Assistance Act is | 6 |
| amended by changing Section 4 as follows:
| 7 |
| (320 ILCS 25/4) (from Ch. 67 1/2, par. 404)
| 8 |
| Sec. 4. Amount of Grant.
| 9 |
| (a) In general. Any individual 65 years or older or any | 10 |
| individual who will
become 65 years old during the calendar | 11 |
| year in which a claim is filed, and any
surviving spouse of | 12 |
| such a claimant, who at the time of death received or was
| 13 |
| entitled to receive a grant pursuant to this Section, which | 14 |
| surviving spouse
will become 65 years of age within the 24 | 15 |
| months immediately following the
death of such claimant and | 16 |
| which surviving spouse but for his or her age is
otherwise | 17 |
| qualified to receive a grant pursuant to this Section, and any
| 18 |
| disabled person whose annual household income is less than the | 19 |
| income eligibility limitation, as defined in subsection (a-5),
| 20 |
| $14,000 for grant
years before the 1998 grant year, less than | 21 |
| $16,000 for the 1998 and 1999
grant years, and less than (i) | 22 |
| $21,218 for a household containing one person,
(ii) $28,480 for | 23 |
| a household containing 2 persons, or (iii) $35,740 for a
| 24 |
| household containing 3 or more persons for the 2000 grant year | 25 |
| and thereafter
and whose household is liable for payment of | 26 |
| property taxes accrued or has
paid rent constituting property | 27 |
| taxes accrued and is domiciled in this State
at the time he or | 28 |
| she files his or her claim is entitled to claim a
grant under | 29 |
| this Act.
With respect to claims filed by individuals who will | 30 |
| become 65 years old
during the calendar year in which a claim | 31 |
| is filed, the amount of any grant
to which that household is | 32 |
| entitled shall be an amount equal to 1/12 of the
amount to |
|
|
|
SB2242 Engrossed |
- 2 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| which the claimant would otherwise be entitled as provided in
| 2 |
| this Section, multiplied by the number of months in which the | 3 |
| claimant was
65 in the calendar year in which the claim is | 4 |
| filed.
| 5 |
| (a-5) Income eligibility limitation. For purposes of this | 6 |
| Section, "income eligibility limitation" means an amount: | 7 |
| (i) for grant years before the 1998 grant year, less | 8 |
| than $14,000; | 9 |
| (ii) for the 1998 and 1999 grant year, less than | 10 |
| $16,000; | 11 |
| (iii) for grant years 2000 through 2005: | 12 |
| (A) less than $21,218 for a household containing | 13 |
| one person; | 14 |
| (B) less than $28,480 for a household containing 2 | 15 |
| persons; or | 16 |
| (C) less than $35,740 for a
household containing 3 | 17 |
| or more persons; | 18 |
| (iv) for grant year 2006:
| 19 |
| (A) less than $23,218 for a household containing | 20 |
| one person; | 21 |
| (B) less than $30,480 for a household containing 2 | 22 |
| persons; or | 23 |
| (C) less than $37,740 for a
household containing 3 | 24 |
| or more persons; or | 25 |
| (v) for grant years 2007 and thereafter, less than the | 26 |
| income eligibility limitation of the previous grant year as | 27 |
| increased by the annual rate of increase, for the previous | 28 |
| calendar year, of the Consumer Price Index for All Urban
| 29 |
| Consumers for all items, published by the United States | 30 |
| Bureau of Labor Statistics. | 31 |
| (b) Limitation. Except as otherwise provided in | 32 |
| subsections (a) and (f)
of this Section, the maximum amount of | 33 |
| grant which a claimant is
entitled to claim is the amount by | 34 |
| which the property taxes accrued which
were paid or payable | 35 |
| during the last preceding tax year or rent
constituting | 36 |
| property taxes accrued upon the claimant's residence for the
|
|
|
|
SB2242 Engrossed |
- 3 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| last preceding taxable year exceeds 3 1/2% of the claimant's | 2 |
| household
income for that year but in no event is the grant to | 3 |
| exceed (i) $700 less
4.5% of household income for that year for | 4 |
| those with a household income of
$14,000 or less or (ii) $70 if | 5 |
| household income for that year is more than
$14,000.
