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Public Act 097-0074 | ||||
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AN ACT concerning State government.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. The Department of Human Services Act is amended | ||||
by adding Section 10-66 as follows: | ||||
(20 ILCS 1305/10-66 new) | ||||
Sec. 10-66. Rate reductions. Rates for medical services | ||||
purchased by the Divisions of Alcohol and Substance Abuse, | ||||
Community Health and Prevention, Developmental Disabilities, | ||||
Mental Health, or Rehabilitation Services within the | ||||
Department of Human Services shall not be reduced below the | ||||
rates calculated on April 1, 2011 unless the Department of | ||||
Human Services promulgates rules and rules are implemented | ||||
authorizing rate reductions. | ||||
Section 2. The Civil Administrative Code of Illinois is | ||||
amended by changing Section 2310-315 as follows:
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(20 ILCS 2310/2310-315) (was 20 ILCS 2310/55.41)
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Sec. 2310-315. Prevention and treatment of AIDS. To perform | ||||
the
following in relation to the prevention and
treatment of | ||||
acquired immunodeficiency syndrome (AIDS):
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(1) Establish a State AIDS Control Unit within the |
Department as
a
separate administrative subdivision, to | ||
coordinate all State
programs and services relating to the | ||
prevention, treatment, and
amelioration of AIDS.
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(2) Conduct a public information campaign for physicians,
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hospitals, health facilities, public health departments, law | ||
enforcement
personnel, public employees, laboratories, and the | ||
general public on
acquired immunodeficiency syndrome (AIDS) | ||
and promote necessary measures
to reduce the incidence of AIDS | ||
and the mortality from AIDS. This program
shall include, but | ||
not be limited to, the establishment of a statewide
hotline and | ||
a State AIDS information clearinghouse that will provide
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periodic reports and releases to public officials, health | ||
professionals,
community service organizations, and the | ||
general public regarding new
developments or procedures | ||
concerning prevention and treatment of AIDS.
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(3) (Blank).
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(4) Establish alternative blood test services that are not
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operated by a blood bank, plasma center or hospital. The
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Department shall prescribe by rule minimum criteria, standards | ||
and
procedures for the establishment and operation of such | ||
services, which shall
include, but not be limited to | ||
requirements for the provision of
information, counseling and | ||
referral services that ensure appropriate
counseling and | ||
referral for persons whose blood is tested and shows evidence | ||
of
exposure to the human immunodeficiency virus (HIV) or other
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identified causative agent of acquired immunodeficiency |
syndrome (AIDS).
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(5) Establish regional and community service networks of | ||
public
and
private service providers or health care | ||
professionals who may be involved
in AIDS research, prevention | ||
and treatment.
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(6) Provide grants to individuals, organizations or | ||
facilities
to support
the following:
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(A) Information, referral, and treatment
services.
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(B) Interdisciplinary workshops for professionals | ||
involved in
research and treatment.
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(C) Establishment and operation of a statewide
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hotline.
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(D) Establishment and operation of alternative testing
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services.
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(E) Research into detection, prevention, and
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treatment.
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(F) Supplementation of other public and private
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resources.
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(G) Implementation by long-term care facilities of | ||
Department
standards and procedures for the care and | ||
treatment of persons with AIDS
and the development of | ||
adequate numbers and types of placements for those
persons.
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(7) (Blank).
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(8) Accept any gift, donation, bequest, or grant of funds
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from private or
public agencies, including federal funds that | ||
may be provided for AIDS control
efforts.
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(9) Develop and implement, in consultation with the | ||
Long-Term
Care
Facility Advisory Board, standards and | ||
procedures for long-term care
facilities that provide care and | ||
treatment of persons with AIDS, including
appropriate | ||
infection control procedures. The Department shall work
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cooperatively with organizations representing those facilities | ||
to
develop
adequate numbers and types of placements for persons | ||
with AIDS and shall
advise those facilities on proper | ||
implementation of its standards
and procedures.
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(10) The Department shall create and administer a training
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program
for State employees who have a need for understanding | ||
matters relating to
AIDS in order to deal with or advise the | ||
public. The training
shall
include information on the cause and | ||
effects of AIDS, the means of
detecting it and preventing its | ||
transmission, the availability of related
counseling and | ||
referral, and other matters that may be
appropriate.
The | ||
training may also be made available to employees of local
| ||
governments,
public service agencies, and private agencies | ||
that contract
with the State;
in those cases the Department may | ||
charge a reasonable fee to
recover the
cost of the training.
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(11) Approve tests or testing procedures used in | ||
determining
exposure to HIV or any other identified causative | ||
agent of AIDS.
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(12) Provide prescription drug benefits counseling for | ||
persons with HIV or AIDS.
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(13) Continue to administer the AIDS Drug Assistance |
Program that provides drugs to prolong the lives of low income | ||
Persons with Acquired Immunodeficiency Syndrome (AIDS) or | ||
Human Immunodeficiency Virus (HIV) infection who are not | ||
eligible under Article V of the Illinois Public Aid Code for | ||
Medical Assistance, as provided under Title 77, Chapter 1, | ||
Subchapter (k), Part 692, Section 692.10 of the Illinois | ||
Administrative Code, effective August 1, 2000, except that the | ||
financial qualification for that program shall be that the | ||
anticipated gross monthly income shall be at or below 500% of | ||
the most recent Federal Poverty Guidelines published annually | ||
by the United States Department of Health and Human Services | ||
for the size of the household. Notwithstanding the preceding | ||
sentence, the Department of Public Health may determine the | ||
income eligibility standard for the AIDS Drug Assistance | ||
Program each year and may set the standard at more than 500% of | ||
the Federal Poverty Guidelines for the size of the household, | ||
provided that moneys appropriated to the Department for the | ||
program are sufficient to cover the increased cost of | ||
implementing the higher income eligibility standard. | ||
Rulemaking authority to implement this amendatory Act of the | ||
95th General Assembly, if any, is conditioned on the rules | ||
being adopted in accordance with all provisions of the Illinois | ||
Administrative Procedure Act and all rules and procedures of | ||
the Joint Committee on Administrative Rules; any purported rule | ||
not so adopted, for whatever reason, is unauthorized. If the | ||
Department reduces the financial qualification for new |
applicants while allowing currently enrolled individuals to | ||
remain on the program, the Department shall maintain a waiting | ||
list of applicants who would otherwise be eligible except that | ||
they do not meet the financial qualifications. Upon | ||
determination that program finances are adequate, the | ||
Department shall permit qualified individuals who are on the | ||
waiting list to enroll in the program. | ||
(14) In order to implement the provisions of Public Act | ||
95-7, the Department must expand HIV testing in health care | ||
settings where undiagnosed individuals are likely to be | ||
identified. The Department must purchase rapid HIV kits and | ||
make grants for technical assistance, staff to conduct HIV | ||
testing and counseling, and related purposes. The Department | ||
must make grants to (i) facilities serving patients that are | ||
uninsured at high rates, (ii) facilities located in areas with | ||
a high prevalence of HIV or AIDS, (iii) facilities that have a | ||
high likelihood of identifying individuals who are undiagnosed | ||
with HIV or AIDS, or (iv) any combination of items (i), (ii), | ||
and (iii). | ||
(Source: P.A. 94-909, eff. 6-23-06; 95-744, eff. 7-18-08; | ||
95-1042, eff. 3-25-09.)
