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91_HB0486sam001
LRB9100447STsbam
1 AMENDMENT TO HOUSE BILL 486
2 AMENDMENT NO. . Amend House Bill 486 as follows:
3 by replacing the title with the following:
4 "AN ACT concerning organ transplants."; and
5 by replacing everything after the enacting clause with the
6 following:
7 "Section 5. The Civil Administrative Code of Illinois is
8 amended by adding Section 2310-260 as follows:
9 (20 ILCS 2310/2310-260 new)
10 Sec. 2310-260. Payments for post transplant maintenance
11 and retention.
12 (a) The Department shall establish and administer a
13 program to pay recipients for drugs and other costs
14 prescribed exclusively for post transplant maintenance and
15 retention when those costs are not otherwise reimbursed. The
16 Department shall establish eligibility standards and an
17 application process by rule. Notwithstanding any other
18 provision of this Code to the contrary, the Department may,
19 by rule, require participants to pay a co-payment for the
20 drugs covered under this program.
21 (b) Participation in the program shall be limited to
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1 persons whose household income is not greater than 400% of
2 the federal poverty level as established by the federal
3 Office of Management and Budget. The program shall be
4 available only to eligible Illinois residents who have
5 resided in Illinois for at least 12 months; however, a person
6 shall not be excluded because that person received the
7 transplant outside of the State of Illinois.
8 (c) The Department shall pay a maximum amount per
9 transplant recipient based on the following:
10 (1) Available moneys in the Post Transplant
11 Maintenance and Retention Fund.
12 (2) Covered immunosuppressive drugs.
13 (3) The terms of any contract between the Department
14 and the provider.
15 The reimbursement rates shall be the same as the Medicaid
16 reimbursement rate for the drug, minus any co-payment and
17 other medical services.
18 (d) Payment shall be made under the program to or on
19 behalf of a program-eligible recipient only for costs not
20 reimbursed or eligible for reimbursement by any other third
21 party or governmental entity, including, without limitation,
22 private or group insurance, Medicaid, Medicare, and the
23 Veterans Administration. The Director may, however, waive
24 this requirement in individually considered cases if the
25 Director determines that its enforcement will deny services
26 to a class of post transplant patients because of conflicting
27 State or federal laws or regulations.
28 (e) The Director may restrict or categorize
29 reimbursements to meet budgetary limitations.
30 (f) The Director shall maintain an immunosuppressive drug
31 formulary that shall include all drugs eligible for
32 reimbursement by the program. The Director shall establish an
33 internal review procedure for updating the formulary; the
34 procedure shall allow the addition and deletion of allowable
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1 drugs to the formulary. The internal review procedure shall
2 take place at least quarterly during a fiscal year.
3 (g) Payments made under the program established under
4 this Section shall be made, subject to appropriations, from
5 the Post Transplant Maintenance and Retention Fund, a special
6 fund that is hereby created in the State Treasury. The
7 following shall be deposited into the Fund: (i) amounts
8 appropriated to the Department for that purpose, and (ii)
9 gifts, grants, and donations for that purpose from public and
10 private sources. Interest accruing on moneys in the Fund
11 shall remain in the Fund. Moneys in the Fund may be used only
12 by the Department to make payments for post transplant
13 maintenance and retention under the program established under
14 this Section.
15 (h) Moneys remaining in the Post Transplant Maintenance
16 and Retention Fund at the end of the fiscal year may be used
17 in the following fiscal year.
18 Section 10. The State Finance Act is amended by adding
19 Section 5.541 as follows:
20 (30 ILCS 105/5.541 new)
21 Sec. 5.541. The Post Transplant Maintenance and
22 Retention Fund.
23 Section 99. Effective date. This Act takes effect on
24 July 1, 2000.".