Illinois General Assembly - Full Text of SB1802
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Full Text of SB1802  97th General Assembly


Rep. Sara Feigenholtz

Filed: 5/28/2011





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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. For State fiscal year 2012,
8rates for medical services purchased by the Divisions of
9Alcohol and Substance Abuse, Community Health and Prevention,
10Developmentally Disabilities, Mental Health, or Rehabilitation
11Services within the Department of Human Services shall not be
12reduced below the rates calculated on April 1, 2011 unless the
13Department of Human Services promulgates rules and rules are
14implemented authorizing rate reductions.
15    Section 2. The Civil Administrative Code of Illinois is



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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



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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



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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



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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.



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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).



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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



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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 the Department, parents
16or guardians of students attending the Illinois School for the
17Deaf or the Illinois School for the Visually Impaired shall be
18asked to financially participate in the following fees for
19services or activities provided at the schools:
20        (1) Registration.
21        (2) Books, labs, and supplies (fees may vary depending
22    on the classes in which a student participates).
23        (3) Room and board for residential students.
24        (4) Meals for day students.
25        (5) Athletic or extracurricular activities (students
26    participating in multiple activities will not be required



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1    to pay for more than 2 activities).
2        (6) Driver's education (if applicable).
3        (7) Graduation.
4        (8) Yearbook (optional).
5        (9) Activities (field trips or other leisure
6    activities).
7        (10) Other activities or services identified by the
8    Department.
9    Students, parents, or guardians who are receiving Medicaid
10or Temporary Assistance for Needy Families (TANF) shall not be
11required to financially participate in the fees established in
12this subsection (c).
13    Exceptions may be granted to parents or guardians who are
14unable to meet the financial participation obligations due to
15extenuating circumstances. Requests for exceptions must be
16made in writing and must be submitted to the Director of the
17Division of Rehabilitation Services for review.
18    Section 5. The State Prompt Payment Act is amended by
19changing Section 3-2 as follows:
20    (30 ILCS 540/3-2)
21    Sec. 3-2. Beginning July 1, 1993, in any instance where a
22State official or agency is late in payment of a vendor's bill
23or invoice for goods or services furnished to the State, as
24defined in Section 1, properly approved in accordance with



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1rules promulgated under Section 3-3, the State official or
2agency shall pay interest to the vendor in accordance with the
4        (1) Any bill, except a bill submitted under Article V
5    of the Illinois Public Aid Code, approved for payment under
6    this Section must be paid or the payment issued to the
7    payee within 90 60 days of receipt of a proper bill or
8    invoice. If payment is not issued to the payee within this
9    90-day 60 day period, an interest penalty of 1.0% of any
10    amount approved and unpaid shall be added for each month or
11    fraction thereof after the end of this 90-day 60 day
12    period, until final payment is made. Any bill, except a
13    bill for pharmacy or nursing facility services or goods,
14    submitted under Article V of the Illinois Public Aid Code
15    approved for payment under this Section must be paid or the
16    payment issued to the payee within 60 days after receipt of
17    a proper bill or invoice, and, if payment is not issued to
18    the payee within this 60-day period, an interest penalty of
19    2.0% of any amount approved and unpaid shall be added for
20    each month or fraction thereof after the end of this 60-day
21    period, until final payment is made. Any bill for pharmacy
22    or nursing facility services or goods submitted under
23    Article V of the Illinois Public Aid Code, approved for
24    payment under this Section must be paid or the payment
25    issued to the payee within 60 days of receipt of a proper
26    bill or invoice. If payment is not issued to the payee



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1    within this 60-day 60 day period, an interest penalty of
2    1.0% of any amount approved and unpaid shall be added for
3    each month or fraction thereof after the end of this 60-day
4    60 day period, until final payment is made.
5        (1.1) A State agency shall review in a timely manner
6    each bill or invoice after its receipt. If the State agency
7    determines that the bill or invoice contains a defect
8    making it unable to process the payment request, the agency
9    shall notify the vendor requesting payment as soon as
10    possible after discovering the defect pursuant to rules
11    promulgated under Section 3-3; provided, however, that the
12    notice for construction related bills or invoices must be
13    given not later than 30 days after the bill or invoice was
14    first submitted. The notice shall identify the defect and
15    any additional information necessary to correct the
16    defect. If one or more items on a construction related bill
17    or invoice are disapproved, but not the entire bill or
18    invoice, then the portion that is not disapproved shall be
19    paid.
20        (2) Where a State official or agency is late in payment
21    of a vendor's bill or invoice properly approved in
22    accordance with this Act, and different late payment terms
23    are not reduced to writing as a contractual agreement, the
24    State official or agency shall automatically pay interest
25    penalties required by this Section amounting to $50 or more
26    to the appropriate vendor. Each agency shall be responsible



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1    for determining whether an interest penalty is owed and for
2    paying the interest to the vendor. Interest due to a vendor
3    that amounts to less than $50 shall not be paid but shall
4    be accrued until all interest due the vendor for all
5    similar warrants exceeds $50, at which time the accrued
6    interest shall be payable and interest will begin accruing
7    again, except that interest accrued as of the end of the
8    fiscal year that does not exceed $50 shall be payable at
9    that time. In the event an individual has paid a vendor for
10    services in advance, the provisions of this Section shall
11    apply until payment is made to that individual.
12        (3) The provisions of Public Act 96-1501 this
13    amendatory Act of the 96th General Assembly reducing the
14    interest rate on pharmacy claims under Article V of the
15    Illinois Public Aid Code to 1.0% per month shall apply to
16    any pharmacy bills for services and goods under Article V
17    of the Illinois Public Aid Code received on or after the
18    date 60 days before January 25, 2011 (the effective date of
19    Public Act 96-1501) until the effective date of this
20    amendatory Act of the 97th General Assembly this amendatory
21    Act of the 96th General Assembly.
22(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10;
2396-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff.
241-25-11; 96-1530, eff. 2-16-11; revised 2-22-11.)
25    Section 10. The Children's Health Insurance Program Act is