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Section 3. The Disabled Persons Rehabilitation Act is | ||
amended by adding Section 10a as follows: | ||
(20 ILCS 2405/10a new) |
Sec. 10a. Financial Participation of Students Attending | ||
the Illinois School for the Deaf and the Illinois School for | ||
the Visually Impaired. | ||
(a) General. The Illinois School for the Deaf and the | ||
Illinois School for the Visually Impaired are required to | ||
provide eligible students with disabilities with a free and | ||
appropriate education. As part of the admission process to | ||
either school, the Department shall complete a financial | ||
analysis on each student attending the Illinois School for the | ||
Deaf or the Illinois School for the Visually Impaired and shall | ||
ask parents or guardians to participate, if applicable, in the | ||
cost of identified services or activities that are not | ||
education related. | ||
(b) Completion of financial analysis.
Prior to admission, | ||
and annually thereafter, a financial analysis shall be | ||
completed on each student attending the Illinois School for the | ||
Deaf or the Illinois School for the Visually Impaired. If at | ||
any time there is reason to believe there is a change in the | ||
student's financial situation that will affect their financial | ||
participation, a new financial analysis shall be completed. | ||
(1) In completing the student's financial analysis, | ||
the income of the student's family shall be used. Proof of | ||
income must be provided and retained for each parent or | ||
guardian. | ||
(2) Any funds that have been established on behalf of | ||
the student for completion of their primary or secondary |
education shall be considered when completing the | ||
financial analysis. | ||
(3) Falsification of information used to complete the | ||
financial analysis may result in the Department taking | ||
action to recoup monies previously expended by the | ||
Department in providing services to the student. | ||
(c) Financial Participation. Utilizing a sliding scale | ||
based on income standards developed by rule by the Department | ||
with input from the superintendent of each school, parents or | ||
guardians of students attending the Illinois School for the | ||
Deaf or the Illinois School for the Visually Impaired may be | ||
asked to financially participate in the following fees for | ||
services or activities provided at the schools: | ||
(1) Registration. | ||
(2) Books, labs, and supplies (fees may vary depending | ||
on the classes in which a student participates). | ||
(3) Room and board for residential students. | ||
(4) Meals for day students. | ||
(5) Athletic or extracurricular activities (students | ||
participating in multiple activities will not be required | ||
to pay for more than 2 activities). | ||
(6) Driver's education (if applicable). | ||
(7) Graduation. | ||
(8) Yearbook (optional). | ||
(9) Activities (field trips or other leisure | ||
activities). |
(10) Other activities or services identified by the | ||
Department. | ||
Students, parents, or guardians who are receiving Medicaid | ||
or Temporary Assistance for Needy Families (TANF) shall not be | ||
required to financially participate in the fees established in | ||
this subsection (c). | ||
Exceptions may be granted to parents or guardians who are | ||
unable to meet the financial participation obligations due to | ||
extenuating circumstances. Requests for exceptions must be | ||
made in writing and must be submitted to the superintendent for | ||
initial recommendation with a final determination by the | ||
Director of the Division of Rehabilitation Services. | ||
Any fees collected under this subsection (c) shall be held | ||
locally by the school and used exclusively for the purpose for | ||
which the fee was assessed. | ||
Section 5. The State Prompt Payment Act is amended by | ||
changing Section 3-2 as follows:
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(30 ILCS 540/3-2)
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Sec. 3-2. Beginning July 1, 1993, in any instance where a | ||
State official or
agency is late in payment of a vendor's bill | ||
or invoice for goods or services
furnished to the State, as | ||
defined in Section 1, properly approved in
accordance with | ||
rules promulgated under Section 3-3, the State official or
| ||
agency shall pay interest to the vendor in accordance with the |
following:
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(1) Any bill, except a bill submitted under Article V | ||
of the Illinois Public Aid Code and except as provided | ||
under paragraph (1.05) of this Section , approved for | ||
payment under this Section must be paid
or the payment | ||
issued to the payee within 60 days of receipt
of a proper | ||
bill or invoice.
If payment is not issued to the payee | ||
within this 60-day 60 day
period, an
interest penalty of | ||
1.0% of any amount approved and unpaid shall be added
for | ||
each month or fraction thereof after the end of this 60-day | ||
60 day period,
until final payment is made. Any bill, | ||
except a bill for pharmacy
or nursing facility services or | ||
goods and except as provided under paragraph (1.05) of this | ||
Section , submitted under Article V of the Illinois Public | ||
Aid Code approved for payment under this Section must be | ||
paid
or the payment issued to the payee within 60 days | ||
after receipt
of a proper bill or invoice, and,
if payment | ||
is not issued to the payee within this 60-day
period, an
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interest penalty of 2.0% of any amount approved and unpaid | ||
shall be added
for each month or fraction thereof after the | ||
end of this 60-day period,
until final payment is made. Any | ||
bill for pharmacy or nursing facility services or
goods | ||
submitted under Article V of the Illinois Public Aid
Code , | ||
except as provided under paragraph (1.05) of this Section, | ||
, approved for payment under this Section must be paid
or | ||
the payment issued to the payee within 60 days of
receipt |
of a proper bill or invoice. If payment is not
issued to | ||
the payee within this 60-day 60 day period, an interest
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penalty of 1.0% of any amount approved and unpaid shall be
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added for each month or fraction thereof after the end of | ||
this 60-day 60 day period, until final payment is made.
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(1.05) For State fiscal year 2012 and future fiscal | ||
years, any bill approved for payment under this Section | ||
must be paid
or the payment issued to the payee within 90 | ||
days of receipt
of a proper bill or invoice.
If payment is | ||
not issued to the payee within this 90-day
period, an
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interest penalty of 1.0% of any amount approved and unpaid | ||
shall be added
for each month or fraction thereof after the | ||
end of this 90-day period,
until final payment is made.
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(1.1) A State agency shall review in a timely manner | ||
each bill or
invoice after its receipt. If the
State agency | ||
determines that the bill or invoice contains a defect | ||
making it
unable to process the payment request, the agency
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shall notify the vendor requesting payment as soon as | ||
possible after
discovering the
defect pursuant to rules | ||
promulgated under Section 3-3; provided, however, that the | ||
notice for construction related bills or invoices must be | ||
given not later than 30 days after the bill or invoice was | ||
first submitted. The notice shall
identify the defect and | ||
any additional information
necessary to correct the | ||
defect. If one or more items on a construction related bill | ||
or invoice are disapproved, but not the entire bill or |
invoice, then the portion that is not disapproved shall be | ||
paid.
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(2) Where a State official or agency is late in payment | ||
of a
vendor's bill or invoice properly approved in | ||
accordance with this Act, and
different late payment terms | ||
are not reduced to writing as a contractual
agreement, the | ||
State official or agency shall automatically pay interest
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penalties required by this Section amounting to $50 or more | ||
to the appropriate
vendor. Each agency shall be responsible | ||
for determining whether an interest
penalty
is
owed and
for | ||
paying the interest to the vendor.
Interest due to a vendor | ||
that amounts to less than $50 shall not be paid but shall | ||
be accrued until all interest due the vendor for all | ||
similar warrants exceeds $50, at which time the accrued | ||
interest shall be payable and interest will begin accruing | ||
again, except that interest accrued as of the end of the | ||
fiscal year that does not exceed $50 shall be payable at | ||
that time. In the event an
individual has paid a vendor for | ||
services in advance, the provisions of this
Section shall | ||
apply until payment is made to that individual.
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(3) The provisions of Public Act 96-1501 this | ||
amendatory Act of the 96th General Assembly reducing the | ||
interest rate on pharmacy claims under Article V of the | ||
Illinois Public Aid Code to 1.0% per month shall apply to | ||
any pharmacy bills for services and goods under Article V | ||
of the Illinois Public Aid Code received on or after the |
date 60 days before January 25, 2011 ( the effective date of | ||
Public Act 96-1501) except as provided under paragraph | ||
(1.05) of this Section this amendatory Act of the 96th | ||
General Assembly . | ||
(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10; | ||
96-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff. | ||
1-25-11; 96-1530, eff. 2-16-11; revised 2-22-11.)
