|
Sen. Melinda Bush
Filed: 5/14/2021
| | 10200HB0135sam001 | | LRB102 02749 BMS 26581 a |
|
|
1 | | AMENDMENT TO HOUSE BILL 135
|
2 | | AMENDMENT NO. ______. Amend House Bill 135 by replacing |
3 | | everything after the enacting clause with the following:
|
4 | | "Section 5. The State Employees Group Insurance Act of |
5 | | 1971 is amended by changing Section 6.11 as follows:
|
6 | | (5 ILCS 375/6.11)
|
7 | | Sec. 6.11. Required health benefits; Illinois Insurance |
8 | | Code
requirements. The program of health
benefits shall |
9 | | provide the post-mastectomy care benefits required to be |
10 | | covered
by a policy of accident and health insurance under |
11 | | Section 356t of the Illinois
Insurance Code. The program of |
12 | | health benefits shall provide the coverage
required under |
13 | | Sections 356g, 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, |
14 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, |
15 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, |
16 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
|
| | 10200HB0135sam001 | - 2 - | LRB102 02749 BMS 26581 a |
|
|
1 | | 356z.36, and 356z.41 , and 356z.43 of the
Illinois Insurance |
2 | | Code.
The program of health benefits must comply with Sections |
3 | | 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article |
4 | | XXXIIB of the
Illinois Insurance Code. The Department of |
5 | | Insurance shall enforce the requirements of this Section with |
6 | | respect to Sections 370c and 370c.1 of the Illinois Insurance |
7 | | Code; all other requirements of this Section shall be enforced |
8 | | by the Department of Central Management Services.
|
9 | | Rulemaking authority to implement Public Act 95-1045, if |
10 | | any, is conditioned on the rules being adopted in accordance |
11 | | with all provisions of the Illinois Administrative Procedure |
12 | | Act and all rules and procedures of the Joint Committee on |
13 | | Administrative Rules; any purported rule not so adopted, for |
14 | | whatever reason, is unauthorized. |
15 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
16 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
17 | | 1-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13, |
18 | | eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; |
19 | | 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
20 | | 1-1-21 .) |
21 | | Section 10. The Counties Code is amended by changing |
22 | | Section 5-1069.3 as follows: |
23 | | (55 ILCS 5/5-1069.3)
|
24 | | Sec. 5-1069.3. Required health benefits. If a county, |
|
| | 10200HB0135sam001 | - 3 - | LRB102 02749 BMS 26581 a |
|
|
1 | | including a home
rule
county, is a self-insurer for purposes |
2 | | of providing health insurance coverage
for its employees, the |
3 | | coverage shall include coverage for the post-mastectomy
care |
4 | | benefits required to be covered by a policy of accident and |
5 | | health
insurance under Section 356t and the coverage required |
6 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, |
7 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
8 | | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, |
9 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 |
10 | | of
the Illinois Insurance Code. The coverage shall comply with |
11 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois |
12 | | Insurance Code. The Department of Insurance shall enforce the |
13 | | requirements of this Section. The requirement that health |
14 | | benefits be covered
as provided in this Section is an
|
15 | | exclusive power and function of the State and is a denial and |
16 | | limitation under
Article VII, Section 6, subsection (h) of the |
17 | | Illinois Constitution. A home
rule county to which this |
18 | | Section applies must comply with every provision of
this |
19 | | Section.
|
20 | | Rulemaking authority to implement Public Act 95-1045, if |
21 | | any, is conditioned on the rules being adopted in accordance |
22 | | with all provisions of the Illinois Administrative Procedure |
23 | | Act and all rules and procedures of the Joint Committee on |
24 | | Administrative Rules; any purported rule not so adopted, for |
25 | | whatever reason, is unauthorized. |
26 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
|
| | 10200HB0135sam001 | - 4 - | LRB102 02749 BMS 26581 a |
|
|
1 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
2 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, |
3 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; |
4 | | 101-625, eff. 1-1-21 .) |
5 | | Section 15. The Illinois Municipal Code is amended by |
6 | | changing Section 10-4-2.3 as follows: |
7 | | (65 ILCS 5/10-4-2.3)
|
8 | | Sec. 10-4-2.3. Required health benefits. If a |
9 | | municipality, including a
home rule municipality, is a |
10 | | self-insurer for purposes of providing health
insurance |
11 | | coverage for its employees, the coverage shall include |
12 | | coverage for
the post-mastectomy care benefits required to be |
13 | | covered by a policy of
accident and health insurance under |
14 | | Section 356t and the coverage required
under Sections 356g, |
15 | | 356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, |
16 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, |
17 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
18 | | 356z.36, and 356z.41 , and 356z.43 of the Illinois
Insurance
|
19 | | Code. The coverage shall comply with Sections 155.22a, 355b, |
20 | | 356z.19, and 370c of
the Illinois Insurance Code. The |
21 | | Department of Insurance shall enforce the requirements of this |
22 | | Section. The requirement that health
benefits be covered as |
23 | | provided in this is an exclusive power and function of
the |
24 | | State and is a denial and limitation under Article VII, |
|
| | 10200HB0135sam001 | - 5 - | LRB102 02749 BMS 26581 a |
|
|
1 | | Section 6,
subsection (h) of the Illinois Constitution. A home |
2 | | rule municipality to which
this Section applies must comply |
3 | | with every provision of this Section.