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1amended by changing Section 30 as follows:
2    (215 ILCS 106/30)
3    Sec. 30. Cost sharing.
4    (a) Children enrolled in a health benefits program pursuant
5to subdivision (a)(2) of Section 25 and persons enrolled in a
6health benefits waiver program pursuant to Section 40 shall be
7subject to the following cost sharing requirements:
8        (1) There shall be no co-payment required for well-baby
9    or well-child care, including age-appropriate
10    immunizations as required under federal law.
11        (2) Health insurance premiums for family members,
12    either children or adults, in families whose household
13    income is above 150% of the federal poverty level shall be
14    payable monthly, subject to rules promulgated by the
15    Department for grace periods and advance payments, and
16    shall be as follows:
17            (A) $15 per month for one family member.
18            (B) $25 per month for 2 family members.
19            (C) $30 per month for 3 family members.
20            (D) $35 per month for 4 family members.
21            (E) $40 per month for 5 or more family members.
22        (3) Co-payments for children or adults in families
23    whose income is at or below 150% of the federal poverty
24    level, at a minimum and to the extent permitted under
25    federal law, shall be $2 for all medical visits and



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1    prescriptions provided under this Act and up to $10 for
2    emergency room use for a non-emergency situation as defined
3    by the Department by rule and subject to federal approval.
4        (4) Co-payments for children or adults in families
5    whose income is above 150% of the federal poverty level, at
6    a minimum and to the extent permitted under federal law
7    shall be as follows:
8            (A) $5 for medical visits.
9            (B) $3 for generic prescriptions and $5 for brand
10        name prescriptions.
11            (C) $25 for emergency room use for a non-emergency
12        situation as defined by the Department by rule.
13        (5) (Blank) The maximum amount of out-of-pocket
14    expenses for co-payments shall be $100 per family per year.
15        (6) Co-payments shall be maximized to the extent
16    permitted by federal law and are subject to federal
17    approval.
18    (b) Individuals enrolled in a privately sponsored health
19insurance plan pursuant to subdivision (a)(1) of Section 25
20shall be subject to the cost sharing provisions as stated in
21the privately sponsored health insurance plan.
22(Source: P.A. 94-48, eff. 7-1-05.)
23    Section 15. The Illinois Public Aid Code is amended by
24changing Sections 5-2, 5-4.1, 5-5.12, and 5A-10, as follows:



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1    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
2    Sec. 5-2. Classes of Persons Eligible. Medical assistance
3under this Article shall be available to any of the following
4classes of persons in respect to whom a plan for coverage has
5been submitted to the Governor by the Illinois Department and
6approved by him:
7        1. Recipients of basic maintenance grants under
8    Articles III and IV.
9        2. Persons otherwise eligible for basic maintenance
10    under Articles III and IV, excluding any eligibility
11    requirements that are inconsistent with any federal law or
12    federal regulation, as interpreted by the U.S. Department
13    of Health and Human Services, but who fail to qualify
14    thereunder on the basis of need or who qualify but are not
15    receiving basic maintenance under Article IV, and who have
16    insufficient income and resources to meet the costs of
17    necessary medical care, including but not limited to the
18    following:
19            (a) All persons otherwise eligible for basic
20        maintenance under Article III but who fail to qualify
21        under that Article on the basis of need and who meet
22        either of the following requirements:
23                (i) their income, as determined by the
24            Illinois Department in accordance with any federal
25            requirements, is equal to or less than 70% in
26            fiscal year 2001, equal to or less than 85% in



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1            fiscal year 2002 and until a date to be determined
2            by the Department by rule, and equal to or less
3            than 100% beginning on the date determined by the
4            Department by rule, of the nonfarm income official
5            poverty line, as defined by the federal Office of
6            Management and Budget and revised annually in
7            accordance with Section 673(2) of the Omnibus
8            Budget Reconciliation Act of 1981, applicable to
9            families of the same size; or
10                (ii) their income, after the deduction of
11            costs incurred for medical care and for other types
12            of remedial care, is equal to or less than 70% in
13            fiscal year 2001, equal to or less than 85% in
14            fiscal year 2002 and until a date to be determined
15            by the Department by rule, and equal to or less
16            than 100% beginning on the date determined by the
17            Department by rule, of the nonfarm income official
18            poverty line, as defined in item (i) of this
19            subparagraph (a).
20            (b) All persons who, excluding any eligibility
21        requirements that are inconsistent with any federal
22        law or federal regulation, as interpreted by the U.S.
23        Department of Health and Human Services, would be
24        determined eligible for such basic maintenance under
25        Article IV by disregarding the maximum earned income
26        permitted by federal law.



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1        3. Persons who would otherwise qualify for Aid to the
2    Medically Indigent under Article VII.
3        4. Persons not eligible under any of the preceding
4    paragraphs who fall sick, are injured, or die, not having
5    sufficient money, property or other resources to meet the
6    costs of necessary medical care or funeral and burial
7    expenses.
8        5.(a) Women during pregnancy, after the fact of
9    pregnancy has been determined by medical diagnosis, and
10    during the 60-day period beginning on the last day of the
11    pregnancy, together with their infants and children born
12    after September 30, 1983, whose income and resources are
13    insufficient to meet the costs of necessary medical care to
14    the maximum extent possible under Title XIX of the Federal
15    Social Security Act.
16        (b) The Illinois Department and the Governor shall
17    provide a plan for coverage of the persons eligible under
18    paragraph 5(a) by April 1, 1990. Such plan shall provide
19    ambulatory prenatal care to pregnant women during a
20    presumptive eligibility period and establish an income
21    eligibility standard that is equal to 133% of the nonfarm
22    income official poverty line, as defined by the federal
23    Office of Management and Budget and revised annually in
24    accordance with Section 673(2) of the Omnibus Budget
25    Reconciliation Act of 1981, applicable to families of the
26    same size, provided that costs incurred for medical care