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Section 10. The Children's Health Insurance Program Act is | ||
amended by changing Section 30 as follows:
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(215 ILCS 106/30)
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Sec. 30. Cost sharing.
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(a) Children enrolled in a health benefits program pursuant | ||
to subdivision
(a)(2) of Section 25 and persons enrolled in a | ||
health benefits waiver program pursuant to Section 40 shall be | ||
subject to the following cost sharing
requirements:
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(1) There shall be no co-payment required for well-baby | ||
or well-child
care, including age-appropriate | ||
immunizations as required under
federal law.
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(2) Health insurance premiums for family members, | ||
either children or adults, in families whose household
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income is above 150% of the federal poverty level shall be | ||
payable
monthly, subject to rules promulgated by the | ||
Department for grace periods and
advance payments, and | ||
shall be as follows:
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(A) $15 per month for one family member.
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(B) $25 per month for 2 family members.
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(C) $30 per month for 3 family members. | ||
(D) $35 per month for 4 family members. | ||
(E) $40 per month for 5 or more family members.
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(3) Co-payments for children or adults in families | ||
whose income is at or below
150% of the federal poverty | ||
level, at a minimum and to the extent permitted
under | ||
federal law, shall be $2 for all medical visits and | ||
prescriptions
provided under this Act and up to $10 for | ||
emergency room use for a non-emergency situation as defined | ||
by the Department by rule and subject to federal approval .
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(4) Co-payments for children or adults in families | ||
whose income is above 150%
of the federal poverty level, at | ||
a minimum and to the extent permitted under
federal law | ||
shall be as follows:
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(A) $5 for medical visits.
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(B) $3 for generic prescriptions and $5 for brand | ||
name
prescriptions.
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(C) $25 for emergency room use for a non-emergency
| ||
situation as defined by the Department by rule.
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(5) (Blank) The maximum amount of out-of-pocket | ||
expenses for co-payments shall be
$100 per family per year .
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(6) Co-payments shall be maximized to the extent | ||
permitted by federal law and are subject to federal | ||
approval. |
(b) Individuals enrolled in a privately sponsored health | ||
insurance plan
pursuant to subdivision (a)(1) of Section 25 | ||
shall be subject to the cost
sharing provisions as stated in | ||
the privately sponsored health insurance plan.
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(Source: P.A. 94-48, eff. 7-1-05.)
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Section 15. The Illinois Public Aid Code is amended by | ||
changing Sections 5-2, 5-4.1, 5-5.12, and 5A-10 as follows:
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(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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Sec. 5-2. Classes of Persons Eligible. Medical assistance | ||
under this
Article shall be available to any of the following | ||
classes of persons in
respect to whom a plan for coverage has | ||
been submitted to the Governor
by the Illinois Department and | ||
approved by him:
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1. Recipients of basic maintenance grants under | ||
Articles III and IV.
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2. Persons otherwise eligible for basic maintenance | ||
under Articles
III and IV, excluding any eligibility | ||
requirements that are inconsistent with any federal law or | ||
federal regulation, as interpreted by the U.S. Department | ||
of Health and Human Services, but who fail to qualify | ||
thereunder on the basis of need or who qualify but are not | ||
receiving basic maintenance under Article IV, and
who have | ||
insufficient income and resources to meet the costs of
| ||
necessary medical care, including but not limited to the |
following:
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(a) All persons otherwise eligible for basic | ||
maintenance under Article
III but who fail to qualify | ||
under that Article on the basis of need and who
meet | ||
either of the following requirements:
| ||
(i) their income, as determined by the | ||
Illinois Department in
accordance with any federal | ||
requirements, is equal to or less than 70% in
| ||
fiscal year 2001, equal to or less than 85% in | ||
fiscal year 2002 and until
a date to be determined | ||
by the Department by rule, and equal to or less
| ||
than 100% beginning on the date determined by the | ||
Department by rule, of the nonfarm income official | ||
poverty
line, as defined by the federal Office of | ||
Management and Budget and revised
annually in | ||
accordance with Section 673(2) of the Omnibus | ||
Budget Reconciliation
Act of 1981, applicable to | ||
families of the same size; or
| ||
(ii) their income, after the deduction of | ||
costs incurred for medical
care and for other types | ||
of remedial care, is equal to or less than 70% in
| ||
fiscal year 2001, equal to or less than 85% in | ||
fiscal year 2002 and until
a date to be determined | ||
by the Department by rule, and equal to or less
| ||
than 100% beginning on the date determined by the | ||
Department by rule, of the nonfarm income official |
poverty
line, as defined in item (i) of this | ||
subparagraph (a).
| ||
(b) All persons who, excluding any eligibility | ||
requirements that are inconsistent with any federal | ||
law or federal regulation, as interpreted by the U.S. | ||
Department of Health and Human Services, would be | ||
determined eligible for such basic
maintenance under | ||
Article IV by disregarding the maximum earned income
| ||
permitted by federal law.
| ||
3. Persons who would otherwise qualify for Aid to the | ||
Medically
Indigent under Article VII.
| ||
4. Persons not eligible under any of the preceding | ||
paragraphs who fall
sick, are injured, or die, not having | ||
sufficient money, property or other
resources to meet the | ||
costs of necessary medical care or funeral and burial
| ||
expenses.
| ||
5.(a) Women during pregnancy, after the fact
of | ||
pregnancy has been determined by medical diagnosis, and | ||
during the
60-day period beginning on the last day of the | ||
pregnancy, together with
their infants and children born | ||
after September 30, 1983,
whose income and
resources are | ||
insufficient to meet the costs of necessary medical care to
| ||
the maximum extent possible under Title XIX of the
Federal | ||
Social Security Act.
| ||
(b) The Illinois Department and the Governor shall | ||
provide a plan for
coverage of the persons eligible under |
paragraph 5(a) by April 1, 1990. Such
plan shall provide | ||
ambulatory prenatal care to pregnant women during a
| ||
presumptive eligibility period and establish an income | ||
eligibility standard
that is equal to 133%
of the nonfarm | ||
income official poverty line, as defined by
the federal | ||
Office of Management and Budget and revised annually in
| ||
accordance with Section 673(2) of the Omnibus Budget | ||
Reconciliation Act of
1981, applicable to families of the | ||
same size, provided that costs incurred
for medical care | ||
are not taken into account in determining such income
| ||
eligibility.
| ||
(c) The Illinois Department may conduct a | ||
demonstration in at least one
county that will provide | ||
medical assistance to pregnant women, together
with their | ||
infants and children up to one year of age,
where the | ||
income
eligibility standard is set up to 185% of the | ||
nonfarm income official
poverty line, as defined by the | ||
federal Office of Management and Budget.