|
4 | | Rulemaking authority to implement Public Act 95-1045, if |
5 | | any, is conditioned on the rules being adopted in accordance |
6 | | with all provisions of the Illinois Administrative Procedure |
7 | | Act and all rules and procedures of the Joint Committee on |
8 | | Administrative Rules; any purported rule not so adopted, for |
9 | | whatever reason, is unauthorized. |
10 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
11 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
12 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, |
13 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; |
14 | | 101-625, eff. 1-1-21 .) |
15 | | Section 20. The School Code is amended by changing Section |
16 | | 10-22.3f as follows: |
17 | | (105 ILCS 5/10-22.3f)
|
18 | | Sec. 10-22.3f. Required health benefits. Insurance |
19 | | protection and
benefits
for employees shall provide the |
20 | | post-mastectomy care benefits required to be
covered by a |
21 | | policy of accident and health insurance under Section 356t and |
22 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, |
23 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, |
24 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, |
|
| | 10200HB0135sam001 | - 6 - | LRB102 02749 BMS 26581 a |
|
|
1 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 |
2 | | of
the
Illinois Insurance Code.
Insurance policies shall |
3 | | comply with Section 356z.19 of the Illinois Insurance Code. |
4 | | The coverage shall comply with Sections 155.22a, 355b, and |
5 | | 370c of
the Illinois Insurance Code. The Department of |
6 | | Insurance shall enforce the requirements of this Section.
|
7 | | Rulemaking authority to implement Public Act 95-1045, if |
8 | | any, is conditioned on the rules being adopted in accordance |
9 | | with all provisions of the Illinois Administrative Procedure |
10 | | Act and all rules and procedures of the Joint Committee on |
11 | | Administrative Rules; any purported rule not so adopted, for |
12 | | whatever reason, is unauthorized. |
13 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
14 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
15 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, |
16 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; |
17 | | 101-625, eff. 1-1-21 .) |
18 | | Section 25. The Illinois Insurance Code is amended by |
19 | | adding Section 356z.43 as follows: |
20 | | (215 ILCS 5/356z.43 new) |
21 | | Sec. 356z.43. Coverage for patient care services provided |
22 | | by a pharmacist. A group or individual policy of accident and |
23 | | health insurance or a managed care plan that is amended, |
24 | | delivered, issued, or renewed on or after January 1, 2023 |
|
| | 10200HB0135sam001 | - 7 - | LRB102 02749 BMS 26581 a |
|
|
1 | | shall provide coverage for health care or patient care |
2 | | services provided by a pharmacist if: |
3 | | (1) the pharmacist meets the requirements and scope of |
4 | | practice as set forth in Section 43 of the Pharmacy |
5 | | Practice Act; |
6 | | (2) the health plan provides coverage for the same |
7 | | service provided by a licensed physician, an advanced |
8 | | practice registered nurse, or a physician assistant; |
9 | | (3) the pharmacist is included in the health benefit |
10 | | plan's network of participating providers; and |
11 | | (4) a reimbursement has been successfully negotiated |
12 | | in good faith between the pharmacist and the health plan. |
13 | | Section 30. The Pharmacy Practice Act is amended by |
14 | | changing Section 3 and by adding Section 43 as follows:
|
15 | | (225 ILCS 85/3)
|
16 | | (Section scheduled to be repealed on January 1, 2023)
|
17 | | Sec. 3. Definitions. For the purpose of this Act, except |
18 | | where otherwise
limited therein:
|
19 | | (a) "Pharmacy" or "drugstore" means and includes every |
20 | | store, shop,
pharmacy department, or other place where |
21 | | pharmacist
care is
provided
by a pharmacist (1) where drugs, |
22 | | medicines, or poisons are
dispensed, sold or
offered for sale |
23 | | at retail, or displayed for sale at retail; or
(2)
where
|
24 | | prescriptions of physicians, dentists, advanced practice |
|
| | 10200HB0135sam001 | - 8 - | LRB102 02749 BMS 26581 a |