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1    are not taken into account in determining such income
2    eligibility.
3        (c) The Illinois Department may conduct a
4    demonstration in at least one county that will provide
5    medical assistance to pregnant women, together with their
6    infants and children up to one year of age, where the
7    income eligibility standard is set up to 185% of the
8    nonfarm income official poverty line, as defined by the
9    federal Office of Management and Budget. The Illinois
10    Department shall seek and obtain necessary authorization
11    provided under federal law to implement such a
12    demonstration. Such demonstration may establish resource
13    standards that are not more restrictive than those
14    established under Article IV of this Code.
15        6. Persons under the age of 18 who fail to qualify as
16    dependent under Article IV and who have insufficient income
17    and resources to meet the costs of necessary medical care
18    to the maximum extent permitted under Title XIX of the
19    Federal Social Security Act.
20        7. Persons who are under 21 years of age and would
21    qualify as disabled as defined under the Federal
22    Supplemental Security Income Program, provided medical
23    service for such persons would be eligible for Federal
24    Financial Participation, and provided the Illinois
25    Department determines that:
26            (a) the person requires a level of care provided by



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1        a hospital, skilled nursing facility, or intermediate
2        care facility, as determined by a physician licensed to
3        practice medicine in all its branches;
4            (b) it is appropriate to provide such care outside
5        of an institution, as determined by a physician
6        licensed to practice medicine in all its branches;
7            (c) the estimated amount which would be expended
8        for care outside the institution is not greater than
9        the estimated amount which would be expended in an
10        institution.
11        8. Persons who become ineligible for basic maintenance
12    assistance under Article IV of this Code in programs
13    administered by the Illinois Department due to employment
14    earnings and persons in assistance units comprised of
15    adults and children who become ineligible for basic
16    maintenance assistance under Article VI of this Code due to
17    employment earnings. The plan for coverage for this class
18    of persons shall:
19            (a) extend the medical assistance coverage for up
20        to 12 months following termination of basic
21        maintenance assistance; and
22            (b) offer persons who have initially received 6
23        months of the coverage provided in paragraph (a) above,
24        the option of receiving an additional 6 months of
25        coverage, subject to the following:
26                (i) such coverage shall be pursuant to



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1            provisions of the federal Social Security Act;
2                (ii) such coverage shall include all services
3            covered while the person was eligible for basic
4            maintenance assistance;
5                (iii) no premium shall be charged for such
6            coverage; and
7                (iv) such coverage shall be suspended in the
8            event of a person's failure without good cause to
9            file in a timely fashion reports required for this
10            coverage under the Social Security Act and
11            coverage shall be reinstated upon the filing of
12            such reports if the person remains otherwise
13            eligible.
14        9. Persons with acquired immunodeficiency syndrome
15    (AIDS) or with AIDS-related conditions with respect to whom
16    there has been a determination that but for home or
17    community-based services such individuals would require
18    the level of care provided in an inpatient hospital,
19    skilled nursing facility or intermediate care facility the
20    cost of which is reimbursed under this Article. Assistance
21    shall be provided to such persons to the maximum extent
22    permitted under Title XIX of the Federal Social Security
23    Act.
24        10. Participants in the long-term care insurance
25    partnership program established under the Illinois
26    Long-Term Care Partnership Program Act who meet the



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1    qualifications for protection of resources described in
2    Section 15 of that Act.
3        11. Persons with disabilities who are employed and
4    eligible for Medicaid, pursuant to Section
5    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
6    subject to federal approval, persons with a medically
7    improved disability who are employed and eligible for
8    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
9    the Social Security Act, as provided by the Illinois
10    Department by rule. In establishing eligibility standards
11    under this paragraph 11, the Department shall, subject to
12    federal approval:
13            (a) set the income eligibility standard at not
14        lower than 350% of the federal poverty level;
15            (b) exempt retirement accounts that the person
16        cannot access without penalty before the age of 59 1/2,
17        and medical savings accounts established pursuant to
18        26 U.S.C. 220;
19            (c) allow non-exempt assets up to $25,000 as to
20        those assets accumulated during periods of eligibility
21        under this paragraph 11; and
22            (d) continue to apply subparagraphs (b) and (c) in
23        determining the eligibility of the person under this
24        Article even if the person loses eligibility under this
25        paragraph 11.
26        12. Subject to federal approval, persons who are



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1    eligible for medical assistance coverage under applicable
2    provisions of the federal Social Security Act and the
3    federal Breast and Cervical Cancer Prevention and
4    Treatment Act of 2000. Those eligible persons are defined
5    to include, but not be limited to, the following persons:
6            (1) persons who have been screened for breast or
7        cervical cancer under the U.S. Centers for Disease
8        Control and Prevention Breast and Cervical Cancer
9        Program established under Title XV of the federal
10        Public Health Services Act in accordance with the
11        requirements of Section 1504 of that Act as
12        administered by the Illinois Department of Public
13        Health; and
14            (2) persons whose screenings under the above
15        program were funded in whole or in part by funds
16        appropriated to the Illinois Department of Public
17        Health for breast or cervical cancer screening.
18        "Medical assistance" under this paragraph 12 shall be
19    identical to the benefits provided under the State's
20    approved plan under Title XIX of the Social Security Act.
21    The Department must request federal approval of the
22    coverage under this paragraph 12 within 30 days after the
23    effective date of this amendatory Act of the 92nd General
24    Assembly.
25        In addition to the persons who are eligible for medical
26    assistance pursuant to subparagraphs (1) and (2) of this



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1    paragraph 12, and to be paid from funds appropriated to the
2    Department for its medical programs, any uninsured person
3    as defined by the Department in rules residing in Illinois
4    who is younger than 65 years of age, who has been screened
5    for breast and cervical cancer in accordance with standards
6    and procedures adopted by the Department of Public Health
7    for screening, and who is referred to the Department by the
8    Department of Public Health as being in need of treatment
9    for breast or cervical cancer is eligible for medical
10    assistance benefits that are consistent with the benefits
11    provided to those persons described in subparagraphs (1)
12    and (2). Medical assistance coverage for the persons who
13    are eligible under the preceding sentence is not dependent
14    on federal approval, but federal moneys may be used to pay
15    for services provided under that coverage upon federal
16    approval.
17        13. Subject to appropriation and to federal approval,
18    persons living with HIV/AIDS who are not otherwise eligible
19    under this Article and who qualify for services covered
20    under Section 5-5.04 as provided by the Illinois Department
21    by rule.
22        14. Subject to the availability of funds for this
23    purpose, the Department may provide coverage under this
24    Article to persons who reside in Illinois who are not
25    eligible under any of the preceding paragraphs and who meet
26    the income guidelines of paragraph 2(a) of this Section and



