Bill Text: IL SB1802 | 2011-2012 | 97th General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Illinois Power Agency Act. In provisions concerning the aggregation of retail electrical load of residential and small commercial retail customers by municipalities and counties, provides that any aggregation program that operates as an opt-out program shall apply solely to residential and small commercial retail customers that are taking service from the electric utility through fixed-price bundled service tariffs. Provides that the corporate authorities or the county board shall allow new residents outside of an opt-out period and non-applicable residential and small commercial retail customers who were not eligible to receive the opt-out notice to affirmatively commit to the terms and conditions of an opt-out program at any time during the length of the program under a process disclosed in the plan of operation and governance. Sets forth provisions concerning the plan of operation and governance for an opt-out program. Sets forth provisions concerning requests made by the corporate authorities or the county board in the aggregate area for certain information from the electric utility related to applicable residential and small commercial retail customers in the aggregate area. Provides that the Illinois Commerce Commission shall adopt rules to implement the provisions of the amendatory Act, including, but not limited to, protection of customers already under contract with an alternative retail electric supplier, utility processes for enrollment of opt-out customers, minimum disclosure requirements for opt-out aggregation programs and licensing of municipalities. Makes other changes. Effective immediately.

Spectrum: Bipartisan Bill

Status: (Passed) 2011-06-30 - Public Act . . . . . . . . . 97-0074 [SB1802 Detail]

Download: Illinois-2011-SB1802-Amended.html

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Rep. Sara Feigenholtz

Filed: 5/27/2011

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AMENDMENT TO SENATE BILL 1802
AMENDMENT NO. ______. Amend Senate Bill 1802 by replacing
everything after the enacting clause with the following:
"Section 1. The Department of Human Services Act is amended
by adding Section 10-66 as follows:
(20 ILCS 1305/10-66 new)
Sec. 10-66. Rate reductions. For State fiscal year 2012,
rates for medical services purchased by the Divisions of
Alcohol and Substance Abuse, Community Health and Prevention,
Developmentally Disabilities, Mental Health, or Rehabilitation
Services within the Department of Human Services shall not be
reduced below the rates calculated on April 1, 2011 unless the
Department of Human Services promulgates rules and rules are
implemented authorizing rate reductions.
Section 3. The Disabled Persons Rehabilitation Act is

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amended by adding Section 10a as follows:
(20 ILCS 2405/10a new)
Sec. 10a. Financial Participation of Students Attending
the Illinois School for the Deaf and the Illinois School for
the Visually Impaired.
(a) General. The Illinois School for the Deaf and the
Illinois School for the Visually Impaired are required to
provide eligible students with disabilities with a free and
appropriate education. As part of the admission process to
either school, the Department shall complete a financial
analysis on each student attending the Illinois School for the
Deaf or the Illinois School for the Visually Impaired and shall
ask parents or guardians to participate, if applicable, in the
cost of identified services or activities that are not
education related.
(b) Completion of financial analysis. Prior to admission,
and annually thereafter, a financial analysis shall be
completed on each student attending the Illinois School for the
Deaf or the Illinois School for the Visually Impaired. If at
any time there is reason to believe there is a change in the
student's financial situation that will affect their financial
participation, a new financial analysis shall be completed.
(1) In completing the student's financial analysis,
the income of the student's family shall be used. Proof of
income must be provided and retained for each parent or

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guardian.
(2) Any funds that have been established on behalf of
the student for completion of their primary or secondary
education shall be considered when completing the
financial analysis.
(3) Falsification of information used to complete the
financial analysis may result in the Department taking
action to recoup monies previously expended by the
Department in providing services to the student.
(c) Financial Participation. Utilizing a sliding scale
based on income standards developed by the Department, parents
or guardians of students attending the Illinois School for the
Deaf or the Illinois School for the Visually Impaired shall be
asked to financially participate in the following fees for
services or activities provided at the schools:
(1) Registration.
(2) Books, labs, and supplies (fees may vary depending
on the classes in which a student participates).
(3) Room and board for residential students.
(4) Meals for day students.
(5) Athletic or extracurricular activities (students
participating in multiple activities will not be required
to pay for more than 2 activities).
(6) Driver's education (if applicable).
(7) Graduation.
(8) Yearbook (optional).