|
|
1 | | registered nurses, physician assistants, veterinarians, |
2 | | podiatric physicians, or
optometrists, within the limits of |
3 | | their
licenses, are
compounded, filled, or dispensed; or (3) |
4 | | which has upon it or
displayed within
it, or affixed to or used |
5 | | in connection with it, a sign bearing the word or
words |
6 | | "Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical
Care", |
7 | | "Apothecary", "Drugstore",
"Medicine Store", "Prescriptions", |
8 | | "Drugs", "Dispensary", "Medicines", or any word
or words of |
9 | | similar or like import, either in the English language
or any |
10 | | other language; or (4) where the characteristic prescription
|
11 | | sign (Rx) or similar design is exhibited; or (5) any store, or
|
12 | | shop,
or other place with respect to which any of the above |
13 | | words, objects,
signs or designs are used in any |
14 | | advertisement.
|
15 | | (b) "Drugs" means and includes (1) articles recognized
in |
16 | | the official United States Pharmacopoeia/National Formulary |
17 | | (USP/NF),
or any supplement thereto and being intended for and |
18 | | having for their
main use the diagnosis, cure, mitigation, |
19 | | treatment or prevention of
disease in man or other animals, as |
20 | | approved by the United States Food and
Drug Administration, |
21 | | but does not include devices or their components, parts,
or |
22 | | accessories; and (2) all other articles intended
for and |
23 | | having for their main use the diagnosis, cure, mitigation,
|
24 | | treatment or prevention of disease in man or other animals, as |
25 | | approved
by the United States Food and Drug Administration, |
26 | | but does not include
devices or their components, parts, or |
|
| | 10200HB0135sam001 | - 9 - | LRB102 02749 BMS 26581 a |
|
|
1 | | accessories; and (3) articles
(other than food) having for |
2 | | their main use and intended
to affect the structure or any |
3 | | function of the body of man or other
animals; and (4) articles |
4 | | having for their main use and intended
for use as a component |
5 | | or any articles specified in clause (1), (2)
or (3); but does |
6 | | not include devices or their components, parts or
accessories.
|
7 | | (c) "Medicines" means and includes all drugs intended for
|
8 | | human or veterinary use approved by the United States Food and |
9 | | Drug
Administration.
|
10 | | (d) "Practice of pharmacy" means: |
11 | | (1) the interpretation and the provision of assistance |
12 | | in the monitoring, evaluation, and implementation of |
13 | | prescription drug orders; |
14 | | (2) the dispensing of prescription drug orders; |
15 | | (3) participation in drug and device selection; |
16 | | (4) drug administration limited to the administration |
17 | | of oral, topical, injectable, and inhalation as follows: |
18 | | (A) in the context of patient education on the |
19 | | proper use or delivery of medications; |
20 | | (B) vaccination of patients 14 years of age and |
21 | | older pursuant to a valid prescription or standing |
22 | | order, by a physician licensed to practice medicine in |
23 | | all its branches, upon completion of appropriate |
24 | | training, including how to address contraindications |
25 | | and adverse reactions set forth by rule, with |
26 | | notification to the patient's physician and |
|
| | 10200HB0135sam001 | - 10 - | LRB102 02749 BMS 26581 a |
|
|
1 | | appropriate record retention, or pursuant to hospital |
2 | | pharmacy and therapeutics committee policies and |
3 | | procedures; |
4 | | (B-5) following the initial administration of |
5 | | long-acting or extended-release extended release form |
6 | | opioid antagonists by a physician licensed to practice |
7 | | medicine in all its branches, administration of |
8 | | injections of long-acting or extended-release form |
9 | | opioid antagonists for the treatment of substance use |
10 | | disorder, pursuant to a valid prescription by a |
11 | | physician licensed to practice medicine in all its |
12 | | branches, upon completion of appropriate training, |
13 | | including how to address contraindications and adverse |
14 | | reactions, including, but not limited to, respiratory |
15 | | depression and the performance of cardiopulmonary |
