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91_HB0486ham001
LRB9100447SMdvam02
1 AMENDMENT TO HOUSE BILL 486
2 AMENDMENT NO. . Amend House Bill 486 by replacing
3 everything after the enacting clause with the following:
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.
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1 The program shall be available only to eligible Illinois
2 residents who have resided in Illinois for at least 12
3 months, however, a person shall not be excluded because he or
4 she received the transplant outside the State of Illinois.
5 (c) The Department of Public Health shall pay a maximum
6 amount per kidney transplant recipient based on the
7 following:
8 (1) Available moneys in the Post-Kidney Transplant
9 Maintenance Drug Fund.
10 (2) Covered immunosuppressive drugs.
11 (3) The terms of any contract between the
12 Department of Public Health and the provider.
13 (4) The reimbursement rates shall be the same as
14 the Medicaid reimbursement rate for the drug, minus the
15 copayment.
16 (d) Payment shall be made under the program to or on
17 behalf of a program eligible recipient only for costs not
18 reimbursed or eligible for reimbursement by any other third
19 party or governmental entity (including, without limitation,
20 private or group insurance, Medicaid, Medicare, or the
21 Veterans Administration). The Director of Public Health may,
22 however, waive this requirement in individually considered
23 cases if he or she determines that its enforcement will deny
24 services to a class of post-kidney transplant patients
25 because of conflicting State or federal laws or regulations.
26 (e) The Director of Public Health may restrict or
27 categorize reimbursements to meet budgetary limitations.
28 (f) The Director of Public Health shall maintain an
29 immunosuppressive drug formulary that shall include all drugs
30 eligible for reimbursement by the program. The Director of
31 Public Health shall establish an internal review procedure
32 for updating the formulary; the procedure shall allow the
33 addition and deletion of allowable drugs to the formulary.
34 The internal review procedure shall take place at least
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1 quarterly during a fiscal year.
2 (g) Payments made under the program established under
3 this Section shall be made, subject to appropriations, from
4 the Post-Kidney Transplant Maintenance Drug Fund, a special
5 fund that is hereby established in the State treasury. The
6 following shall be deposited into the Fund: (1) amounts
7 appropriated to the Department of Public Health for that
8 purpose and (ii) gifts, grants, and donations for that
9 purpose from public and private sources. Interest accruing
10 on moneys in the Fund shall remain in the Fund. Moneys in
11 the Fund may be used only by the Department of Public Health
12 to make payments for post-kidney transplant maintenance drugs
13 under the program established under this Section.
14 (h) Moneys remaining in the Post-Kidney Transplant
15 Maintenance Drug Fund at the end of the fiscal year may be
16 used in the following fiscal year.
17 Section 10. The State Finance Act is amended by adding
18 Section 5.490 as follows:
19 (30 ILCS 105/5.490 new)
20 Sec. 5.490. The Post-Kidney Transplant Maintenance Drug
21 Fund.
22 Section 99. Effective date. This Act takes effect July
23 1, 1999.".