The Illinois | ||
Department shall seek and obtain necessary authorization
| ||
provided under federal law to implement such a | ||
demonstration. Such
demonstration may establish resource | ||
standards that are not more
restrictive than those | ||
established under Article IV of this Code.
| ||
6. Persons under the age of 18 who fail to qualify as | ||
dependent under
Article IV and who have insufficient income | ||
and resources to meet the costs
of necessary medical care |
to the maximum extent permitted under Title XIX
of the | ||
Federal Social Security Act.
| ||
7. Persons who are under 21 years of age and would
| ||
qualify as
disabled as defined under the Federal | ||
Supplemental Security Income Program,
provided medical | ||
service for such persons would be eligible for Federal
| ||
Financial Participation, and provided the Illinois | ||
Department determines that:
| ||
(a) the person requires a level of care provided by | ||
a hospital, skilled
nursing facility, or intermediate | ||
care facility, as determined by a physician
licensed to | ||
practice medicine in all its branches;
| ||
(b) it is appropriate to provide such care outside | ||
of an institution, as
determined by a physician | ||
licensed to practice medicine in all its branches;
| ||
(c) the estimated amount which would be expended | ||
for care outside the
institution is not greater than | ||
the estimated amount which would be
expended in an | ||
institution.
| ||
8. Persons who become ineligible for basic maintenance | ||
assistance
under Article IV of this Code in programs | ||
administered by the Illinois
Department due to employment | ||
earnings and persons in
assistance units comprised of | ||
adults and children who become ineligible for
basic | ||
maintenance assistance under Article VI of this Code due to
| ||
employment earnings. The plan for coverage for this class |
of persons shall:
| ||
(a) extend the medical assistance coverage for up | ||
to 12 months following
termination of basic | ||
maintenance assistance; and
| ||
(b) offer persons who have initially received 6 | ||
months of the
coverage provided in paragraph (a) above, | ||
the option of receiving an
additional 6 months of | ||
coverage, subject to the following:
| ||
(i) such coverage shall be pursuant to | ||
provisions of the federal
Social Security Act;
| ||
(ii) such coverage shall include all services | ||
covered while the person
was eligible for basic | ||
maintenance assistance;
| ||
(iii) no premium shall be charged for such | ||
coverage; and
| ||
(iv) such coverage shall be suspended in the | ||
event of a person's
failure without good cause to | ||
file in a timely fashion reports required for
this | ||
coverage under the Social Security Act and | ||
coverage shall be reinstated
upon the filing of | ||
such reports if the person remains otherwise | ||
eligible.
| ||
9. Persons with acquired immunodeficiency syndrome | ||
(AIDS) or with
AIDS-related conditions with respect to whom | ||
there has been a determination
that but for home or | ||
community-based services such individuals would
require |
the level of care provided in an inpatient hospital, | ||
skilled
nursing facility or intermediate care facility the | ||
cost of which is
reimbursed under this Article. Assistance | ||
shall be provided to such
persons to the maximum extent | ||
permitted under Title
XIX of the Federal Social Security | ||
Act.
| ||
10. Participants in the long-term care insurance | ||
partnership program
established under the Illinois | ||
Long-Term Care Partnership Program Act who meet the
| ||
qualifications for protection of resources described in | ||
Section 15 of that
Act.
| ||
11. Persons with disabilities who are employed and | ||
eligible for Medicaid,
pursuant to Section | ||
1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | ||
subject to federal approval, persons with a medically | ||
improved disability who are employed and eligible for | ||
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | ||
the Social Security Act, as
provided by the Illinois | ||
Department by rule. In establishing eligibility standards | ||
under this paragraph 11, the Department shall, subject to | ||
federal approval: | ||
(a) set the income eligibility standard at not | ||
lower than 350% of the federal poverty level; | ||
(b) exempt retirement accounts that the person | ||
cannot access without penalty before the age
of 59 1/2, | ||
and medical savings accounts established pursuant to |
26 U.S.C. 220; | ||
(c) allow non-exempt assets up to $25,000 as to | ||
those assets accumulated during periods of eligibility | ||
under this paragraph 11; and
| ||
(d) continue to apply subparagraphs (b) and (c) in | ||
determining the eligibility of the person under this | ||
Article even if the person loses eligibility under this | ||
paragraph 11.
| ||
12. Subject to federal approval, persons who are | ||
eligible for medical
assistance coverage under applicable | ||
provisions of the federal Social Security
Act and the | ||
federal Breast and Cervical Cancer Prevention and | ||
Treatment Act of
2000. Those eligible persons are defined | ||
to include, but not be limited to,
the following persons:
| ||
(1) persons who have been screened for breast or | ||
cervical cancer under
the U.S. Centers for Disease | ||
Control and Prevention Breast and Cervical Cancer
| ||
Program established under Title XV of the federal | ||
Public Health Services Act in
accordance with the | ||
requirements of Section 1504 of that Act as | ||
administered by
the Illinois Department of Public | ||
Health; and
| ||
(2) persons whose screenings under the above | ||
program were funded in whole
or in part by funds | ||
appropriated to the Illinois Department of Public | ||
Health
for breast or cervical cancer screening.
|
"Medical assistance" under this paragraph 12 shall be | ||
identical to the benefits
provided under the State's | ||
approved plan under Title XIX of the Social Security
Act. | ||
The Department must request federal approval of the | ||
coverage under this
paragraph 12 within 30 days after the | ||
effective date of this amendatory Act of
the 92nd General | ||
Assembly.
| ||
In addition to the persons who are eligible for medical | ||
assistance pursuant to subparagraphs (1) and (2) of this | ||
paragraph 12, and to be paid from funds appropriated to the | ||
Department for its medical programs, any uninsured person | ||
as defined by the Department in rules residing in Illinois | ||
who is younger than 65 years of age, who has been screened | ||
for breast and cervical cancer in accordance with standards | ||
and procedures adopted by the Department of Public Health | ||
for screening, and who is referred to the Department by the | ||
Department of Public Health as being in need of treatment | ||
for breast or cervical cancer is eligible for medical | ||
assistance benefits that are consistent with the benefits | ||
provided to those persons described in subparagraphs (1) | ||
and (2). Medical assistance coverage for the persons who | ||
are eligible under the preceding sentence is not dependent | ||
on federal approval, but federal moneys may be used to pay | ||
for services provided under that coverage upon federal | ||
approval. | ||
13. Subject to appropriation and to federal approval, |
persons living with HIV/AIDS who are not otherwise eligible | ||
under this Article and who qualify for services covered | ||
under Section 5-5.04 as provided by the Illinois Department | ||
by rule.
| ||
14. Subject to the availability of funds for this | ||
purpose, the Department may provide coverage under this | ||
Article to persons who reside in Illinois who are not | ||
eligible under any of the preceding paragraphs and who meet | ||
the income guidelines of paragraph 2(a) of this Section and | ||
(i) have an application for asylum pending before the | ||
federal Department of Homeland Security or on appeal before | ||
a court of competent jurisdiction and are represented | ||
either by counsel or by an advocate accredited by the | ||
federal Department of Homeland Security and employed by a | ||
not-for-profit organization in regard to that application | ||
or appeal, or (ii) are receiving services through a | ||
federally funded torture treatment center. Medical | ||
coverage under this paragraph 14 may be provided for up to | ||
24 continuous months from the initial eligibility date so | ||
long as an individual continues to satisfy the criteria of | ||
this paragraph 14. If an individual has an appeal pending | ||
regarding an application for asylum before the Department | ||
of Homeland Security, eligibility under this paragraph 14 | ||
may be extended until a final decision is rendered on the | ||
appeal. The Department may adopt rules governing the | ||
implementation of this paragraph 14.