16 | | resuscitation, set forth by rule, with notification to |
17 | | the patient's physician and appropriate record |
18 | | retention, or pursuant to hospital pharmacy and |
19 | | therapeutics committee policies and procedures; |
20 | | (C) administration of injections of |
21 | | alpha-hydroxyprogesterone caproate, pursuant to a |
22 | | valid prescription, by a physician licensed to |
23 | | practice medicine in all its branches, upon completion |
24 | | of appropriate training, including how to address |
25 | | contraindications and adverse reactions set forth by |
26 | | rule, with notification to the patient's physician and |
|
| | 10200HB0135sam001 | - 11 - | LRB102 02749 BMS 26581 a |
|
|
1 | | appropriate record retention, or pursuant to hospital |
2 | | pharmacy and therapeutics committee policies and |
3 | | procedures; and |
4 | | (D) administration of injections of long-term |
5 | | antipsychotic medications pursuant to a valid |
6 | | prescription by a physician licensed to practice |
7 | | medicine in all its branches, upon completion of |
8 | | appropriate training conducted by an Accreditation |
9 | | Council of Pharmaceutical Education accredited |
10 | | provider, including how to address contraindications |
11 | | and adverse reactions set forth by rule, with |
12 | | notification to the patient's physician and |
13 | | appropriate record retention, or pursuant to hospital |
14 | | pharmacy and therapeutics committee policies and |
15 | | procedures. |
16 | | (5) vaccination of patients ages 10 through 13 limited |
17 | | to the Influenza (inactivated influenza vaccine and live |
18 | | attenuated influenza intranasal vaccine) and Tdap (defined |
19 | | as tetanus, diphtheria, acellular pertussis) vaccines, |
20 | | pursuant to a valid prescription or standing order, by a |
21 | | physician licensed to practice medicine in all its |
22 | | branches, upon completion of appropriate training, |
23 | | including how to address contraindications and adverse |
24 | | reactions set forth by rule, with notification to the |
25 | | patient's physician and appropriate record retention, or |
26 | | pursuant to hospital pharmacy and therapeutics committee |
|
| | 10200HB0135sam001 | - 12 - | LRB102 02749 BMS 26581 a |
|
|
1 | | policies and procedures; |
2 | | (6) drug regimen review; |
3 | | (7) drug or drug-related research; |
4 | | (8) the provision of patient counseling; |
5 | | (9) the practice of telepharmacy; |
6 | | (10) the provision of those acts or services necessary |
7 | | to provide pharmacist care; |
8 | | (11) medication therapy management; and |
9 | | (12) the responsibility for compounding and labeling |
10 | | of drugs and devices (except labeling by a manufacturer, |
11 | | repackager, or distributor of non-prescription drugs and |
12 | | commercially packaged legend drugs and devices), proper |
13 | | and safe storage of drugs and devices, and maintenance of |
14 | | required records ; and . |
15 | | (13) the assessment and consultation of patients and |
16 | | dispensing of hormonal contraceptives. |
17 | | A pharmacist who performs any of the acts defined as the |
18 | | practice of pharmacy in this State must be actively licensed |
19 | | as a pharmacist under this Act.
|
20 | | (e) "Prescription" means and includes any written, oral, |
21 | | facsimile, or
electronically transmitted order for drugs
or |
22 | | medical devices, issued by a physician licensed to practice |
23 | | medicine in
all its branches, dentist, veterinarian, podiatric |
24 | | physician, or
optometrist, within the
limits of his or her |
25 | | license, by a physician assistant in accordance with
|
26 | | subsection (f) of Section 4, or by an advanced practice |
|
| | 10200HB0135sam001 | - 13 - | LRB102 02749 BMS 26581 a |
|
|
1 | | registered nurse in
accordance with subsection (g) of Section |
2 | | 4, containing the
following: (1) name
of the patient; (2) date |
3 | | when prescription was issued; (3) name
and strength of drug or |
4 | | description of the medical device prescribed;
and (4) |
5 | | quantity; (5) directions for use; (6) prescriber's name,
|
6 | | address,
and signature; and (7) DEA registration number where |
7 | | required, for controlled
substances.