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1    (i) have an application for asylum pending before the
2    federal Department of Homeland Security or on appeal before
3    a court of competent jurisdiction and are represented
4    either by counsel or by an advocate accredited by the
5    federal Department of Homeland Security and employed by a
6    not-for-profit organization in regard to that application
7    or appeal, or (ii) are receiving services through a
8    federally funded torture treatment center. Medical
9    coverage under this paragraph 14 may be provided for up to
10    24 continuous months from the initial eligibility date so
11    long as an individual continues to satisfy the criteria of
12    this paragraph 14. If an individual has an appeal pending
13    regarding an application for asylum before the Department
14    of Homeland Security, eligibility under this paragraph 14
15    may be extended until a final decision is rendered on the
16    appeal. The Department may adopt rules governing the
17    implementation of this paragraph 14.
18        15. Family Care Eligibility.
19            (a) Through December 31, 2013, a A caretaker
20        relative who is 19 years of age or older when countable
21        income is at or below 185% of the Federal Poverty Level
22        Guidelines, as published annually in the Federal
23        Register, for the appropriate family size. Beginning
24        January 1, 2014, a caretaker relative who is 19 years
25        of age or older when countable income is at or below
26        133% of the Federal Poverty Level Guidelines, as



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1        published annually in the Federal Register, for the
2        appropriate family size. A person may not spend down to
3        become eligible under this paragraph 15.
4            (b) Eligibility shall be reviewed annually.
5            (c) Caretaker relatives enrolled under this
6        paragraph 15 in families with countable income above
7        150% and at or below 185% of the Federal Poverty Level
8        Guidelines shall be counted as family members and pay
9        premiums as established under the Children's Health
10        Insurance Program Act.
11            (d) Premiums shall be billed by and payable to the
12        Department or its authorized agent, on a monthly basis.
13            (e) The premium due date is the last day of the
14        month preceding the month of coverage.
15            (f) Individuals shall have a grace period through
16        30 days of coverage to pay the premium.
17            (g) Failure to pay the full monthly premium by the
18        last day of the grace period shall result in
19        termination of coverage.
20            (h) Partial premium payments shall not be
21        refunded.
22            (i) Following termination of an individual's
23        coverage under this paragraph 15, the following action
24        is required before the individual can be re-enrolled:
25                (1) A new application must be completed and the
26            individual must be determined otherwise eligible.



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1                (2) There must be full payment of premiums due
2            under this Code, the Children's Health Insurance
3            Program Act, the Covering ALL KIDS Health
4            Insurance Act, or any other healthcare program
5            administered by the Department for periods in
6            which a premium was owed and not paid for the
7            individual.
8                (3) The first month's premium must be paid if
9            there was an unpaid premium on the date the
10            individual's previous coverage was canceled.
11        The Department is authorized to implement the
12    provisions of this amendatory Act of the 95th General
13    Assembly by adopting the medical assistance rules in effect
14    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
15    89 Ill. Admin. Code 120.32 along with only those changes
16    necessary to conform to federal Medicaid requirements,
17    federal laws, and federal regulations, including but not
18    limited to Section 1931 of the Social Security Act (42
19    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
20    of Health and Human Services, and the countable income
21    eligibility standard authorized by this paragraph 15. The
22    Department may not otherwise adopt any rule to implement
23    this increase except as authorized by law, to meet the
24    eligibility standards authorized by the federal government
25    in the Medicaid State Plan or the Title XXI Plan, or to
26    meet an order from the federal government or any court.



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1        16. Subject to appropriation, uninsured persons who
2    are not otherwise eligible under this Section who have been
3    certified and referred by the Department of Public Health
4    as having been screened and found to need diagnostic
5    evaluation or treatment, or both diagnostic evaluation and
6    treatment, for prostate or testicular cancer. For the
7    purposes of this paragraph 16, uninsured persons are those
8    who do not have creditable coverage, as defined under the
9    Health Insurance Portability and Accountability Act, or
10    have otherwise exhausted any insurance benefits they may
11    have had, for prostate or testicular cancer diagnostic
12    evaluation or treatment, or both diagnostic evaluation and
13    treatment. To be eligible, a person must furnish a Social
14    Security number. A person's assets are exempt from
15    consideration in determining eligibility under this
16    paragraph 16. Such persons shall be eligible for medical
17    assistance under this paragraph 16 for so long as they need
18    treatment for the cancer. A person shall be considered to
19    need treatment if, in the opinion of the person's treating
20    physician, the person requires therapy directed toward
21    cure or palliation of prostate or testicular cancer,
22    including recurrent metastatic cancer that is a known or
23    presumed complication of prostate or testicular cancer and
24    complications resulting from the treatment modalities
25    themselves. Persons who require only routine monitoring
26    services are not considered to need treatment. "Medical



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1    assistance" under this paragraph 16 shall be identical to
2    the benefits provided under the State's approved plan under
3    Title XIX of the Social Security Act. Notwithstanding any
4    other provision of law, the Department (i) does not have a
5    claim against the estate of a deceased recipient of
6    services under this paragraph 16 and (ii) does not have a
7    lien against any homestead property or other legal or
8    equitable real property interest owned by a recipient of
9    services under this paragraph 16.
10    In implementing the provisions of Public Act 96-20, the
11Department is authorized to adopt only those rules necessary,
12including emergency rules. Nothing in Public Act 96-20 permits
13the Department to adopt rules or issue a decision that expands
14eligibility for the FamilyCare Program to a person whose income
15exceeds 185% of the Federal Poverty Level as determined from
16time to time by the U.S. Department of Health and Human
17Services, unless the Department is provided with express
18statutory authority.
19    The Illinois Department and the Governor shall provide a
20plan for coverage of the persons eligible under paragraph 7 as
21soon as possible after July 1, 1984.
22    The eligibility of any such person for medical assistance
23under this Article is not affected by the payment of any grant
24under the Senior Citizens and Disabled Persons Property Tax
25Relief and Pharmaceutical Assistance Act or any distributions
26or items of income described under subparagraph (X) of



