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91_HB0486enr HB0486 Enrolled LRB9100447SMdv 1 AN ACT concerning organ 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 2310-260 as follows: 6 (20 ILCS 2310/2310-260 new) 7 Sec. 2310-260. Payments for post transplant maintenance 8 and retention. 9 (a) The Department shall establish and administer a 10 program to pay recipients for drugs and other costs 11 prescribed exclusively for post transplant maintenance and 12 retention when those costs are not otherwise reimbursed. The 13 Department shall establish eligibility standards and an 14 application process by rule. Notwithstanding any other 15 provision of this Code to the contrary, the Department may, 16 by rule, require participants to pay a co-payment for the 17 drugs covered under this program. 18 (b) Participation in the program shall be limited to 19 persons whose household income is not greater than 400% of 20 the federal poverty level as established by the federal 21 Office of Management and Budget. The program shall be 22 available only to eligible Illinois residents who have 23 resided in Illinois for at least 12 months; however, a person 24 shall not be excluded because that person received the 25 transplant outside of the State of Illinois. 26 (c) The Department shall pay a maximum amount per 27 transplant recipient based on the following: 28 (1) Available moneys in the Post Transplant 29 Maintenance and Retention Fund. 30 (2) Covered immunosuppressive drugs. 31 (3) The terms of any contract between the Department HB0486 Enrolled -2- LRB9100447SMdv 1 and the provider. 2 The reimbursement rates shall be the same as the Medicaid 3 reimbursement rate for the drug, minus any co-payment and 4 other medical services. 5 (d) Payment shall be made under the program to or on 6 behalf of a program-eligible recipient only for costs not 7 reimbursed or eligible for reimbursement by any other third 8 party or governmental entity, including, without limitation, 9 private or group insurance, Medicaid, Medicare, and the 10 Veterans Administration. The Director may, however, waive 11 this requirement in individually considered cases if the 12 Director determines that its enforcement will deny services 13 to a class of post transplant patients because of conflicting 14 State or federal laws or regulations. 15 (e) The Director may restrict or categorize 16 reimbursements to meet budgetary limitations. 17 (f) The Director shall maintain an immunosuppressive drug 18 formulary that shall include all drugs eligible for 19 reimbursement by the program. The Director shall establish an 20 internal review procedure for updating the formulary; the 21 procedure shall allow the addition and deletion of allowable 22 drugs to the formulary. The internal review procedure shall 23 take place at least quarterly during a fiscal year. 24 (g) Payments made under the program established under 25 this Section shall be made, subject to appropriations, from 26 the Post Transplant Maintenance and Retention Fund, a special 27 fund that is hereby created in the State Treasury. The 28 following shall be deposited into the Fund: (i) amounts 29 appropriated to the Department for that purpose, and (ii) 30 gifts, grants, and donations for that purpose from public and 31 private sources. Interest accruing on moneys in the Fund 32 shall remain in the Fund. Moneys in the Fund may be used only 33 by the Department to make payments for post transplant 34 maintenance and retention under the program established under HB0486 Enrolled -3- LRB9100447SMdv 1 this Section. 2 (h) Moneys remaining in the Post Transplant Maintenance 3 and Retention Fund at the end of the fiscal year may be used 4 in the following fiscal year. 5 Section 10. The State Finance Act is amended by adding 6 Section 5.541 as follows: 7 (30 ILCS 105/5.541 new) 8 Sec. 5.541. The Post Transplant Maintenance and 9 Retention Fund. 10 Section 99. Effective date. This Act takes effect on 11 July 1, 2000.