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91_HB0486eng HB0486 Engrossed LRB9100447SMdv 1 AN ACT concerning kidney transplants. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Civil Administrative Code of Illinois is 5 amended by adding Section 55.91 as follows: 6 (20 ILCS 2310/55.91 new) 7 Sec. 55.91. Payments for post-kidney transplant 8 maintenance drugs. 9 (a) The Department of Public Health shall establish and 10 administer a program to pay recipients for costs of drugs 11 prescribed exclusively for post-kidney transplant maintenance 12 when those costs are not otherwise reimbursed. The 13 Department of Public Health shall establish eligibility 14 standards and an application process by rule. Notwithstanding 15 any other provision of this Code to the contrary, the 16 Department of Public Health may, by rule, require 17 participants to pay a co-payment for the drugs covered under 18 this program. 19 (b) Participation in the program shall be limited to 20 persons whose household income is not greater than 400% of 21 the federal poverty level as established by the federal 22 Office of Management and Budget. 23 The program shall be available only to eligible Illinois 24 residents who have resided in Illinois for at least 12 25 months, however, a person shall not be excluded because he or 26 she received the transplant outside the State of Illinois. 27 (c) The Department of Public Health shall pay a maximum 28 amount per kidney transplant recipient based on the 29 following: 30 (1) Available moneys in the Post-Kidney Transplant 31 Maintenance Drug Fund. HB0486 Engrossed -2- LRB9100447SMdv 1 (2) Covered immunosuppressive drugs. 2 (3) The terms of any contract between the 3 Department of Public Health and the provider. 4 (4) The reimbursement rates shall be the same as 5 the Medicaid reimbursement rate for the drug, minus the 6 co-payment. 7 (d) Payment shall be made under the program to or on 8 behalf of a program eligible recipient only for costs not 9 reimbursed or eligible for reimbursement by any other third 10 party or governmental entity (including, without limitation, 11 private or group insurance, Medicaid, Medicare, or the 12 Veterans Administration). The Director of Public Health may, 13 however, waive this requirement in individually considered 14 cases if he or she determines that its enforcement will deny 15 services to a class of post-kidney transplant patients 16 because of conflicting State or federal laws or regulations. 17 (e) The Director of Public Health may restrict or 18 categorize reimbursements to meet budgetary limitations. 19 (f) The Director of Public Health shall maintain an 20 immunosuppressive drug formulary that shall include all drugs 21 eligible for reimbursement by the program. The Director of 22 Public Health shall establish an internal review procedure 23 for updating the formulary; the procedure shall allow the 24 addition and deletion of allowable drugs to the formulary. 25 The internal review procedure shall take place at least 26 quarterly during a fiscal year. 27 (g) Payments made under the program established under 28 this Section shall be made, subject to appropriations, from 29 the Post-Kidney Transplant Maintenance Drug Fund, a special 30 fund that is hereby established in the State treasury. The 31 following shall be deposited into the Fund: (1) amounts 32 appropriated to the Department of Public Health for that 33 purpose and (ii) gifts, grants, and donations for that 34 purpose from public and private sources. Interest accruing HB0486 Engrossed -3- LRB9100447SMdv 1 on moneys in the Fund shall remain in the Fund. Moneys in 2 the Fund may be used only by the Department of Public Health 3 to make payments for post-kidney transplant maintenance drugs 4 under the program established under this Section. 5 (h) Moneys remaining in the Post-Kidney Transplant 6 Maintenance Drug Fund at the end of the fiscal year may be 7 used in the following fiscal year. 8 Section 10. The State Finance Act is amended by adding 9 Section 5.490 as follows: 10 (30 ILCS 105/5.490 new) 11 Sec. 5.490. The Post-Kidney Transplant Maintenance Drug 12 Fund. 13 Section 99. Effective date. This Act takes effect July 14 1, 1999.