|
15. Family Care Eligibility. | ||
(a) Through December 31, 2013, a A caretaker | ||
relative who is 19 years of age or older when countable | ||
income is at or below 185% of the Federal Poverty Level | ||
Guidelines, as published annually in the Federal | ||
Register, for the appropriate family size. Beginning | ||
January 1, 2014, a caretaker relative who is 19 years | ||
of age or older when countable income is at or below | ||
133% of the Federal Poverty Level Guidelines, as | ||
published annually in the Federal Register, for the | ||
appropriate family size. A person may not spend down to | ||
become eligible under this paragraph 15. | ||
(b) Eligibility shall be reviewed annually. | ||
(c) Caretaker relatives enrolled under this | ||
paragraph 15 in families with countable income above | ||
150% and at or below 185% of the Federal Poverty Level | ||
Guidelines shall be counted as family members and pay | ||
premiums as established under the Children's Health | ||
Insurance Program Act. | ||
(d) Premiums shall be billed by and payable to the | ||
Department or its authorized agent, on a monthly basis. | ||
(e) The premium due date is the last day of the | ||
month preceding the month of coverage. | ||
(f) Individuals shall have a grace period through | ||
30 days of coverage to pay the premium. | ||
(g) Failure to pay the full monthly premium by the |
last day of the grace period shall result in | ||
termination of coverage. | ||
(h) Partial premium payments shall not be | ||
refunded. | ||
(i) Following termination of an individual's | ||
coverage under this paragraph 15, the following action | ||
is required before the individual can be re-enrolled: | ||
(1) A new application must be completed and the | ||
individual must be determined otherwise eligible. | ||
(2) There must be full payment of premiums due | ||
under this Code, the Children's Health Insurance | ||
Program Act, the Covering ALL KIDS Health | ||
Insurance Act, or any other healthcare program | ||
administered by the Department for periods in | ||
which a premium was owed and not paid for the | ||
individual. | ||
(3) The first month's premium must be paid if | ||
there was an unpaid premium on the date the | ||
individual's previous coverage was canceled. | ||
The Department is authorized to implement the | ||
provisions of this amendatory Act of the 95th General | ||
Assembly by adopting the medical assistance rules in effect | ||
as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | ||
89 Ill. Admin. Code 120.32 along with only those changes | ||
necessary to conform to federal Medicaid requirements, | ||
federal laws, and federal regulations, including but not |
limited to Section 1931 of the Social Security Act (42 | ||
U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | ||
of Health and Human Services, and the countable income | ||
eligibility standard authorized by this paragraph 15. The | ||
Department may not otherwise adopt any rule to implement | ||
this increase except as authorized by law, to meet the | ||
eligibility standards authorized by the federal government | ||
in the Medicaid State Plan or the Title XXI Plan, or to | ||
meet an order from the federal government or any court. | ||
16. Subject to appropriation, uninsured persons who | ||
are not otherwise eligible under this Section who have been | ||
certified and referred by the Department of Public Health | ||
as having been screened and found to need diagnostic | ||
evaluation or treatment, or both diagnostic evaluation and | ||
treatment, for prostate or testicular cancer. For the | ||
purposes of this paragraph 16, uninsured persons are those | ||
who do not have creditable coverage, as defined under the | ||
Health Insurance Portability and Accountability Act, or | ||
have otherwise exhausted any insurance benefits they may | ||
have had, for prostate or testicular cancer diagnostic | ||
evaluation or treatment, or both diagnostic evaluation and | ||
treatment.
To be eligible, a person must furnish a Social | ||
Security number.
A person's assets are exempt from | ||
consideration in determining eligibility under this | ||
paragraph 16.
Such persons shall be eligible for medical | ||
assistance under this paragraph 16 for so long as they need |
treatment for the cancer. A person shall be considered to | ||
need treatment if, in the opinion of the person's treating | ||
physician, the person requires therapy directed toward | ||
cure or palliation of prostate or testicular cancer, | ||
including recurrent metastatic cancer that is a known or | ||
presumed complication of prostate or testicular cancer and | ||
complications resulting from the treatment modalities | ||
themselves. Persons who require only routine monitoring | ||
services are not considered to need treatment.
"Medical | ||
assistance" under this paragraph 16 shall be identical to | ||
the benefits provided under the State's approved plan under | ||
Title XIX of the Social Security Act.
Notwithstanding any | ||
other provision of law, the Department (i) does not have a | ||
claim against the estate of a deceased recipient of | ||
services under this paragraph 16 and (ii) does not have a | ||
lien against any homestead property or other legal or | ||
equitable real property interest owned by a recipient of | ||
services under this paragraph 16. | ||
In implementing the provisions of Public Act 96-20, the | ||
Department is authorized to adopt only those rules necessary, | ||
including emergency rules. Nothing in Public Act 96-20 permits | ||
the Department to adopt rules or issue a decision that expands | ||
eligibility for the FamilyCare Program to a person whose income | ||
exceeds 185% of the Federal Poverty Level as determined from | ||
time to time by the U.S. Department of Health and Human | ||
Services, unless the Department is provided with express |
statutory authority. | ||
The Illinois Department and the Governor shall provide a | ||
plan for
coverage of the persons eligible under paragraph 7 as | ||
soon as possible after
July 1, 1984.
| ||
The eligibility of any such person for medical assistance | ||
under this
Article is not affected by the payment of any grant | ||
under the Senior
Citizens and Disabled Persons Property Tax | ||
Relief and Pharmaceutical
Assistance Act or any distributions | ||
or items of income described under
subparagraph (X) of
| ||
paragraph (2) of subsection (a) of Section 203 of the Illinois | ||
Income Tax
Act. The Department shall by rule establish the | ||
amounts of
assets to be disregarded in determining eligibility | ||
for medical assistance,
which shall at a minimum equal the | ||
amounts to be disregarded under the
Federal Supplemental | ||
Security Income Program. The amount of assets of a
single | ||
person to be disregarded
shall not be less than $2,000, and the | ||
amount of assets of a married couple
to be disregarded shall | ||
not be less than $3,000.
| ||
To the extent permitted under federal law, any person found | ||
guilty of a
second violation of Article VIIIA
shall be | ||
ineligible for medical assistance under this Article, as | ||
provided
in Section 8A-8.
| ||
The eligibility of any person for medical assistance under | ||
this Article
shall not be affected by the receipt by the person | ||
of donations or benefits
from fundraisers held for the person | ||
in cases of serious illness,
as long as neither the person nor |
members of the person's family
have actual control over the | ||
donations or benefits or the disbursement
of the donations or | ||
benefits.
| ||
(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; | ||
96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. | ||
8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123, | ||
eff. 1-1-11; 96-1270, eff. 7-26-10; revised 9-16-10.)
| ||
(305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
| ||
Sec. 5-4.1. Co-payments. The Department may by rule provide | ||
that recipients
under any Article of this Code shall pay a fee | ||
as a co-payment for services.
Co-payments shall be maximized to | ||
the extent permitted by federal law. Provided, however, that | ||
any such rule must provide that no
co-payment requirement can | ||
exist
for renal dialysis, radiation therapy, cancer | ||
chemotherapy, or insulin, and
other products necessary on a | ||
recurring basis, the absence of which would
be life | ||
threatening, or where co-payment expenditures for required | ||
services
and/or medications for chronic diseases that the | ||
Illinois Department shall
by rule designate shall cause an | ||
extensive financial burden on the
recipient, and provided no | ||
co-payment shall exist for emergency room
encounters which are | ||
for medical emergencies. The Department shall seek approval of | ||
a State plan amendment that allows pharmacies to refuse to | ||
dispense drugs in circumstances where the recipient does not | ||
pay the required co-payment. In the event the State plan |
amendment is rejected, co-payments may not exceed $3 for brand | ||
name drugs, $1 for other pharmacy
services other than for | ||
generic drugs, and $2 for physician services, dental
services, | ||
optical services and supplies, chiropractic services, podiatry
| ||
services, and encounter rate clinic services. There shall be no | ||
co-payment for
generic drugs. Co-payments may not exceed $10 | ||
for emergency room use for a non-emergency situation as defined | ||
by the Department by rule and subject to federal approval. | ||
Co-payments may not exceed $3 for hospital outpatient and | ||
clinic
services.
| ||
(Source: P.A. 96-1501, eff. 1-25-11.)
| ||
(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
| ||
Sec. 5-5.12. Pharmacy payments.
| ||
(a) Every request submitted by a pharmacy for reimbursement | ||
under this
Article for prescription drugs provided to a | ||
recipient of aid under this
Article shall include the name of | ||
the prescriber or an acceptable
identification number as | ||
established by the Department.