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1paragraph (2) of subsection (a) of Section 203 of the Illinois
2Income Tax Act. The Department shall by rule establish the
3amounts of assets to be disregarded in determining eligibility
4for medical assistance, which shall at a minimum equal the
5amounts to be disregarded under the Federal Supplemental
6Security Income Program. The amount of assets of a single
7person to be disregarded shall not be less than $2,000, and the
8amount of assets of a married couple to be disregarded shall
9not be less than $3,000.
10    To the extent permitted under federal law, any person found
11guilty of a second violation of Article VIIIA shall be
12ineligible for medical assistance under this Article, as
13provided in Section 8A-8.
14    The eligibility of any person for medical assistance under
15this Article shall not be affected by the receipt by the person
16of donations or benefits from fundraisers held for the person
17in cases of serious illness, as long as neither the person nor
18members of the person's family have actual control over the
19donations or benefits or the disbursement of the donations or
21(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
2296-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.
238-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123,
24eff. 1-1-11; 96-1270, eff. 7-26-10; revised 9-16-10.)
25    (305 ILCS 5/5-4.1)  (from Ch. 23, par. 5-4.1)



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1    Sec. 5-4.1. Co-payments. The Department may by rule provide
2that recipients under any Article of this Code shall pay a fee
3as a co-payment for services. Co-payments shall be maximized to
4the extent permitted by federal law. Provided, however, that
5any such rule must provide that no co-payment requirement can
6exist for renal dialysis, radiation therapy, cancer
7chemotherapy, or insulin, and other products necessary on a
8recurring basis, the absence of which would be life
9threatening, or where co-payment expenditures for required
10services and/or medications for chronic diseases that the
11Illinois Department shall by rule designate shall cause an
12extensive financial burden on the recipient, and provided no
13co-payment shall exist for emergency room encounters which are
14for medical emergencies. The Department shall seek approval of
15a State plan amendment that allows pharmacies to refuse to
16dispense drugs in circumstances where the recipient does not
17pay the required co-payment. In the event the State plan
18amendment is rejected, co-payments may not exceed $3 for brand
19name drugs, $1 for other pharmacy services other than for
20generic drugs, and $2 for physician services, dental services,
21optical services and supplies, chiropractic services, podiatry
22services, and encounter rate clinic services. There shall be no
23co-payment for generic drugs. Co-payments may not exceed $10
24for emergency room use for a non-emergency situation as defined
25by the Department by rule and subject to federal approval.
26Co-payments may not exceed $3 for hospital outpatient and



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1clinic services.
2(Source: P.A. 96-1501, eff. 1-25-11.)
3    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
4    Sec. 5-5.12. Pharmacy payments.
5    (a) Every request submitted by a pharmacy for reimbursement
6under this Article for prescription drugs provided to a
7recipient of aid under this Article shall include the name of
8the prescriber or an acceptable identification number as
9established by the Department.
10    (b) Pharmacies providing prescription drugs under this
11Article shall be reimbursed at a rate which shall include a
12professional dispensing fee as determined by the Illinois
13Department, plus the current acquisition cost of the
14prescription drug dispensed. The Illinois Department shall
15update its information on the acquisition costs of all
16prescription drugs no less frequently than every 30 days.
17However, the Illinois Department may set the rate of
18reimbursement for the acquisition cost, by rule, at a
19percentage of the current average wholesale acquisition cost.
20    (c) (Blank).
21    (d) The Department shall not impose requirements for prior
22approval based on a preferred drug list for anti-retroviral,
23anti-hemophilic factor concentrates, or any atypical
24antipsychotics, conventional antipsychotics, or
25anticonvulsants used for the treatment of serious mental



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1illnesses until 30 days after it has conducted a study of the
2impact of such requirements on patient care and submitted a
3report to the Speaker of the House of Representatives and the
4President of the Senate. The Department shall review
5utilization of narcotic medications in the medical assistance
6program and impose utilization controls that protect against
8    (e) When making determinations as to which drugs shall be
9on a prior approval list, the Department shall include as part
10of the analysis for this determination, the degree to which a
11drug may affect individuals in different ways based on factors
12including the gender of the person taking the medication.
13    (f) The Department shall cooperate with the Department of
14Public Health and the Department of Human Services Division of
15Mental Health in identifying psychotropic medications that,
16when given in a particular form, manner, duration, or frequency
17(including "as needed") in a dosage, or in conjunction with
18other psychotropic medications to a nursing home resident, may
19constitute a chemical restraint or an "unnecessary drug" as
20defined by the Nursing Home Care Act or Titles XVIII and XIX of
21the Social Security Act and the implementing rules and
22regulations. The Department shall require prior approval for
23any such medication prescribed for a nursing home resident that
24appears to be a chemical restraint or an unnecessary drug. The
25Department shall consult with the Department of Human Services
26Division of Mental Health in developing a protocol and criteria



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1for deciding whether to grant such prior approval.
2    (g) The Department may by rule provide for reimbursement of
3the dispensing of a 90-day supply of a generic, non-narcotic
4maintenance medication in circumstances where it is cost
6    (h) Effective July 1, 2011, the Department shall
7discontinue coverage of select over-the-counter drugs,
8including analgesics and cough and cold and allergy
10    (i) The Department shall seek any necessary waiver from the
11federal government in order to establish a program limiting the
12pharmacies eligible to dispense specialty drugs and shall issue
13a Request for Proposals in order to maximize savings on these
14drugs. The Department shall by rule establish the drugs
15required to be dispensed in this program.
16(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
1796-1501, eff. 1-25-11.)
18    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
19    Sec. 5A-10. Applicability.
20    (a) The assessment imposed by Section 5A-2 shall not take
21effect or shall cease to be imposed, and any moneys remaining
22in the Fund shall be refunded to hospital providers in
23proportion to the amounts paid by them, if:
24        (1) The sum of the appropriations for State fiscal
25    years 2004 and 2005 from the General Revenue Fund for