| 6 |
| (c) Public aid recipients. If household income in one or | 7 |
| more
months during a year includes cash assistance in excess of | 8 |
| $55 per month
from the Department of Healthcare and Family | 9 |
| Services
Public Aid or the Department of Human Services (acting
| 10 |
| as successor to the Department of Public Aid under the | 11 |
| Department of Human
Services Act) which was determined under | 12 |
| regulations of
that Department on a measure of need that | 13 |
| included an allowance for actual
rent or property taxes paid by | 14 |
| the recipient of that assistance, the amount
of grant to which | 15 |
| that household is entitled, except as otherwise provided in
| 16 |
| subsection (a), shall be the product of (1) the maximum amount | 17 |
| computed as
specified in subsection (b) of this Section and (2) | 18 |
| the ratio of the number of
months in which household income did | 19 |
| not include such cash assistance over $55
to the number twelve. | 20 |
| If household income did not include such cash assistance
over | 21 |
| $55 for any months during the year, the amount of the grant to | 22 |
| which the
household is entitled shall be the maximum amount | 23 |
| computed as specified in
subsection (b) of this Section. For | 24 |
| purposes of this paragraph (c), "cash
assistance" does not | 25 |
| include any amount received under the federal Supplemental
| 26 |
| Security Income (SSI) program.
| 27 |
| (d) Joint ownership. If title to the residence is held | 28 |
| jointly by
the claimant with a person who is not a member of | 29 |
| his or her household,
the amount of property taxes accrued used | 30 |
| in computing the amount of grant
to which he or she is entitled | 31 |
| shall be the same percentage of property
taxes accrued as is | 32 |
| the percentage of ownership held by the claimant in the
| 33 |
| residence.
| 34 |
| (e) More than one residence. If a claimant has occupied | 35 |
| more than
one residence in the taxable year, he or she may | 36 |
| claim only one residence
for any part of a month. In the case |
|
|
|
SB2242 Engrossed |
- 4 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| of property taxes accrued, he or she
shall prorate 1/12 of the | 2 |
| total property taxes accrued on
his or her residence to each | 3 |
| month that he or she owned and occupied
that residence; and, in | 4 |
| the case of rent constituting property taxes accrued,
shall | 5 |
| prorate each month's rent payments to the residence
actually | 6 |
| occupied during that month.
| 7 |
| (f) There is hereby established a program of pharmaceutical | 8 |
| assistance
to the aged and disabled which shall be administered | 9 |
| by the Department in
accordance with this Act, to consist of | 10 |
| payments to authorized pharmacies, on
behalf of beneficiaries | 11 |
| of the program, for the reasonable costs of covered
| 12 |
| prescription drugs. Each beneficiary who pays $5 for an | 13 |
| identification card
shall pay no additional prescription | 14 |
| costs. Each beneficiary who pays $25 for
an identification card | 15 |
| shall pay $3 per prescription. In addition, after a
beneficiary | 16 |
| receives $2,000 in benefits during a State fiscal year, that
| 17 |
| beneficiary shall also be charged 20% of the cost of each | 18 |
| prescription for
which payments are made by the program during | 19 |
| the remainder of the fiscal
year. To become a beneficiary under | 20 |
| this program a person must: (1)
be (i) 65 years of age or | 21 |
| older, or (ii) the surviving spouse of such
a claimant, who at | 22 |
| the time of death received or was entitled to receive
benefits | 23 |
| pursuant to this subsection, which surviving spouse will become | 24 |
| 65
years of age within the 24 months immediately following the | 25 |
| death of such
claimant and which surviving spouse but for his | 26 |
| or her age is otherwise
qualified to receive benefits pursuant | 27 |
| to this subsection, or (iii) disabled,
and (2) be domiciled in | 28 |
| this State at the time he or she files
his or her claim, and (3) | 29 |
| have a maximum household income of less
than the income | 30 |
| eligibility limitation, as defined in subsection (a-5)
$14,000 | 31 |
| for grant years before the 1998 grant year, less than $16,000
| 32 |
| for the 1998 and 1999 grant years, and less than (i) $21,218 | 33 |
| for a household
containing one person, (ii) $28,480 for a | 34 |
| household containing 2 persons, or
(iii) $35,740 for a | 35 |
| household containing 3 more persons for the 2000 grant
year
and | 36 |
| thereafter . In addition, each eligible person must (1) obtain |
|
|
|
SB2242 Engrossed |
- 5 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| an
identification card from the Department, (2) at the time the | 2 |
| card is obtained,
sign a statement assigning to the State of | 3 |
| Illinois benefits which may be
otherwise claimed under any | 4 |
| private insurance plans, and (3) present the
identification | 5 |
| card to the dispensing pharmacist.