| ||
(b) Pharmacies providing prescription drugs under
this | ||
Article shall be reimbursed at a rate which shall include
a | ||
professional dispensing fee as determined by the Illinois
| ||
Department, plus the current acquisition cost of the | ||
prescription
drug dispensed. The Illinois Department shall | ||
update its
information on the acquisition costs of all | ||
prescription drugs
no less frequently than every 30 days. |
However, the Illinois
Department may set the rate of | ||
reimbursement for the acquisition
cost, by rule, at a | ||
percentage of the current average wholesale
acquisition cost.
| ||
(c) (Blank).
| ||
(d) The Department shall not impose requirements for prior | ||
approval
based on a preferred drug list for anti-retroviral, | ||
anti-hemophilic factor
concentrates,
or
any atypical | ||
antipsychotics, conventional antipsychotics,
or | ||
anticonvulsants used for the treatment of serious mental
| ||
illnesses
until 30 days after it has conducted a study of the | ||
impact of such
requirements on patient care and submitted a | ||
report to the Speaker of the
House of Representatives and the | ||
President of the Senate. The Department shall review | ||
utilization of narcotic medications in the medical assistance | ||
program and impose utilization controls that protect against | ||
abuse.
| ||
(e) When making determinations as to which drugs shall be | ||
on a prior approval list, the Department shall include as part | ||
of the analysis for this determination, the degree to which a | ||
drug may affect individuals in different ways based on factors | ||
including the gender of the person taking the medication. | ||
(f) The Department shall cooperate with the Department of | ||
Public Health and the Department of Human Services Division of | ||
Mental Health in identifying psychotropic medications that, | ||
when given in a particular form, manner, duration, or frequency | ||
(including "as needed") in a dosage, or in conjunction with |
other psychotropic medications to a nursing home resident, may | ||
constitute a chemical restraint or an "unnecessary drug" as | ||
defined by the Nursing Home Care Act or Titles XVIII and XIX of | ||
the Social Security Act and the implementing rules and | ||
regulations. The Department shall require prior approval for | ||
any such medication prescribed for a nursing home resident that | ||
appears to be a chemical restraint or an unnecessary drug. The | ||
Department shall consult with the Department of Human Services | ||
Division of Mental Health in developing a protocol and criteria | ||
for deciding whether to grant such prior approval. | ||
(g) The Department may by rule provide for reimbursement of | ||
the dispensing of a 90-day supply of a generic, non-narcotic | ||
maintenance medication in circumstances where it is cost | ||
effective. | ||
(h) Effective July 1, 2011, the Department shall | ||
discontinue coverage of select over-the-counter drugs, | ||
including analgesics and cough and cold and allergy | ||
medications. | ||
(i) The Department shall seek any necessary waiver from the | ||
federal government in order to establish a program limiting the | ||
pharmacies eligible to dispense specialty drugs and shall issue | ||
a Request for Proposals in order to maximize savings on these | ||
drugs. The Department shall by rule establish the drugs | ||
required to be dispensed in this program. | ||
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; | ||
96-1501, eff. 1-25-11.)
|
(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
| ||
Sec. 5A-10. Applicability.
| ||
(a) The assessment imposed by Section 5A-2 shall not take | ||
effect or shall
cease to be imposed, and
any moneys
remaining | ||
in the Fund shall be refunded to hospital providers
in | ||
proportion to the amounts paid by them, if:
| ||
(1) The sum of the appropriations for State fiscal | ||
years 2004 and 2005
from the
General Revenue Fund for | ||
hospital payments
under the medical assistance program is | ||
less than $4,500,000,000 or the appropriation for each of | ||
State fiscal years 2006, 2007 and 2008 from the General | ||
Revenue Fund for hospital payments under the medical | ||
assistance program is less than $2,500,000,000 increased | ||
annually to reflect any increase in the number of | ||
recipients, or the annual appropriation for State fiscal | ||
years 2009 , 2010, 2011, 2013, and 2014 through 2014 , from | ||
the General Revenue Fund combined with the Hospital | ||
Provider Fund as authorized in Section 5A-8 for hospital | ||
payments under the medical assistance program, is less than | ||
the amount appropriated for State fiscal year 2009, | ||
adjusted annually to reflect any change in the number of | ||
recipients, excluding State fiscal year 2009 supplemental | ||
appropriations made necessary by the enactment of the | ||
American Recovery and Reinvestment Act of 2009; or
| ||
(2) For State fiscal years prior to State fiscal year |
2009, the Department of Healthcare and Family Services | ||
(formerly Department of Public Aid) makes changes in its | ||
rules
that
reduce the hospital inpatient or outpatient | ||
payment rates, including adjustment
payment rates, in | ||
effect on October 1, 2004, except for hospitals described | ||
in
subsection (b) of Section 5A-3 and except for changes in | ||
the methodology for calculating outlier payments to | ||
hospitals for exceptionally costly stays, so long as those | ||
changes do not reduce aggregate
expenditures below the | ||
amount expended in State fiscal year 2005 for such
| ||
services; or
| ||
(2.1) For State fiscal years 2009 through 2014, the
| ||
Department of Healthcare and Family Services adopts any | ||
administrative rule change to reduce payment rates or | ||
alters any payment methodology that reduces any payment | ||
rates made to operating hospitals under the approved Title | ||
XIX or Title XXI State plan in effect January 1, 2008 | ||
except for: | ||
(A) any changes for hospitals described in | ||
subsection (b) of Section 5A-3; or | ||
(B) any rates for payments made under this Article | ||
V-A; or | ||
(C) any changes proposed in State plan amendment | ||
transmittal numbers 08-01, 08-02, 08-04, 08-06, and | ||
08-07; or | ||
(D) in relation to any admissions on or after |
January 1, 2011, a modification in the methodology for | ||
calculating outlier payments to hospitals for | ||
exceptionally costly stays, for hospitals reimbursed | ||
under the diagnosis-related grouping methodology; | ||
provided that the Department shall be limited to one | ||
such modification during the 36-month period after the | ||
effective date of this amendatory Act of the 96th | ||
General Assembly; or | ||
(3) The payments to hospitals required under Section | ||
5A-12 or Section 5A-12.2 are changed or
are
not eligible | ||
for federal matching funds under Title XIX or XXI of the | ||
Social
Security Act.
| ||
(b) The assessment imposed by Section 5A-2 shall not take | ||
effect or
shall
cease to be imposed if the assessment is | ||
determined to be an impermissible
tax under Title XIX
of the | ||
Social Security Act. Moneys in the Hospital Provider Fund | ||
derived
from assessments imposed prior thereto shall be
| ||
disbursed in accordance with Section 5A-8 to the extent federal | ||
financial participation is
not reduced due to the | ||
impermissibility of the assessments, and any
remaining
moneys | ||
shall be
refunded to hospital providers in proportion to the | ||
amounts paid by them.
| ||
(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08; 96-8, | ||
eff. 4-28-09; 96-1530, eff. 2-16-11.)
| ||
Section 20. The Senior Citizens and Disabled Persons |
Property Tax Relief and Pharmaceutical Assistance Act is | ||
amended by changing Section 4 as follows:
| ||
(320 ILCS 25/4) (from Ch. 67 1/2, par. 404)
| ||
Sec. 4. Amount of Grant.
| ||
(a) In general. Any individual 65 years or older or any | ||
individual who will
become 65 years old during the calendar | ||
year in which a claim is filed, and any
surviving spouse of | ||
such a claimant, who at the time of death received or was
| ||
entitled to receive a grant pursuant to this Section, which | ||
surviving spouse
will become 65 years of age within the 24 | ||
months immediately following the
death of such claimant and | ||
which surviving spouse but for his or her age is
otherwise | ||
qualified to receive a grant pursuant to this Section, and any
| ||
disabled person whose annual household income is less than the | ||
income eligibility limitation, as defined in subsection (a-5)
| ||
and whose household is liable for payment of property taxes | ||
accrued or has
paid rent constituting property taxes accrued | ||
and is domiciled in this State
at the time he or she files his | ||
or her claim is entitled to claim a
grant under this Act.