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1    hospital payments under the medical assistance program is
2    less than $4,500,000,000 or the appropriation for each of
3    State fiscal years 2006, 2007 and 2008 from the General
4    Revenue Fund for hospital payments under the medical
5    assistance program is less than $2,500,000,000 increased
6    annually to reflect any increase in the number of
7    recipients, or the annual appropriation for State fiscal
8    years 2009, 2010, 2011, 2013, and 2014 through 2014, from
9    the General Revenue Fund combined with the Hospital
10    Provider Fund as authorized in Section 5A-8 for hospital
11    payments under the medical assistance program, is less than
12    the amount appropriated for State fiscal year 2009,
13    adjusted annually to reflect any change in the number of
14    recipients, excluding State fiscal year 2009 supplemental
15    appropriations made necessary by the enactment of the
16    American Recovery and Reinvestment Act of 2009; or
17        (2) For State fiscal years prior to State fiscal year
18    2009, the Department of Healthcare and Family Services
19    (formerly Department of Public Aid) makes changes in its
20    rules that reduce the hospital inpatient or outpatient
21    payment rates, including adjustment payment rates, in
22    effect on October 1, 2004, except for hospitals described
23    in subsection (b) of Section 5A-3 and except for changes in
24    the methodology for calculating outlier payments to
25    hospitals for exceptionally costly stays, so long as those
26    changes do not reduce aggregate expenditures below the



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1    amount expended in State fiscal year 2005 for such
2    services; or
3        (2.1) For State fiscal years 2009 through 2014, the
4    Department of Healthcare and Family Services adopts any
5    administrative rule change to reduce payment rates or
6    alters any payment methodology that reduces any payment
7    rates made to operating hospitals under the approved Title
8    XIX or Title XXI State plan in effect January 1, 2008
9    except for:
10            (A) any changes for hospitals described in
11        subsection (b) of Section 5A-3; or
12            (B) any rates for payments made under this Article
13        V-A; or
14            (C) any changes proposed in State plan amendment
15        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
16        08-07; or
17            (D) in relation to any admissions on or after
18        January 1, 2011, a modification in the methodology for
19        calculating outlier payments to hospitals for
20        exceptionally costly stays, for hospitals reimbursed
21        under the diagnosis-related grouping methodology;
22        provided that the Department shall be limited to one
23        such modification during the 36-month period after the
24        effective date of this amendatory Act of the 96th
25        General Assembly; or
26        (3) The payments to hospitals required under Section



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1    5A-12 or Section 5A-12.2 are changed or are not eligible
2    for federal matching funds under Title XIX or XXI of the
3    Social Security Act.
4    (b) The assessment imposed by Section 5A-2 shall not take
5effect or shall cease to be imposed if the assessment is
6determined to be an impermissible tax under Title XIX of the
7Social Security Act. Moneys in the Hospital Provider Fund
8derived from assessments imposed prior thereto shall be
9disbursed in accordance with Section 5A-8 to the extent federal
10financial participation is not reduced due to the
11impermissibility of the assessments, and any remaining moneys
12shall be refunded to hospital providers in proportion to the
13amounts paid by them.
14(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08; 96-8,
15eff. 4-28-09; 96-1530, eff. 2-16-11.)
16    Section 20. The Senior Citizens and Disabled Persons
17Property Tax Relief and Pharmaceutical Assistance Act is
18amended by changing Section 4 as follows:
19    (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
20    Sec. 4. Amount of Grant.
21    (a) In general. Any individual 65 years or older or any
22individual who will become 65 years old during the calendar
23year in which a claim is filed, and any surviving spouse of
24such a claimant, who at the time of death received or was



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1entitled to receive a grant pursuant to this Section, which
2surviving spouse will become 65 years of age within the 24
3months immediately following the death of such claimant and
4which surviving spouse but for his or her age is otherwise
5qualified to receive a grant pursuant to this Section, and any
6disabled person whose annual household income is less than the
7income eligibility limitation, as defined in subsection (a-5)
8and whose household is liable for payment of property taxes
9accrued or has paid rent constituting property taxes accrued
10and is domiciled in this State at the time he or she files his
11or her claim is entitled to claim a grant under this Act. With
12respect to claims filed by individuals who will become 65 years
13old during the calendar year in which a claim is filed, the
14amount of any grant to which that household is entitled shall
15be an amount equal to 1/12 of the amount to which the claimant
16would otherwise be entitled as provided in this Section,
17multiplied by the number of months in which the claimant was 65
18in the calendar year in which the claim is filed.
19    (a-5) Income eligibility limitation. For purposes of this
20Section, "income eligibility limitation" means an amount for
21grant years 2008 and thereafter:
22        (1) less than $22,218 for a household containing one
23    person;
24        (2) less than $29,480 for a household containing 2
25    persons; or
26        (3) less than $36,740 for a household containing 3 or



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1    more persons.
2    For 2009 claim year applications submitted during calendar
3year 2010, a household must have annual household income of
4less than $27,610 for a household containing one person; less
5than $36,635 for a household containing 2 persons; or less than
6$45,657 for a household containing 3 or more persons.
7    The Department on Aging may adopt rules such that on
8January 1, 2011, and thereafter, the foregoing household income
9eligibility limits may be changed to reflect the annual cost of
10living adjustment in Social Security and Supplemental Security
11Income benefits that are applicable to the year for which those
12benefits are being reported as income on an application.
13    If a person files as a surviving spouse, then only his or
14her income shall be counted in determining his or her household
16    (b) Limitation. Except as otherwise provided in
17subsections (a) and (f) of this Section, the maximum amount of
18grant which a claimant is entitled to claim is the amount by
19which the property taxes accrued which were paid or payable
20during the last preceding tax year or rent constituting
21property taxes accrued upon the claimant's residence for the
22last preceding taxable year exceeds 3 1/2% of the claimant's
23household income for that year but in no event is the grant to
24exceed (i) $700 less 4.5% of household income for that year for
25those with a household income of $14,000 or less or (ii) $70 if
26household income for that year is more than $14,000.



