HB 5579 — CIRCUIT BREAKR-COVERED RX DRUG

*LRB09517728DRJ43804b* HB5579 95THEngrossed GENERALLRB095 ASSEMBLY17728 StateDRJ of43804 Illinoisb andAN 2008ACT HB5579concerning byaging. Rep.

Kevin Joyce SYNOPSIS AS INTRODUCED:

ILCS 25/3.15 from Ch.

67 1/2, par.

403.15 ILCS 25/4 from Ch.

67 1/2, par.

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

Provides that beginning January 1, 2009, "covered prescription drug" includes any prescription drug used in treating the effects of multiple sclerosis (instead of providing that the term includes any prescription drug used in the treatment of multiple sclerosis).

Effective immediately.

LRB095 17728 DRJ 43804 b FISCAL NOTE ACT MAY APPLY A BILL FOR HB5579 LRB095 17728 DRJ 43804 b AN ACT concerning aging.

(3) any prescription drug used in the treatment of arthritis, (4) beginning on January 1, 2001, any prescription drug used in the treatment of cancer, (5) beginning on January 1, 2001, any prescription drug used in the treatment of Alzheimer’s disease, (6) beginning on January 1, 2001, any prescription drug used in the treatment of Parkinson’s disease, (7) beginning on January 1, 2001, any prescription drug used in the treatment of glaucoma, (8) beginning on January 1, 2001, any prescription drug used in the treatment of lung disease and smoking related illnesses, (9) beginning on July 1, 2001, any prescription drug used in the treatment of osteoporosis, and (10) beginning on January 1, 2009 2004, any prescription drug used in treating HB5579 Engrossed - 2 - LRB095 17728 DRJ 43804 b the effects the treatment of multiple sclerosis.

Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.

If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.

Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.

For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois HB5579 Engrossed - 3 - LRB095 17728 DRJ 43804 b Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.

With respect to claims filed by individuals who will become 65 years HB5579 - 3 - LRB095 17728 DRJ 43804 b old during the calendar year in which a claim is filed, the amount of any grant to which that household is entitled shall HB5579 Engrossed - 4 - LRB095 17728 DRJ 43804 b 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.

HB5579 - 4 - LRB095 17728 DRJ 43804 b (b) Limitation.

Except as otherwise provided in subsections (a) and (f) of this Section, the maximum amount of HB5579 Engrossed - 5 - LRB095 17728 DRJ 43804 b 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.

If household income did not include such cash assistance over HB5579 - 5 - LRB095 17728 DRJ 43804 b $55 for any months during the year, the amount of the grant to which the household is entitled shall be the maximum amount HB5579 Engrossed - 6 - LRB095 17728 DRJ 43804 b computed as specified in subsection (b) of this Section.

(f) There is hereby established a program of pharmaceutical assistance to the aged and disabled which shall be administered by the Department in accordance with this Act, to consist of payments to authorized pharmacies, on behalf of beneficiaries HB5579 - 6 - LRB095 17728 DRJ 43804 b of the program, for the reasonable costs of covered prescription drugs.

Each beneficiary who pays $5 for an HB5579 Engrossed - 7 - LRB095 17728 DRJ 43804 b identification card shall pay no additional prescription costs.

HB5579 - 7 - LRB095 17728 DRJ 43804 b The Department may adopt rules specifying participation requirements for the pharmaceutical assistance program, HB5579 Engrossed - 8 - LRB095 17728 DRJ 43804 b including copayment amounts, identification card fees, expenditure limits, and the benefit threshold after which a 20% charge is imposed on the cost of each prescription, to be in effect on and after July 1, 2004.

When issuing an oral prescription for covered prescription medication described in item (i) of this paragraph, the prescriber shall stipulate "brand medically necessary" and that a substitution is not HB5579 - 8 - LRB095 17728 DRJ 43804 b permitted.

If the covered prescription drug and its authorizing prescription do not meet the criteria listed above, the HB5579 Engrossed - 9 - LRB095 17728 DRJ 43804 b beneficiary may purchase the non-generic equivalent of the covered prescription drug by paying the difference between the generic cost and the non-generic cost plus the beneficiary co-pay.

The provisions of this subsection (f), other than this HB5579 - 9 - LRB095 17728 DRJ 43804 b paragraph, are inoperative after December 31, 2005.

Beneficiaries who received benefits under the program HB5579 Engrossed - 10 - LRB095 17728 DRJ 43804 b established by this subsection (f) are not entitled, at the termination of the program, to any refund of the identification card fee paid under this subsection.

and (4) have a maximum household income of (i) less than $21,218 for a household containing one person, (ii) less HB5579 - 10 - LRB095 17728 DRJ 43804 b than $28,480 for a household containing 2 persons, or (iii) less than $35,740 for a household containing 3 or more HB5579 Engrossed - 11 - LRB095 17728 DRJ 43804 b persons.

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 HB5579 - 11 - LRB095 17728 DRJ 43804 b enrolling in that program.

Beneficiaries under the program established under this HB5579 Engrossed - 12 - LRB095 17728 DRJ 43804 b subsection shall be divided into the following 5 eligibility groups:

(D) Eligibility Group 4 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 HB5579 - 12 - LRB095 17728 DRJ 43804 b status and are not eligible for Medicare Part D coverage.

If the State applies and receives federal approval for HB5579 Engrossed - 13 - LRB095 17728 DRJ 43804 b a waiver under Title XIX of the Social Security Act, persons in Eligibility Group 4 shall continue to receive benefits through the approved waiver, and Eligibility Group 4 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.

For individuals in Eligibility Groups 1, 2, 3, and 4, once the program established under this subsection and Medicare combined have paid $1,750 in a year for covered HB5579 - 13 - LRB095 17728 DRJ 43804 b prescription drugs, the beneficiary shall pay 20% of the cost of each prescription in addition to the co-payments set forth HB5579 Engrossed - 14 - LRB095 17728 DRJ 43804 b in this paragraph.

Notwithstanding Section 3.15, for purposes of the program established under this subsection, the term "covered HB5579 - 14 - LRB095 17728 DRJ 43804 b prescription drug" has the following meanings:

For Eligibility Group 1, "covered prescription drug" HB5579 Engrossed - 15 - LRB095 17728 DRJ 43804 b means:

HB5579 - 15 - LRB095 17728 DRJ 43804 b For Eligibility Group 3, "covered prescription drug" means those drugs covered by the Medicare Part D HB5579 Engrossed - 16 - LRB095 17728 DRJ 43804 b Prescription Drug Plan in which the beneficiary is enrolled.

Any person otherwise eligible for pharmaceutical assistance under this subsection whose covered drugs are HB5579 - 16 - LRB095 17728 DRJ 43804 b covered by any public program is ineligible for assistance under this subsection to the extent that the cost of those HB5579 Engrossed - 17 - LRB095 17728 DRJ 43804 b drugs is covered by the other program.

(h) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.

If, HB5579 Engrossed - 18 - LRB095 17728 DRJ 43804 b however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.

Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.

For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.