The prescription may, but |
8 | | is not required to, list the illness, disease, or condition |
9 | | for which the drug or device is being prescribed. DEA |
10 | | registration numbers shall not be required on inpatient drug |
11 | | orders. A prescription for medication other than controlled |
12 | | substances shall be valid for up to 15 months from the date |
13 | | issued for the purpose of refills, unless the prescription |
14 | | states otherwise.
|
15 | | (f) "Person" means and includes a natural person, |
16 | | partnership,
association, corporation, government entity, or |
17 | | any other legal
entity.
|
18 | | (g) "Department" means the Department of Financial and
|
19 | | Professional Regulation.
|
20 | | (h) "Board of Pharmacy" or "Board" means the State Board
|
21 | | of Pharmacy of the Department of Financial and Professional |
22 | | Regulation.
|
23 | | (i) "Secretary"
means the Secretary
of Financial and |
24 | | Professional Regulation.
|
25 | | (j) "Drug product selection" means the interchange for a
|
26 | | prescribed pharmaceutical product in accordance with Section |
|
| | 10200HB0135sam001 | - 14 - | LRB102 02749 BMS 26581 a |
|
|
1 | | 25 of
this Act and Section 3.14 of the Illinois Food, Drug and |
2 | | Cosmetic Act.
|
3 | | (k) "Inpatient drug order" means an order issued by an |
4 | | authorized
prescriber for a resident or patient of a facility |
5 | | licensed under the
Nursing Home Care Act, the ID/DD Community |
6 | | Care Act, the MC/DD Act, the Specialized Mental Health |
7 | | Rehabilitation Act of 2013, the Hospital Licensing Act, or the |
8 | | University of Illinois Hospital Act, or a facility which is |
9 | | operated by the Department of Human
Services (as successor to |
10 | | the Department of Mental Health
and Developmental |
11 | | Disabilities) or the Department of Corrections.
|
12 | | (k-5) "Pharmacist" means an individual health care |
13 | | professional and
provider currently licensed by this State to |
14 | | engage in the practice of
pharmacy.
|
15 | | (l) "Pharmacist in charge" means the licensed pharmacist |
16 | | whose name appears
on a pharmacy license and who is |
17 | | responsible for all aspects of the
operation related to the |
18 | | practice of pharmacy.
|
19 | | (m) "Dispense" or "dispensing" means the interpretation, |
20 | | evaluation, and implementation of a prescription drug order, |
21 | | including the preparation and delivery of a drug or device to a |
22 | | patient or patient's agent in a suitable container |
23 | | appropriately labeled for subsequent administration to or use |
24 | | by a patient in accordance with applicable State and federal |
25 | | laws and regulations.
"Dispense" or "dispensing" does not mean |
26 | | the physical delivery to a patient or a
patient's |
|
| | 10200HB0135sam001 | - 15 - | LRB102 02749 BMS 26581 a |
|
|
1 | | representative in a home or institution by a designee of a |
2 | | pharmacist
or by common carrier. "Dispense" or "dispensing" |
3 | | also does not mean the physical delivery
of a drug or medical |
4 | | device to a patient or patient's representative by a
|
5 | | pharmacist's designee within a pharmacy or drugstore while the |
6 | | pharmacist is
on duty and the pharmacy is open.
|
7 | | (n) "Nonresident pharmacy"
means a pharmacy that is |
8 | | located in a state, commonwealth, or territory
of the United |
9 | | States, other than Illinois, that delivers, dispenses, or
|
10 | | distributes, through the United States Postal Service, |
11 | | commercially acceptable parcel delivery service, or other |
12 | | common
carrier, to Illinois residents, any substance which |
13 | | requires a prescription.
|
14 | | (o) "Compounding" means the preparation and mixing of |
15 | | components, excluding flavorings, (1) as the result of a |
16 | | prescriber's prescription drug order or initiative based on |
17 | | the prescriber-patient-pharmacist relationship in the course |
18 | | of professional practice or (2) for the purpose of, or |
19 | | incident to, research, teaching, or chemical analysis and not |
20 | | for sale or dispensing. "Compounding" includes the preparation |
21 | | of drugs or devices in anticipation of receiving prescription |
22 | | drug orders based on routine, regularly observed dispensing |
23 | | patterns. Commercially available products may be compounded |
24 | | for dispensing to individual patients only if all of the |
25 | | following conditions are met: (i) the commercial product is |
26 | | not reasonably available from normal distribution channels in |
|
| | 10200HB0135sam001 | - 16 - | LRB102 02749 BMS 26581 a |
|
|
1 | | a timely manner to meet the patient's needs and (ii) the |
2 | | prescribing practitioner has requested that the drug be |
3 | | compounded.