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1    (c) Public aid recipients. If household income in one or
2more months during a year includes cash assistance in excess of
3$55 per month from the Department of Healthcare and Family
4Services or the Department of Human Services (acting as
5successor to the Department of Public Aid under the Department
6of Human Services Act) which was determined under regulations
7of that Department on a measure of need that included an
8allowance for actual rent or property taxes paid by the
9recipient of that assistance, the amount of grant to which that
10household is entitled, except as otherwise provided in
11subsection (a), shall be the product of (1) the maximum amount
12computed as specified in subsection (b) of this Section and (2)
13the ratio of the number of months in which household income did
14not include such cash assistance over $55 to the number twelve.
15If household income did not include such cash assistance over
16$55 for any months during the year, the amount of the grant to
17which the household is entitled shall be the maximum amount
18computed as specified in subsection (b) of this Section. For
19purposes of this paragraph (c), "cash assistance" does not
20include any amount received under the federal Supplemental
21Security Income (SSI) program.
22    (d) Joint ownership. If title to the residence is held
23jointly by the claimant with a person who is not a member of
24his or her household, the amount of property taxes accrued used
25in computing the amount of grant to which he or she is entitled
26shall be the same percentage of property taxes accrued as is



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1the percentage of ownership held by the claimant in the
3    (e) More than one residence. If a claimant has occupied
4more than one residence in the taxable year, he or she may
5claim only one residence for any part of a month. In the case
6of property taxes accrued, he or she shall prorate 1/12 of the
7total property taxes accrued on his or her residence to each
8month that he or she owned and occupied that residence; and, in
9the case of rent constituting property taxes accrued, shall
10prorate each month's rent payments to the residence actually
11occupied during that month.
12    (f) (Blank).
13    (g) Effective January 1, 2006, there is hereby established
14a program of pharmaceutical assistance to the aged and
15disabled, entitled the Illinois Seniors and Disabled Drug
16Coverage Program, which shall be administered by the Department
17of Healthcare and Family Services and the Department on Aging
18in accordance with this subsection, to consist of coverage of
19specified prescription drugs on behalf of beneficiaries of the
20program as set forth in this subsection.
21    To become a beneficiary under the program established under
22this subsection, a person must:
23        (1) be (i) 65 years of age or older or (ii) disabled;
24    and
25        (2) be domiciled in this State; and
26        (3) enroll with a qualified Medicare Part D



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1    Prescription Drug Plan if eligible and apply for all
2    available subsidies under Medicare Part D; and
3        (4) for the 2006 and 2007 claim years, have a maximum
4    household income of (i) less than $21,218 for a household
5    containing one person, (ii) less than $28,480 for a
6    household containing 2 persons, or (iii) less than $35,740
7    for a household containing 3 or more persons; and
8        (5) for the 2008 claim year, have a maximum household
9    income of (i) less than $22,218 for a household containing
10    one person, (ii) $29,480 for a household containing 2
11    persons, or (iii) $36,740 for a household containing 3 or
12    more persons; and
13        (6) for 2009 claim year applications submitted during
14    calendar year 2010, have annual household income of less
15    than (i) $27,610 for a household containing one person;
16    (ii) less than $36,635 for a household containing 2
17    persons; or (iii) less than $45,657 for a household
18    containing 3 or more persons; and .
19        (7) as of September 1, 2011, have a maximum household
20    income at or below 200% of the federal poverty level.
21    The Department of Healthcare and Family Services may adopt
22rules such that on January 1, 2011, and thereafter, the
23foregoing household income eligibility limits may be changed to
24reflect the annual cost of living adjustment in Social Security
25and Supplemental Security Income benefits that are applicable
26to the year for which those benefits are being reported as



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1income on an application.
2    All individuals enrolled as of December 31, 2005, in the
3pharmaceutical assistance program operated pursuant to
4subsection (f) of this Section and all individuals enrolled as
5of December 31, 2005, in the SeniorCare Medicaid waiver program
6operated pursuant to Section 5-5.12a of the Illinois Public Aid
7Code shall be automatically enrolled in the program established
8by this subsection for the first year of operation without the
9need for further application, except that they must apply for
10Medicare Part D and the Low Income Subsidy under Medicare Part
11D. A person enrolled in the pharmaceutical assistance program
12operated pursuant to subsection (f) of this Section as of
13December 31, 2005, shall not lose eligibility in future years
14due only to the fact that they have not reached the age of 65.
15    To the extent permitted by federal law, the Department may
16act as an authorized representative of a beneficiary in order
17to enroll the beneficiary in a Medicare Part D Prescription
18Drug Plan if the beneficiary has failed to choose a plan and,
19where possible, to enroll beneficiaries in the low-income
20subsidy program under Medicare Part D or assist them in
21enrolling in that program.
22    Beneficiaries under the program established under this
23subsection shall be divided into the following 4 eligibility
25        (A) Eligibility Group 1 shall consist of beneficiaries
26    who are not eligible for Medicare Part D coverage and who



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1    are:
2            (i) disabled and under age 65; or
3            (ii) age 65 or older, with incomes over 200% of the
4        Federal Poverty Level; or
5            (iii) age 65 or older, with incomes at or below
6        200% of the Federal Poverty Level and not eligible for
7        federally funded means-tested benefits due to
8        immigration status.
9        (B) Eligibility Group 2 shall consist of beneficiaries
10    who are eligible for Medicare Part D coverage.
11        (C) Eligibility Group 3 shall consist of beneficiaries
12    age 65 or older, with incomes at or below 200% of the
13    Federal Poverty Level, who are not barred from receiving
14    federally funded means-tested benefits due to immigration
15    status and are not eligible for Medicare Part D coverage.
16        If the State applies and receives federal approval for
17    a waiver under Title XIX of the Social Security Act,
18    persons in Eligibility Group 3 shall continue to receive
19    benefits through the approved waiver, and Eligibility
20    Group 3 may be expanded to include disabled persons under
21    age 65 with incomes under 200% of the Federal Poverty Level
22    who are not eligible for Medicare and who are not barred
23    from receiving federally funded means-tested benefits due
24    to immigration status.
25        (D) Eligibility Group 4 shall consist of beneficiaries
26    who are otherwise described in Eligibility Group 2 who have