| 6 |
| The Department may adopt rules specifying
participation
| 7 |
| requirements for the pharmaceutical assistance program, | 8 |
| including copayment
amounts,
identification card fees, | 9 |
| expenditure limits, and the benefit threshold after
which a 20% | 10 |
| charge is imposed on the cost of each prescription, to be in
| 11 |
| effect on and
after July 1, 2004.
Notwithstanding any other | 12 |
| provision of this paragraph, however, the Department
may not
| 13 |
| increase the identification card fee above the amount in effect | 14 |
| on May 1, 2003
without
the express consent of the General | 15 |
| Assembly.
To the extent practicable, those requirements shall | 16 |
| be
commensurate
with the requirements provided in rules adopted | 17 |
| by the Department of Healthcare and Family Services
Public Aid
| 18 |
| to
implement the pharmacy assistance program under Section | 19 |
| 5-5.12a of the Illinois
Public
Aid Code.
| 20 |
| Whenever a generic equivalent for a covered prescription | 21 |
| drug is available,
the Department shall reimburse only for the | 22 |
| reasonable costs of the generic
equivalent, less the co-pay | 23 |
| established in this Section, unless (i) the covered
| 24 |
| prescription drug contains one or more ingredients defined as a | 25 |
| narrow
therapeutic index drug at 21 CFR 320.33, (ii) the | 26 |
| prescriber indicates on the
face of the prescription "brand | 27 |
| medically necessary", and (iii) the prescriber
specifies that a | 28 |
| substitution is not permitted. When issuing an oral
| 29 |
| prescription for covered prescription medication described in | 30 |
| item (i) of this
paragraph, the prescriber shall stipulate | 31 |
| "brand medically necessary" and
that a substitution is not | 32 |
| permitted. If the covered prescription drug and its
authorizing | 33 |
| prescription do not meet the criteria listed above, the | 34 |
| beneficiary
may purchase the non-generic equivalent of the | 35 |
| covered prescription drug by
paying the difference between the | 36 |
| generic cost and the non-generic cost plus
the beneficiary |
|
|
|
SB2242 Engrossed |
- 6 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| co-pay.
| 2 |
| Any person otherwise eligible for pharmaceutical | 3 |
| assistance under this
Act whose covered drugs are covered by | 4 |
| any public program for assistance in
purchasing any covered | 5 |
| prescription drugs shall be ineligible for assistance
under | 6 |
| this Act to the extent such costs are covered by such other | 7 |
| plan.
| 8 |
| The fee to be charged by the Department for the | 9 |
| identification card shall
be equal to $5 per coverage year for | 10 |
| persons below the official poverty line
as defined by the | 11 |
| United States Department of Health and Human Services and
$25 | 12 |
| per coverage year for all other persons.
