Public Act 095-0208
 		





HB1257 Enrolled
LRB095 07696 DRJ 27850 b






    AN ACT concerning aging.

 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:


 
    Section 5. 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 
$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 
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.
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.

    (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) 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 
of the program, for the reasonable costs of covered

prescription drugs.  Each beneficiary who pays $5 for an 
identification card
shall pay no additional prescription 
costs.  Each beneficiary who pays $25 for
an identification card 
shall pay $3 per prescription.  In addition, after a
beneficiary 
receives $2,000 in benefits during a State fiscal year, that

beneficiary shall also be charged 20% of the cost of each 
prescription for
which payments are made by the program during 
the remainder of the fiscal
year.  To become a beneficiary under 
this program a person must: (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 
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.  In addition, each eligible person must (1) obtain 
an
identification card from the Department, (2) at the time the 
card is obtained,
sign a statement assigning to the State of 
Illinois benefits which may be
otherwise claimed under any 
private insurance plans, and (3) present the
identification 
card to the dispensing pharmacist.

    The Department may adopt rules specifying
participation

requirements for the pharmaceutical assistance program, 
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.
Notwithstanding any other 
provision of this paragraph, however, the Department
may not

increase the identification card fee above the amount in effect 
on May 1, 2003
without
the express consent of the General 
Assembly.
To the extent practicable, those requirements shall 
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.

    Whenever a generic equivalent for a covered prescription 
drug is available,
the Department shall reimburse only for the 
reasonable costs of the generic
equivalent, less the co-pay 
established in this Section, unless (i) the covered

prescription drug contains one or more ingredients defined as a 
narrow
therapeutic index drug at 21 CFR 320.33, (ii) the 
prescriber indicates on the
face of the prescription "brand 
medically necessary", and (iii) the prescriber
specifies that a 
substitution is not permitted.  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 
permitted.  If the covered prescription drug and its
authorizing 
prescription do not meet the criteria listed above, the 
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.

    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 
this Act to the extent such costs are covered by such other 
plan.

    The fee to be charged by the Department for the 
identification card shall
be equal to $5 per coverage year for 
persons below the official poverty line
as defined by the 
United States Department of Health and Human Services and
$25 
per coverage year for all other persons.

    In the event that 2 or more persons are eligible for any 
benefit under
this Act, and are members of the same household, 
(1) each such person shall
be entitled to participate in the 
pharmaceutical assistance program, provided
that he or she 
meets all other requirements imposed by this subsection
and (2) 
each participating household member contributes the fee 
required
for that person by the preceding paragraph for the 
purpose
of obtaining an identification card.
    The provisions of this subsection (f), other than this 
paragraph, are inoperative after December 31, 2005. 
Beneficiaries who received benefits under the program 
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.
    (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.  The program under this 
subsection replaces and supersedes the program established 
under subsection (f), which shall end at midnight on December 
31, 2005.
    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) 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. If any income eligibility limit set forth in items 
    (i) through (iii)  is less than 200% of the Federal Poverty 
    Level for any year, the income eligibility limit for that 
    year for households of that size shall be income equal to 
    or less than 200% of the Federal Poverty Level.
    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 5 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 
    otherwise described in Eligibility Group 1 but 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 eligible for Medicare Part D coverage.
        (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 
    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 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.
        (E)  On and after January 1, 2007, Eligibility Group 5 
    shall consist of beneficiaries who are otherwise described 
    in Eligibility Groups 2 and 3 who
Group 1 but are eligible 
    for Medicare Part D and 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.  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, 3, and 
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. For individuals in Eligibility Group 5, 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.  If the drug is included in the 
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 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.
    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 for Eligibility Group 1 that are 
    also 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 Medicare Part D 
    Prescription Drug Plan in which the beneficiary is 
    enrolled.
        For Eligibility Group 4, "covered prescription drug" 
    means those drugs covered by the Medical Assistance Program 
    under Article V of the Illinois Public Aid Code.
        For Eligibility Group 5, for individuals otherwise 
    described in Eligibility Group 2, "covered prescription 
    drug" means:
(1)  those drugs covered for Eligibility Group 
    2
1 that 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 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.
For Eligibility Group 5, for 
    individuals otherwise described in Eligibility Group 3, 
    "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, or 5 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.


(Source: P.A. 93-130, eff. 7-10-03; 94-86, eff. 1-1-06; 94-909, 
eff. 6-23-06.)

 

    Section 99. Effective date. This Act takes effect upon 
becoming law.