With | ||
respect to claims filed by individuals who will become 65 years | ||
old
during the calendar year in which a claim is filed, the | ||
amount of any grant
to which that household is entitled shall | ||
be an amount equal to 1/12 of the
amount to which the claimant | ||
would otherwise be entitled as provided in
this Section, | ||
multiplied by the number of months in which the claimant was
65 |
in the calendar year in which the claim is filed.
| ||
(a-5) Income eligibility limitation. For purposes of this | ||
Section, "income eligibility limitation" means an amount for | ||
grant years 2008 and thereafter: | ||
(1) less than $22,218 for a household containing one | ||
person; | ||
(2) less than $29,480 for a household containing 2 | ||
persons; or | ||
(3) less than $36,740 for a
household containing 3 or | ||
more persons. | ||
For 2009 claim year applications submitted during calendar | ||
year 2010, a household must have annual household income of | ||
less than $27,610 for a household containing one person; less | ||
than $36,635 for a household containing 2 persons; or less than | ||
$45,657 for a household containing 3 or more persons. | ||
The Department on Aging may adopt rules such that on | ||
January 1, 2011, and thereafter, the foregoing household income | ||
eligibility limits may be changed to reflect the annual cost of | ||
living adjustment in Social Security and Supplemental Security | ||
Income benefits that are applicable to the year for which those | ||
benefits are being reported as income on an application. | ||
If a person files as a surviving spouse, then only his or | ||
her income shall be counted in determining his or her household | ||
income. | ||
(b) Limitation. Except as otherwise provided in | ||
subsections (a) and (f)
of this Section, the maximum amount of |
grant which a claimant is
entitled to claim is the amount by | ||
which the property taxes accrued which
were paid or payable | ||
during the last preceding tax year or rent
constituting | ||
property taxes accrued upon the claimant's residence for the
| ||
last preceding taxable year exceeds 3 1/2% of the claimant's | ||
household
income for that year but in no event is the grant to | ||
exceed (i) $700 less
4.5% of household income for that year for | ||
those with a household income of
$14,000 or less or (ii) $70 if | ||
household income for that year is more than
$14,000.
| ||
(c) Public aid recipients. If household income in one or | ||
more
months during a year includes cash assistance in excess of | ||
$55 per month
from the Department of Healthcare and Family | ||
Services or the Department of Human Services (acting
as | ||
successor to the Department of Public Aid under the Department | ||
of Human
Services Act) which was determined under regulations | ||
of
that Department on a measure of need that included an | ||
allowance for actual
rent or property taxes paid by the | ||
recipient of that assistance, the amount
of grant to which that | ||
household is entitled, except as otherwise provided in
| ||
subsection (a), shall be the product of (1) the maximum amount | ||
computed as
specified in subsection (b) of this Section and (2) | ||
the ratio of the number of
months in which household income did | ||
not include such cash assistance over $55
to the number twelve. | ||
If household income did not include such cash assistance
over | ||
$55 for any months during the year, the amount of the grant to | ||
which the
household is entitled shall be the maximum amount |
computed as specified in
subsection (b) of this Section. For | ||
purposes of this paragraph (c), "cash
assistance" does not | ||
include any amount received under the federal Supplemental
| ||
Security Income (SSI) program.
| ||
(d) Joint ownership. If title to the residence is held | ||
jointly by
the claimant with a person who is not a member of | ||
his or her household,
the amount of property taxes accrued used | ||
in computing the amount of grant
to which he or she is entitled | ||
shall be the same percentage of property
taxes accrued as is | ||
the percentage of ownership held by the claimant in the
| ||
residence.
| ||
(e) More than one residence. If a claimant has occupied | ||
more than
one residence in the taxable year, he or she may | ||
claim only one residence
for any part of a month. In the case | ||
of property taxes accrued, he or she
shall prorate 1/12 of the | ||
total property taxes accrued on
his or her residence to each | ||
month that he or she owned and occupied
that residence; and, in | ||
the case of rent constituting property taxes accrued,
shall | ||
prorate each month's rent payments to the residence
actually | ||
occupied during that month.
| ||
(f) (Blank).
| ||
(g) Effective January 1, 2006, there is hereby established | ||
a program of pharmaceutical assistance to the aged and | ||
disabled, entitled the Illinois Seniors and Disabled Drug | ||
Coverage Program, which shall be administered by the Department | ||
of Healthcare and Family Services and the Department on Aging |
in accordance with this subsection, to consist of coverage of | ||
specified prescription drugs on behalf of beneficiaries of the | ||
program as set forth in this subsection. | ||
To become a beneficiary under the program established under | ||
this subsection, a person must: | ||
(1) be (i) 65 years of age or older or (ii) disabled; | ||
and | ||
(2) be domiciled in this State; and | ||
(3) enroll with a qualified Medicare Part D | ||
Prescription Drug Plan if eligible and apply for all | ||
available subsidies under Medicare Part D; and | ||
(4) for the 2006 and 2007 claim years, have a maximum | ||
household income of (i) less than $21,218 for a household | ||
containing one person, (ii) less than $28,480 for a | ||
household containing 2 persons, or (iii) less than $35,740 | ||
for a household containing 3 or more persons; and | ||
(5) for the 2008 claim year, have a maximum household | ||
income of (i) less than $22,218 for a household containing | ||
one person, (ii) $29,480 for a household containing 2 | ||
persons, or (iii) $36,740 for a household containing 3 or | ||
more persons; and | ||
(6) for 2009 claim year applications submitted during | ||
calendar year 2010, have annual household income of less | ||
than (i) $27,610 for a household containing one person; | ||
(ii) less than $36,635 for a household containing 2 | ||
persons; or (iii) less than $45,657 for a household |
containing 3 or more persons ; and . | ||
(7) as of September 1, 2011, have a maximum household | ||
income at or below 200% of the federal poverty level. | ||
The Department of Healthcare and Family Services may adopt | ||
rules such that on January 1, 2011, and thereafter, the | ||
foregoing household income eligibility limits may be changed to | ||
reflect the annual cost of living adjustment in Social Security | ||
and Supplemental Security Income benefits that are applicable | ||
to the year for which those benefits are being reported as | ||
income on an application. | ||
All individuals enrolled as of December 31, 2005, in the | ||
pharmaceutical assistance program operated pursuant to | ||
subsection (f) of this Section and all individuals enrolled as | ||
of December 31, 2005, in the SeniorCare Medicaid waiver program | ||
operated pursuant to Section 5-5.12a of the Illinois Public Aid | ||
Code shall be automatically enrolled in the program established | ||
by this subsection for the first year of operation without the | ||
need for further application, except that they must apply for | ||
Medicare Part D and the Low Income Subsidy under Medicare Part | ||
D. A person enrolled in the pharmaceutical assistance program | ||
operated pursuant to subsection (f) of this Section as of | ||
December 31, 2005, shall not lose eligibility in future years | ||
due only to the fact that they have not reached the age of 65. | ||
To the extent permitted by federal law, the Department may | ||
act as an authorized representative of a beneficiary in order | ||
to enroll the beneficiary in a Medicare Part D Prescription |
Drug Plan if the beneficiary has failed to choose a plan and, | ||
where possible, to enroll beneficiaries in the low-income | ||
subsidy program under Medicare Part D or assist them in | ||
enrolling in that program. | ||
Beneficiaries under the program established under this | ||
subsection shall be divided into the following 4 eligibility | ||
groups: | ||
(A) Eligibility Group 1 shall consist of beneficiaries | ||
who are not eligible for Medicare Part D coverage and who
| ||
are: | ||
(i) disabled and under age 65; or | ||
(ii) age 65 or older, with incomes over 200% of the | ||
Federal Poverty Level; or | ||
(iii) age 65 or older, with incomes at or below | ||
200% of the Federal Poverty Level and not eligible for | ||
federally funded means-tested benefits due to | ||
immigration status. | ||
(B) Eligibility Group 2 shall consist of beneficiaries | ||
who are eligible for Medicare Part D coverage. | ||
(C) Eligibility Group 3 shall consist of beneficiaries | ||
age 65 or older, with incomes at or below 200% of the | ||
Federal Poverty Level, who are not barred from receiving | ||
federally funded means-tested benefits due to immigration | ||
status and are not eligible for Medicare Part D coverage. | ||
If the State applies and receives federal approval for | ||
a waiver under Title XIX of the Social Security Act, |
persons in Eligibility Group 3 shall continue to receive | ||
benefits through the approved waiver, and Eligibility | ||
Group 3 may be expanded to include disabled persons under | ||
age 65 with incomes under 200% of the Federal Poverty Level | ||
who are not eligible for Medicare and who are not barred | ||
from receiving federally funded means-tested benefits due | ||
to immigration status. | ||
(D) Eligibility Group 4 shall consist of beneficiaries | ||
who are otherwise described in Eligibility Group 2 who have | ||
a diagnosis of HIV or AIDS.