| 13 |
| In the event that 2 or more persons are eligible for any | 14 |
| benefit under
this Act, and are members of the same household, | 15 |
| (1) each such person shall
be entitled to participate in the | 16 |
| pharmaceutical assistance program, provided
that he or she | 17 |
| meets all other requirements imposed by this subsection
and (2) | 18 |
| each participating household member contributes the fee | 19 |
| required
for that person by the preceding paragraph for the | 20 |
| purpose
of obtaining an identification card. | 21 |
| The provisions of this subsection (f), other than this | 22 |
| paragraph, are inoperative after December 31, 2005. | 23 |
| Beneficiaries who received benefits under the program | 24 |
| established by this subsection (f) are not entitled, at the | 25 |
| termination of the program, to any refund of the identification | 26 |
| card fee paid under this subsection. | 27 |
| (g) Effective January 1, 2006, there is hereby established | 28 |
| a program of pharmaceutical assistance to the aged and | 29 |
| disabled, entitled the Illinois Seniors and Disabled Drug | 30 |
| Coverage Program, which shall be administered by the Department | 31 |
| of Healthcare and Family Services and the Department on Aging | 32 |
| in accordance with this subsection, to consist of coverage of | 33 |
| specified prescription drugs on behalf of beneficiaries of the | 34 |
| program as set forth in this subsection. The program under this | 35 |
| subsection replaces and supersedes the program established | 36 |
| under subsection (f), which shall end at midnight on December |
|
|
|
SB2242 Engrossed |
- 7 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| 31, 2005. | 2 |
| To become a beneficiary under the program established under | 3 |
| this subsection, a person must: | 4 |
| (1) be (i) 65 years of age or older or (ii) disabled; | 5 |
| and | 6 |
| (2) be domiciled in this State; and | 7 |
| (3) enroll with a qualified Medicare Part D | 8 |
| Prescription Drug Plan if eligible and apply for all | 9 |
| available subsidies under Medicare Part D; and | 10 |
| (4) have a maximum household income of (i) less than | 11 |
| $21,218 for a household containing one person, (ii) less | 12 |
| than $28,480 for a household containing 2 persons, or (iii) | 13 |
| less than $35,740 for a household containing 3 or more | 14 |
| persons. If any income eligibility limit set forth in items | 15 |
| (i) through (iii) is less than 200% of the Federal Poverty | 16 |
| Level for any year, the income eligibility limit for that | 17 |
| year for households of that size shall be income equal to | 18 |
| or less than 200% of the Federal Poverty Level. | 19 |
| All individuals enrolled as of December 31, 2005, in the | 20 |
| pharmaceutical assistance program operated pursuant to | 21 |
| subsection (f) of this Section and all individuals enrolled as | 22 |
| of December 31, 2005, in the SeniorCare Medicaid waiver program | 23 |
| operated pursuant to Section 5-5.12a of the Illinois Public Aid | 24 |
| Code shall be automatically enrolled in the program established | 25 |
| by this subsection for the first year of operation without the | 26 |
| need for further application, except that they must apply for | 27 |
| Medicare Part D and the Low Income Subsidy under Medicare Part | 28 |
| D. A person enrolled in the pharmaceutical assistance program | 29 |
| operated pursuant to subsection (f) of this Section as of | 30 |
| December 31, 2005, shall not lose eligibility in future years | 31 |
| due only to the fact that they have not reached the age of 65. | 32 |
| To the extent permitted by federal law, the Department may | 33 |
| act as an authorized representative of a beneficiary in order | 34 |
| to enroll the beneficiary in a Medicare Part D Prescription | 35 |
| Drug Plan if the beneficiary has failed to choose a plan and, | 36 |
| where possible, to enroll beneficiaries in the low-income |
|
|
|
SB2242 Engrossed |