|
4 | | (p) (Blank).
|
5 | | (q) (Blank).
|
6 | | (r) "Patient counseling" means the communication between a |
7 | | pharmacist or a student pharmacist under the supervision of a |
8 | | pharmacist and a patient or the patient's representative about |
9 | | the patient's medication or device for the purpose of |
10 | | optimizing proper use of prescription medications or devices. |
11 | | "Patient counseling" may include without limitation (1) |
12 | | obtaining a medication history; (2) acquiring a patient's |
13 | | allergies and health conditions; (3) facilitation of the |
14 | | patient's understanding of the intended use of the medication; |
15 | | (4) proper directions for use; (5) significant potential |
16 | | adverse events; (6) potential food-drug interactions; and (7) |
17 | | the need to be compliant with the medication therapy. A |
18 | | pharmacy technician may only participate in the following |
19 | | aspects of patient counseling under the supervision of a |
20 | | pharmacist: (1) obtaining medication history; (2) providing |
21 | | the offer for counseling by a pharmacist or student |
22 | | pharmacist; and (3) acquiring a patient's allergies and health |
23 | | conditions.
|
24 | | (s) "Patient profiles" or "patient drug therapy record" |
25 | | means the
obtaining, recording, and maintenance of patient |
26 | | prescription
information, including prescriptions for |
|
| | 10200HB0135sam001 | - 17 - | LRB102 02749 BMS 26581 a |
|
|
1 | | controlled substances, and
personal information.
|
2 | | (t) (Blank).
|
3 | | (u) "Medical device" or "device" means an instrument, |
4 | | apparatus, implement, machine,
contrivance, implant, in vitro |
5 | | reagent, or other similar or related article,
including any |
6 | | component part or accessory, required under federal law to
|
7 | | bear the label "Caution: Federal law requires dispensing by or |
8 | | on the order
of a physician". A seller of goods and services |
9 | | who, only for the purpose of
retail sales, compounds, sells, |
10 | | rents, or leases medical devices shall not,
by reasons |
11 | | thereof, be required to be a licensed pharmacy.
|
12 | | (v) "Unique identifier" means an electronic signature, |
13 | | handwritten
signature or initials, thumb print, or other |
14 | | acceptable biometric
or electronic identification process as |
15 | | approved by the Department.
|
16 | | (w) "Current usual and customary retail price" means the |
17 | | price that a pharmacy charges to a non-third-party payor.
|
18 | | (x) "Automated pharmacy system" means a mechanical system |
19 | | located within the confines of the pharmacy or remote location |
20 | | that performs operations or activities, other than compounding |
21 | | or administration, relative to storage, packaging, dispensing, |
22 | | or distribution of medication, and which collects, controls, |
23 | | and maintains all transaction information. |
24 | | (y) "Drug regimen review" means and includes the |
25 | | evaluation of prescription drug orders and patient records for |
26 | | (1)
known allergies; (2) drug or potential therapy |
|
| | 10200HB0135sam001 | - 18 - | LRB102 02749 BMS 26581 a |
|
|
1 | | contraindications;
(3) reasonable dose, duration of use, and |
2 | | route of administration, taking into consideration factors |
3 | | such as age, gender, and contraindications; (4) reasonable |
4 | | directions for use; (5) potential or actual adverse drug |
5 | | reactions; (6) drug-drug interactions; (7) drug-food |
6 | | interactions; (8) drug-disease contraindications; (9) |
7 | | therapeutic duplication; (10) patient laboratory values when |
8 | | authorized and available; (11) proper utilization (including |
9 | | over or under utilization) and optimum therapeutic outcomes; |
10 | | and (12) abuse and misuse.
|
11 | | (z) "Electronically transmitted prescription" means a |
12 | | prescription that is created, recorded, or stored by |
13 | | electronic means; issued and validated with an electronic |
14 | | signature; and transmitted by electronic means directly from |
15 | | the prescriber to a pharmacy. An electronic prescription is |
16 | | not an image of a physical prescription that is transferred by |
17 | | electronic means from computer to computer, facsimile to |
18 | | facsimile, or facsimile to computer.