| ||
The program established under this subsection shall cover | ||
the cost of covered prescription drugs in excess of the | ||
beneficiary cost-sharing amounts set forth in this paragraph | ||
that are not covered by Medicare. The Department of Healthcare | ||
and Family Services may establish by emergency rule changes in | ||
cost-sharing necessary to conform the cost of the program to | ||
the amounts appropriated for State fiscal year 2012 and future | ||
fiscal years except that the 24-month limitation on the | ||
adoption of emergency rules and the provisions of Sections | ||
5-115 and 5-125 of the Illinois Administrative Procedure Act | ||
shall not apply to rules adopted under this subsection (g). The | ||
adoption of emergency rules authorized by this subsection (g) | ||
shall be deemed to be necessary for the public interest, | ||
safety, and welfare. In 2006, beneficiaries shall pay a | ||
co-payment of $2 for each prescription of a generic drug and $5 | ||
for each prescription of a brand-name drug. In future years, |
beneficiaries shall pay co-payments equal to the co-payments | ||
required under Medicare Part D for "other low-income subsidy | ||
eligible individuals" pursuant to 42 CFR 423.782(b). For | ||
individuals in Eligibility Groups 1, 2, and 3, once the program | ||
established under this subsection and Medicare combined have | ||
paid $1,750 in a year for covered prescription drugs, the | ||
beneficiary shall pay 20% of the cost of each prescription in | ||
addition to the co-payments set forth in this paragraph. For | ||
individuals in Eligibility Group 4, once the program | ||
established under this subsection and Medicare combined have | ||
paid $1,750 in a year for covered prescription drugs, the | ||
beneficiary shall pay 20% of the cost of each prescription in | ||
addition to the co-payments set forth in this paragraph unless | ||
the drug is included in the formulary of the Illinois AIDS Drug | ||
Assistance Program operated by the Illinois Department of | ||
Public Health and covered by the Medicare Part D Prescription | ||
Drug Plan in which the beneficiary is enrolled. If the drug is | ||
included in the formulary of the Illinois AIDS Drug Assistance | ||
Program and covered by the Medicare Part D Prescription Drug | ||
Plan in which the beneficiary is enrolled, individuals in | ||
Eligibility Group 4 shall continue to pay the co-payments set | ||
forth in this paragraph after the program established under | ||
this subsection and Medicare combined have paid $1,750 in a | ||
year for covered prescription drugs.
| ||
For beneficiaries eligible for Medicare Part D coverage, | ||
the program established under this subsection shall pay 100% of |
the premiums charged by a qualified Medicare Part D | ||
Prescription Drug Plan for Medicare Part D basic prescription | ||
drug coverage, not including any late enrollment penalties. | ||
Qualified Medicare Part D Prescription Drug Plans may be | ||
limited by the Department of Healthcare and Family Services to | ||
those plans that sign a coordination agreement with the | ||
Department. | ||
For Notwithstanding Section 3.15, for purposes of the | ||
program established under this subsection, the term "covered | ||
prescription drug" has the following meanings: | ||
For Eligibility Group 1, "covered prescription drug" | ||
means: (1) any cardiovascular agent or drug; (2) any | ||
insulin or other prescription drug used in the treatment of | ||
diabetes, including syringe and needles used to administer | ||
the insulin; (3) any prescription drug used in the | ||
treatment of arthritis; (4) any prescription drug used in | ||
the treatment of cancer; (5) any prescription drug used in | ||
the treatment of Alzheimer's disease; (6) any prescription | ||
drug used in the treatment of Parkinson's disease; (7) any | ||
prescription drug used in the treatment of glaucoma; (8) | ||
any prescription drug used in the treatment of lung disease | ||
and smoking-related illnesses; (9) any prescription drug | ||
used in the treatment of osteoporosis; and (10) any | ||
prescription drug used in the treatment of multiple | ||
sclerosis. The Department may add additional therapeutic | ||
classes by rule. The Department may adopt a preferred drug |
list within any of the classes of drugs described in items | ||
(1) through (10) of this paragraph. The specific drugs or | ||
therapeutic classes of covered prescription drugs shall be | ||
indicated by rule. | ||
For Eligibility Group 2, "covered prescription drug" | ||
means those drugs covered by the Medicare Part D | ||
Prescription Drug Plan in which the beneficiary is | ||
enrolled. | ||
For Eligibility Group 3, "covered prescription drug" | ||
means those drugs covered by the Medical Assistance Program | ||
under Article V of the Illinois Public Aid Code. | ||
For Eligibility Group 4, "covered prescription drug" | ||
means those drugs covered by the Medicare Part D | ||
Prescription Drug Plan in which the beneficiary is | ||
enrolled. | ||
An individual in Eligibility Group 1, 2, 3, or 4 may opt to | ||
receive a $25 monthly payment in lieu of the direct coverage | ||
described in this subsection. | ||
Any person otherwise eligible for pharmaceutical | ||
assistance under this subsection whose covered drugs are | ||
covered by any public program is ineligible for assistance | ||
under this subsection to the extent that the cost of those | ||
drugs is covered by the other program. | ||
The Department of Healthcare and Family Services shall | ||
establish by rule the methods by which it will provide for the | ||
coverage called for in this subsection. Those methods may |
include direct reimbursement to pharmacies or the payment of a | ||
capitated amount to Medicare Part D Prescription Drug Plans. | ||
For a pharmacy to be reimbursed under the program | ||
established under this subsection, it must comply with rules | ||
adopted by the Department of Healthcare and Family Services | ||
regarding coordination of benefits with Medicare Part D | ||
Prescription Drug Plans. A pharmacy may not charge a | ||
Medicare-enrolled beneficiary of the program established under | ||
this subsection more for a covered prescription drug than the | ||
appropriate Medicare cost-sharing less any payment from or on | ||
behalf of the Department of Healthcare and Family Services. | ||
The Department of Healthcare and Family Services or the | ||
Department on Aging, as appropriate, may adopt rules regarding | ||
applications, counting of income, proof of Medicare status, | ||
mandatory generic policies, and pharmacy reimbursement rates | ||
and any other rules necessary for the cost-efficient operation | ||
of the program established under this subsection. | ||
(h) A qualified individual is not entitled to duplicate
| ||
benefits in a coverage period as a result of the changes made
| ||
by this amendatory Act of the 96th General Assembly.
| ||
(Source: P.A. 95-208, eff. 8-16-07; 95-644, eff. 10-12-07; | ||
95-876, eff. 8-21-08; 96-804, eff. 1-1-10; revised 9-16-10.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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