- 8 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| subsidy program under Medicare Part D or assist them in | 2 |
| enrolling in that program. | 3 |
| Beneficiaries under the program established under this | 4 |
| subsection shall be divided into the following 4 eligibility | 5 |
| groups: | 6 |
| (A) Eligibility Group 1 shall consist of beneficiaries | 7 |
| who are not eligible for Medicare Part D coverage and who
| 8 |
| are: | 9 |
| (i) disabled and under age 65; or | 10 |
| (ii) age 65 or older, with incomes over 200% of the | 11 |
| Federal Poverty Level; or | 12 |
| (iii) age 65 or older, with incomes at or below | 13 |
| 200% of the Federal Poverty Level and not eligible for | 14 |
| federally funded means-tested benefits due to | 15 |
| immigration status. | 16 |
| (B) Eligibility Group 2 shall consist of beneficiaries | 17 |
| otherwise described in Eligibility Group 1 but who are | 18 |
| eligible for Medicare Part D coverage. | 19 |
| (C) Eligibility Group 3 shall consist of beneficiaries | 20 |
| age 65 or older, with incomes at or below 200% of the | 21 |
| Federal Poverty Level, who are not barred from receiving | 22 |
| federally funded means-tested benefits due to immigration | 23 |
| status and are eligible for Medicare Part D coverage. | 24 |
| (D) Eligibility Group 4 shall consist of beneficiaries | 25 |
| age 65 or older, with incomes at or below 200% of the | 26 |
| Federal Poverty Level, who are not barred from receiving | 27 |
| federally funded means-tested benefits due to immigration | 28 |
| status and are not eligible for Medicare Part D coverage. | 29 |
| If the State applies and receives federal approval for a | 30 |
| waiver under Title XIX of the Social Security Act, persons in | 31 |
| Eligibility Group 4 shall continue to receive benefits through | 32 |
| the approved waiver, and Eligibility Group 4 may be expanded to | 33 |
| include disabled persons under age 65 with incomes under 200% | 34 |
| of the Federal Poverty Level who are not eligible for Medicare | 35 |
| and who are not barred from receiving federally funded | 36 |
| means-tested benefits due to immigration status. |
|
|
|
SB2242 Engrossed |
- 9 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| The program established under this subsection shall cover | 2 |
| the cost of covered prescription drugs in excess of the | 3 |
| beneficiary cost-sharing amounts set forth in this paragraph | 4 |
| that are not covered by Medicare. In 2006, beneficiaries shall | 5 |
| pay a co-payment of $2 for each prescription of a generic drug | 6 |
| and $5 for each prescription of a brand-name drug. In future | 7 |
| years, beneficiaries shall pay co-payments equal to the | 8 |
| co-payments required under Medicare Part D for "other | 9 |
| low-income subsidy eligible individuals" pursuant to 42 CFR | 10 |
| 423.782(b). Once the program established under this subsection | 11 |
| and Medicare combined have paid $1,750 in a year for covered | 12 |
| prescription drugs, the beneficiary shall pay 20% of the cost | 13 |
| of each prescription in addition to the co-payments set forth | 14 |
| in this paragraph. | 15 |
| For beneficiaries eligible for Medicare Part D coverage, | 16 |
| the program established under this subsection shall pay 100% of | 17 |
| the premiums charged by a qualified Medicare Part D | 18 |
| Prescription Drug Plan for Medicare Part D basic prescription | 19 |
| drug coverage, not including any late enrollment penalties. | 20 |
| Qualified Medicare Part D Prescription Drug Plans may be | 21 |
| limited by the Department of Healthcare and Family Services to | 22 |
| those plans that sign a coordination agreement with the | 23 |
| Department. | 24 |
| Notwithstanding Section 3.15, for purposes of the program | 25 |
| established under this subsection, the term "covered | 26 |
| prescription drug" has the following meanings: | 27 |
| For Eligibility Group 1, "covered prescription drug" | 28 |