|
19 | | (aa) "Medication therapy management services" means a |
20 | | distinct service or group of services offered by licensed |
21 | | pharmacists, physicians licensed to practice medicine in all |
22 | | its branches, advanced practice registered nurses authorized |
23 | | in a written agreement with a physician licensed to practice |
24 | | medicine in all its branches, or physician assistants |
25 | | authorized in guidelines by a supervising physician that |
26 | | optimize therapeutic outcomes for individual patients through |
|
| | 10200HB0135sam001 | - 19 - | LRB102 02749 BMS 26581 a |
|
|
1 | | improved medication use. In a retail or other non-hospital |
2 | | pharmacy, medication therapy management services shall consist |
3 | | of the evaluation of prescription drug orders and patient |
4 | | medication records to resolve conflicts with the following: |
5 | | (1) known allergies; |
6 | | (2) drug or potential therapy contraindications; |
7 | | (3) reasonable dose, duration of use, and route of |
8 | | administration, taking into consideration factors such as |
9 | | age, gender, and contraindications; |
10 | | (4) reasonable directions for use; |
11 | | (5) potential or actual adverse drug reactions; |
12 | | (6) drug-drug interactions; |
13 | | (7) drug-food interactions; |
14 | | (8) drug-disease contraindications; |
15 | | (9) identification of therapeutic duplication; |
16 | | (10) patient laboratory values when authorized and |
17 | | available; |
18 | | (11) proper utilization (including over or under |
19 | | utilization) and optimum therapeutic outcomes; and |
20 | | (12) drug abuse and misuse. |
21 | | "Medication therapy management services" includes the |
22 | | following: |
23 | | (1) documenting the services delivered and |
24 | | communicating the information provided to patients' |
25 | | prescribers within an appropriate time frame, not to |
26 | | exceed 48 hours; |
|
| | 10200HB0135sam001 | - 20 - | LRB102 02749 BMS 26581 a |
|
|
1 | | (2) providing patient counseling designed to enhance a |
2 | | patient's understanding and the appropriate use of his or |
3 | | her medications; and |
4 | | (3) providing information, support services, and |
5 | | resources designed to enhance a patient's adherence with |
6 | | his or her prescribed therapeutic regimens. |
7 | | "Medication therapy management services" may also include |
8 | | patient care functions authorized by a physician licensed to |
9 | | practice medicine in all its branches for his or her |
10 | | identified patient or groups of patients under specified |
11 | | conditions or limitations in a standing order from the |
12 | | physician. |
13 | | "Medication therapy management services" in a licensed |
14 | | hospital may also include the following: |
15 | | (1) reviewing assessments of the patient's health |
16 | | status; and |
17 | | (2) following protocols of a hospital pharmacy and |
18 | | therapeutics committee with respect to the fulfillment of |
19 | | medication orders.
|
20 | | (bb) "Pharmacist care" means the provision by a pharmacist |
21 | | of medication therapy management services, with or without the |
22 | | dispensing of drugs or devices, intended to achieve outcomes |
23 | | that improve patient health, quality of life, and comfort and |
24 | | enhance patient safety.
|
25 | | (cc) "Protected health information" means individually |
26 | | identifiable health information that, except as otherwise |
|
| | 10200HB0135sam001 | - 21 - | LRB102 02749 BMS 26581 a |
|
|
1 | | provided, is:
|
2 | | (1) transmitted by electronic media; |
3 | | (2) maintained in any medium set forth in the |
4 | | definition of "electronic media" in the federal Health |
5 | | Insurance Portability and Accountability Act; or |
6 | | (3) transmitted or maintained in any other form or |
7 | | medium. |
8 | | "Protected health information" does not include |
9 | | individually identifiable health information found in: |
10 | | (1) education records covered by the federal Family |
11 | | Educational Right and Privacy Act; or |
12 | | (2) employment records held by a licensee in its role |
13 | | as an employer. |
14 | | (dd) "Standing order" means a specific order for a patient |
15 | | or group of patients issued by a physician licensed to |
16 | | practice medicine in all its branches in Illinois. |
17 | | (ee) "Address of record" means the designated address |
18 | | recorded by the Department in the applicant's application file |
19 | | or licensee's license file maintained by the Department's |
20 | | licensure maintenance unit. |
21 | | (ff) "Home pharmacy" means the location of a pharmacy's |
22 | | primary operations.