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1    a diagnosis of HIV or AIDS.
2    The program established under this subsection shall cover
3the cost of covered prescription drugs in excess of the
4beneficiary cost-sharing amounts set forth in this paragraph
5that are not covered by Medicare. The Department of Healthcare
6and Family Services may establish by emergency rule changes in
7cost-sharing necessary to conform the cost of the program to
8the amounts appropriated for State fiscal year 2012 and future
9fiscal years except that the 24-month limitation on the
10adoption of emergency rules and the provisions of Sections
115-115 and 5-125 of the Illinois Administrative Procedure Act
12shall not apply to rules adopted under this subsection (g). The
13adoption of emergency rules authorized by this subsection (g)
14shall be deemed to be necessary for the public interest,
15safety, and welfare. In 2006, beneficiaries shall pay a
16co-payment of $2 for each prescription of a generic drug and $5
17for each prescription of a brand-name drug. In future years,
18beneficiaries shall pay co-payments equal to the co-payments
19required under Medicare Part D for "other low-income subsidy
20eligible individuals" pursuant to 42 CFR 423.782(b). For
21individuals in Eligibility Groups 1, 2, and 3, once the program
22established under this subsection and Medicare combined have
23paid $1,750 in a year for covered prescription drugs, the
24beneficiary shall pay 20% of the cost of each prescription in
25addition to the co-payments set forth in this paragraph. For
26individuals in Eligibility Group 4, once the program



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1established under this subsection and Medicare combined have
2paid $1,750 in a year for covered prescription drugs, the
3beneficiary shall pay 20% of the cost of each prescription in
4addition to the co-payments set forth in this paragraph unless
5the drug is included in the formulary of the Illinois AIDS Drug
6Assistance Program operated by the Illinois Department of
7Public Health and covered by the Medicare Part D Prescription
8Drug Plan in which the beneficiary is enrolled. If the drug is
9included in the formulary of the Illinois AIDS Drug Assistance
10Program and covered by the Medicare Part D Prescription Drug
11Plan in which the beneficiary is enrolled, individuals in
12Eligibility Group 4 shall continue to pay the co-payments set
13forth in this paragraph after the program established under
14this subsection and Medicare combined have paid $1,750 in a
15year for covered prescription drugs.
16    For beneficiaries eligible for Medicare Part D coverage,
17the program established under this subsection shall pay 100% of
18the premiums charged by a qualified Medicare Part D
19Prescription Drug Plan for Medicare Part D basic prescription
20drug coverage, not including any late enrollment penalties.
21Qualified Medicare Part D Prescription Drug Plans may be
22limited by the Department of Healthcare and Family Services to
23those plans that sign a coordination agreement with the
25    For Notwithstanding Section 3.15, for purposes of the
26program established under this subsection, the term "covered



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1prescription drug" has the following meanings:
2        For Eligibility Group 1, "covered prescription drug"
3    means: (1) any cardiovascular agent or drug; (2) any
4    insulin or other prescription drug used in the treatment of
5    diabetes, including syringe and needles used to administer
6    the insulin; (3) any prescription drug used in the
7    treatment of arthritis; (4) any prescription drug used in
8    the treatment of cancer; (5) any prescription drug used in
9    the treatment of Alzheimer's disease; (6) any prescription
10    drug used in the treatment of Parkinson's disease; (7) any
11    prescription drug used in the treatment of glaucoma; (8)
12    any prescription drug used in the treatment of lung disease
13    and smoking-related illnesses; (9) any prescription drug
14    used in the treatment of osteoporosis; and (10) any
15    prescription drug used in the treatment of multiple
16    sclerosis. The Department may add additional therapeutic
17    classes by rule. The Department may adopt a preferred drug
18    list within any of the classes of drugs described in items
19    (1) through (10) of this paragraph. The specific drugs or
20    therapeutic classes of covered prescription drugs shall be
21    indicated by rule.
22        For Eligibility Group 2, "covered prescription drug"
23    means those drugs covered by the Medicare Part D
24    Prescription Drug Plan in which the beneficiary is
25    enrolled.
26        For Eligibility Group 3, "covered prescription drug"



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1    means those drugs covered by the Medical Assistance Program
2    under Article V of the Illinois Public Aid Code.
3        For Eligibility Group 4, "covered prescription drug"
4    means those drugs covered by the Medicare Part D
5    Prescription Drug Plan in which the beneficiary is
6    enrolled.
7    An individual in Eligibility Group 1, 2, 3, or 4 may opt to
8receive a $25 monthly payment in lieu of the direct coverage
9described in this subsection.
10    Any person otherwise eligible for pharmaceutical
11assistance under this subsection whose covered drugs are
12covered by any public program is ineligible for assistance
13under this subsection to the extent that the cost of those
14drugs is covered by the other program.
15    The Department of Healthcare and Family Services shall
16establish by rule the methods by which it will provide for the
17coverage called for in this subsection. Those methods may
18include direct reimbursement to pharmacies or the payment of a
19capitated amount to Medicare Part D Prescription Drug Plans.
20    For a pharmacy to be reimbursed under the program
21established under this subsection, it must comply with rules
22adopted by the Department of Healthcare and Family Services
23regarding coordination of benefits with Medicare Part D
24Prescription Drug Plans. A pharmacy may not charge a
25Medicare-enrolled beneficiary of the program established under
26this subsection more for a covered prescription drug than the



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1appropriate Medicare cost-sharing less any payment from or on
2behalf of the Department of Healthcare and Family Services.
3    The Department of Healthcare and Family Services or the
4Department on Aging, as appropriate, may adopt rules regarding
5applications, counting of income, proof of Medicare status,
6mandatory generic policies, and pharmacy reimbursement rates
7and any other rules necessary for the cost-efficient operation
8of the program established under this subsection.
9    (h) A qualified individual is not entitled to duplicate
10benefits in a coverage period as a result of the changes made
11by this amendatory Act of the 96th General Assembly.
12(Source: P.A. 95-208, eff. 8-16-07; 95-644, eff. 10-12-07;
1395-876, eff. 8-21-08; 96-804, eff. 1-1-10; revised 9-16-10.)
14    Section 99. Effective date. This Act takes effect upon
15becoming law.".