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91_HB3937
LRB9111607STsb
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
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1 Department 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
18 drug 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 Funds
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
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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.