|
23 | | (gg) "Email address of record" means the designated email |
24 | | address recorded by the Department in the applicant's |
25 | | application file or the licensee's license file, as maintained |
26 | | by the Department's licensure maintenance unit. |
|
| | 10200HB0135sam001 | - 22 - | LRB102 02749 BMS 26581 a |
|
|
1 | | (Source: P.A. 100-208, eff. 1-1-18; 100-497, eff. 9-8-17; |
2 | | 100-513, eff. 1-1-18; 100-804, eff. 1-1-19; 100-863, eff. |
3 | | 8-14-18; 101-349, eff. 1-1-20; revised 8-21-20.) |
4 | | (225 ILCS 85/43 new) |
5 | | Sec. 43. Dispensation of hormonal contraceptives. |
6 | | (a) The dispensing of hormonal contraceptives to a patient |
7 | | shall be pursuant to a valid prescription or standing order by |
8 | | a physician licensed to practice medicine in all its branches |
9 | | or the medical director of a local health department, pursuant |
10 | | to the following: |
11 | | (1) a pharmacist may dispense no more than a 12-month |
12 | | supply of hormonal contraceptives to a patient; |
13 | | (2) a pharmacist must complete an educational training |
14 | | program accredited by the Accreditation Council for |
15 | | Pharmacy Education and approved by the Department that is |
16 | | related to the patient self-screening risk assessment, |
17 | | patient assessment contraceptive counseling and education, |
18 | | and dispensation of hormonal contraceptives; |
19 | | (3) a pharmacist shall have the patient complete the |
20 | | self-screening risk assessment tool; the self-screening |
21 | | risk assessment tool is to be based on the most current |
22 | | version of the United States Medical Eligibility Criteria |
23 | | for Contraceptive Use published by the federal Centers for |
24 | | Disease Control and Prevention; |
25 | | (4) based upon the results of the self-screening risk |
|
| | 10200HB0135sam001 | - 23 - | LRB102 02749 BMS 26581 a |
|
|
1 | | assessment and the patient assessment, the pharmacist |
2 | | shall use his or her professional and clinical judgment as |
3 | | to when a patient should be referred to the patient's |
4 | | physician or another health care provider; |
5 | | (5) a pharmacist shall provide, during the patient |
6 | | assessment and consultation, counseling and education |
7 | | about all methods of contraception, including methods not |
8 | | covered under the standing order, and their proper use and |
9 | | effectiveness; |
10 | | (6) the patient consultation shall take place in a |
11 | | private manner; and |
12 | | (7) a pharmacist and pharmacy must maintain |
13 | | appropriate records. |
14 | | (b) The Department may adopt rules to implement this |
15 | | Section. |
16 | | (c) Nothing in this Section shall be interpreted to |
17 | | require a pharmacist to dispense hormonal contraception under |
18 | | a standing order issued by a physician licensed to practice |
19 | | medicine in all its branches or
the medical director of a local |
20 | | health department. |
21 | | Section 35. The Illinois Public Aid Code is amended by |
22 | | adding Section 5-5.12d as follows: |
23 | | (305 ILCS 5/5-5.12d new) |
24 | | Sec. 5-5.12d. Coverage for patient care services for |
|
| | 10200HB0135sam001 | - 24 - | LRB102 02749 BMS 26581 a |
|
|
1 | | hormonal contraceptives provided by a pharmacist. |
2 | | (a) Subject to approval by the federal Centers for |
3 | | Medicare and Medicaid Services, the medical assistance |
4 | | program, including both the fee-for-service and managed care |
5 | | medical assistance programs established under this Article, |
6 | | shall cover patient care services provided by a pharmacist for |
7 | | hormonal contraceptives assessment and consultation. |
8 | | (b) The Department shall establish a fee schedule for |
9 | | patient care services provided by a pharmacist for hormonal |
10 | | contraceptives assessment and consultation. |
11 | | (c) The rate of reimbursement for patient care services |
12 | | provided by a pharmacist for hormonal contraceptives |
13 | | assessment and consultation shall be at 85% of the fee |
14 | | schedule for physician services by the medical assistance |
15 | | program. |
16 | | (d) A pharmacist must be enrolled in the medical |
17 | | assistance program as an ordering and referring provider prior |
18 | | to providing hormonal contraceptives assessment and |
19 | | consultation that is submitted by a pharmacy or pharmacist |
20 | | provider for reimbursement pursuant to this Section. |
21 | | (e) The Department shall apply for any necessary federal |
22 | | waivers or approvals to implement this Section by January 1, |
23 | | 2022. |
24 | | (f) This Section does not restrict or prohibit any |
25 | | services currently provided by pharmacists as authorized by |
26 | | law, including, but not limited to, pharmacist services |