HB 948 — IL CARES RX-COVERED RX DRUGS

*LRB09509871DRJ30082b* HB0948 95THEngrossed GENERALLRB095 ASSEMBLY09871 StateDRJ of30082 Illinoisb andAN 2008ACT HB0948concerning Introducedaging. 2/8/2007, by Rep.

Elga L.

Jefferies SYNOPSIS AS INTRODUCED:

ILCS 25/4 from Ch.

67 1/2, par.

404 Amends the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act.

In provisions concerning the pharmaceutical assistance program ("Illinois Cares Rx"), provides that for Eligibility Group 1 (persons who are not eligible for Medicare Part D coverage and who meet certain other requirements), "covered prescription drug" means those drugs covered by the Medical Assistance Program under the Illinois Public Aid Code (instead of any of 10 specified types of drugs).

LRB095 09871 DRJ 30082 b FISCAL NOTE ACT MAY APPLY A BILL FOR HB0948 LRB095 09871 DRJ 30082 b AN ACT concerning aging.

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 $14,000 for grant years before the 1998 grant year, less than $16,000 for the 1998 and 1999 grant years, and less than (i) $21,218 for a household containing one person, (ii) $28,480 for a household containing 2 persons, or (iii) $35,740 for a household containing 3 or more persons for the 2000 grant year HB0948 Engrossed - 2 - LRB095 09871 DRJ 30082 b and thereafter 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.

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 HB0948 Engrossed - 3 - LRB095 09871 DRJ 30082 b 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 a claimant has occupied HB0948 Engrossed - 4 - LRB095 09871 DRJ 30082 b more than one residence in the taxable year, he or she may claim only one residence for any part of a month.

(1) be (i) 65 years of age or older, or (ii) the surviving spouse of such a claimant, who at the time of death received or was entitled to receive benefits pursuant to this subsection, which surviving spouse will become 65 years of age within the 24 months immediately following the HB0948 Engrossed - 5 - LRB095 09871 DRJ 30082 b death of such claimant and which surviving spouse but for his or her age is otherwise qualified to receive benefits pursuant to this subsection, or (iii) disabled, and (2) be domiciled in this State at the time he or she files his or her claim, and (3) have a maximum household income of less than $14,000 for grant years before the 1998 grant year, less than $16,000 for the 1998 and 1999 grant years, and less than (i) $21,218 for a household containing one person, (ii) $28,480 for a household containing 2 persons, or (iii) $35,740 for a household containing 3 more persons for the 2000 grant year and thereafter.

To the extent practicable, those requirements shall HB0948 Engrossed - 6 - LRB095 09871 DRJ 30082 b be commensurate with the requirements provided in rules adopted by the Department of Healthcare and Family Services to implement the pharmacy assistance program under Section 5-5.12a of the Illinois Public Aid Code.

Any person otherwise eligible for pharmaceutical assistance under this Act whose covered drugs are covered by any public program for assistance in purchasing any covered prescription drugs shall be ineligible for assistance under HB0948 Engrossed - 7 - LRB095 09871 DRJ 30082 b this Act to the extent such costs are covered by such other plan.

(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 HB0948 Engrossed - 8 - LRB095 09871 DRJ 30082 b 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.

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 HB0948 Engrossed - 9 - LRB095 09871 DRJ 30082 b 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) Eligibility Group 1 shall consist of beneficiaries who are not eligible for Medicare Part D coverage and who are:are disabled and under age 65.:

or HB0948 Engrossed - 10 - LRB095 09871 DRJ 30082 b (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.

(C) Eligibility Group 3 shall consist of beneficiaries age 65 or older,older who, 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 eligible for Medicare Part D coverage.

(D) Eligibility Group 4 shall consist of beneficiaries age 65 or older,older who, 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.

HB0948 Engrossed - 11 - LRB095 09871 DRJ 30082 b (E) On and after January 1, 2007, Eligibility Group 5 shall consist of beneficiaries who are otherwise described in Eligibility Group 1 but are eligible for Medicare Part D and have a diagnosis of HIV or AIDS.

If the drug is included in the HB0948 Engrossed - 12 - LRB095 09871 DRJ 30082 b formulary of the Illinois AIDS Drug Assistance Program, individuals in Eligibility Group 5 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 Eligibility Group 1, "covered prescription drug" meansmeans: those drugs covered by the Medical Assistance Program under Article V of the Illinois Public Aid Code.

(5) any prescription drug used in the treatment HB0948 - 13 - LRB095 09871 DRJ 30082 b of Alzheimer’s disease;

(7) any prescription drug used in the treatment of HB0948 Engrossed - 13 - LRB095 09871 DRJ 30082 b glaucoma;

(1) those drugs covered for Eligibility Group 1 that HB0948 - 14 - LRB095 09871 DRJ 30082 b are also covered by the Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled;

and (2) those drugs included in the formulary of the Illinois AIDS Drug HB0948 Engrossed - 14 - LRB095 09871 DRJ 30082 b Assistance Program operated by the Illinois Department of Public Health that are also covered by the Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled.

A pharmacy may not charge a Medicare-enrolled beneficiary of the program established under HB0948 - 15 - LRB095 09871 DRJ 30082 b 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.

HB0948 Engrossed - 15 - LRB095 09871 DRJ 30082 b 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.