| means: (1) any cardiovascular agent or drug; (2) any | 29 |
| insulin or other prescription drug used in the treatment of | 30 |
| diabetes, including syringe and needles used to administer | 31 |
| the insulin; (3) any prescription drug used in the | 32 |
| treatment of arthritis; (4) any prescription drug used in | 33 |
| the treatment of cancer; (5) any prescription drug used in | 34 |
| the treatment of Alzheimer's disease; (6) any prescription | 35 |
| drug used in the treatment of Parkinson's disease; (7) any | 36 |
| prescription drug used in the treatment of glaucoma; (8) |
|
|
|
SB2242 Engrossed |
- 10 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| any prescription drug used in the treatment of lung disease | 2 |
| and smoking-related illnesses; (9) any prescription drug | 3 |
| used in the treatment of osteoporosis; and (10) any | 4 |
| prescription drug used in the treatment of multiple | 5 |
| sclerosis. The Department may add additional therapeutic | 6 |
| classes by rule. The Department may adopt a preferred drug | 7 |
| list within any of the classes of drugs described in items | 8 |
| (1) through (10) of this paragraph. The specific drugs or | 9 |
| therapeutic classes of covered prescription drugs shall be | 10 |
| indicated by rule. | 11 |
| For Eligibility Group 2, "covered prescription drug" | 12 |
| means those drugs covered for Eligibility Group 1 that are | 13 |
| also covered by the Medicare Part D Prescription Drug Plan | 14 |
| in which the beneficiary is enrolled. | 15 |
| For Eligibility Group 3, "covered prescription drug" | 16 |
| means those drugs covered by the Medicare Part D | 17 |
| Prescription Drug Plan in which the beneficiary is | 18 |
| enrolled. | 19 |
| For Eligibility Group 4, "covered prescription drug" | 20 |
| means those drugs covered by the Medical Assistance Program | 21 |
| under Article V of the Illinois Public Aid Code. | 22 |
| An individual in Eligibility Group 3 or 4 may opt to | 23 |
| receive a $25 monthly payment in lieu of the direct coverage | 24 |
| described in this subsection. | 25 |
| Any person otherwise eligible for pharmaceutical | 26 |
| assistance under this subsection whose covered drugs are | 27 |
| covered by any public program is ineligible for assistance | 28 |
| under this subsection to the extent that the cost of those | 29 |
| drugs is covered by the other program. | 30 |
| The Department of Healthcare and Family Services shall | 31 |
| establish by rule the methods by which it will provide for the | 32 |
| coverage called for in this subsection. Those methods may | 33 |
| include direct reimbursement to pharmacies or the payment of a | 34 |
| capitated amount to Medicare Part D Prescription Drug Plans. | 35 |
| For a pharmacy to be reimbursed under the program | 36 |
| established under this subsection, it must comply with rules |
|
|
|
SB2242 Engrossed |
- 11 - |
LRB094 17727 RCE 53026 b |
|
| 1 |
| adopted by the Department of Healthcare and Family Services | 2 |
| regarding coordination of benefits with Medicare Part D | 3 |
| Prescription Drug Plans. A pharmacy may not charge a | 4 |
| Medicare-enrolled beneficiary of the program established under | 5 |
| this subsection more for a covered prescription drug than the | 6 |
| appropriate Medicare cost-sharing less any payment from or on | 7 |
| behalf of the Department of Healthcare and Family Services. | 8 |
| The Department of Healthcare and Family Services or the | 9 |
| Department on Aging, as appropriate, may adopt rules regarding | 10 |
| applications, counting of income, proof of Medicare status, | 11 |
| mandatory generic policies, and pharmacy reimbursement rates | 12 |
| and any other rules necessary for the cost-efficient operation | 13 |
| of the program established under this subsection.
| 14 |
| (Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; revised | 15 |
| 12-15-05.)
| 16 |
| Section 99. Effective date. This Act takes effect upon | 17 |
| becoming law.
|
|