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(9) Activities (field trips or other leisure
activities).
(10) Other activities or services identified by the
Department.
Students, parents, or guardians who are receiving Medicaid
or Temporary Assistance for Needy Families (TANF) shall not be
required to financially participate in the fees established in
this subsection (c).
Exceptions may be granted to parents or guardians who are
unable to meet the financial participation obligations due to
extenuating circumstances. Requests for exceptions must be
made in writing and must be submitted to the Director of the
Division of Rehabilitation Services for review.
Section 5. The State Prompt Payment Act is amended by
changing Section 3-2 as follows:
(30 ILCS 540/3-2)
Sec. 3-2. Beginning July 1, 1993, in any instance where a
State official or agency is late in payment of a vendor's bill
or invoice for goods or services furnished to the State, as
defined in Section 1, properly approved in accordance with
rules promulgated under Section 3-3, the State official or
agency shall pay interest to the vendor in accordance with the
following:
(1) Any bill, except a bill submitted under Article V

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of the Illinois Public Aid Code, approved for payment under
this Section must be paid or the payment issued to the
payee within 90 60 days of receipt of a proper bill or
invoice. If payment is not issued to the payee within this
90-day 60 day period, an interest penalty of 1.0% of any
amount approved and unpaid shall be added for each month or
fraction thereof after the end of this 90-day 60 day
period, until final payment is made. Any bill, except a
bill for pharmacy or nursing facility services or goods,
submitted under Article V of the Illinois Public Aid Code
approved for payment under this Section must be paid or the
payment issued to the payee within 60 days after receipt of
a proper bill or invoice, and, if payment is not issued to
the payee within this 60-day period, an interest penalty of
2.0% of any amount approved and unpaid shall be added for
each month or fraction thereof after the end of this 60-day
period, until final payment is made. Any bill for pharmacy
or nursing facility services or goods submitted under
Article V of the Illinois Public Aid Code, approved for
payment under this Section must be paid or the payment
issued to the payee within 60 days of receipt of a proper
bill or invoice. If payment is not issued to the payee
within this 60-day 60 day period, an interest penalty of
1.0% of any amount approved and unpaid shall be added for
each month or fraction thereof after the end of this 60-day
60 day period, until final payment is made.

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(1.1) A State agency shall review in a timely manner
each bill or invoice after its receipt. If the State agency
determines that the bill or invoice contains a defect
making it unable to process the payment request, the agency
shall notify the vendor requesting payment as soon as
possible after discovering the defect pursuant to rules
promulgated under Section 3-3; provided, however, that the
notice for construction related bills or invoices must be
given not later than 30 days after the bill or invoice was
first submitted. The notice shall identify the defect and
any additional information necessary to correct the
defect. If one or more items on a construction related bill
or invoice are disapproved, but not the entire bill or
invoice, then the portion that is not disapproved shall be
paid.
(2) Where a State official or agency is late in payment
of a vendor's bill or invoice properly approved in
accordance with this Act, and different late payment terms
are not reduced to writing as a contractual agreement, the
State official or agency shall automatically pay interest
penalties required by this Section amounting to $50 or more
to the appropriate vendor. Each agency shall be responsible
for determining whether an interest penalty is owed and for
paying the interest to the vendor. Interest due to a vendor
that amounts to less than $50 shall not be paid but shall
be accrued until all interest due the vendor for all

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similar warrants exceeds $50, at which time the accrued
interest shall be payable and interest will begin accruing
again, except that interest accrued as of the end of the
fiscal year that does not exceed $50 shall be payable at
that time. In the event an individual has paid a vendor for
services in advance, the provisions of this Section shall
apply until payment is made to that individual.
(3) The provisions of Public Act 96-1501 this
amendatory Act of the 96th General Assembly reducing the
interest rate on pharmacy claims under Article V of the
Illinois Public Aid Code to 1.0% per month shall apply to
any pharmacy bills for services and goods under Article V
of the Illinois Public Aid Code received on or after the
date 60 days before January 25, 2011 (the effective date of
Public Act 96-1501) until the effective date of this
amendatory Act of the 97th General Assembly this amendatory
Act of the 96th General Assembly.
(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10;
96-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff.
1-25-11; 96-1530, eff. 2-16-11; revised 2-22-11.)
Section 10. The Children's Health Insurance Program Act is
amended by changing Section 30 as follows:
(215 ILCS 106/30)
Sec. 30. Cost sharing.

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(a) Children enrolled in a health benefits program pursuant
to subdivision (a)(2) of Section 25 and persons enrolled in a
health benefits waiver program pursuant to Section 40 shall be
subject to the following cost sharing requirements:
(1) There shall be no co-payment required for well-baby
or well-child care, including age-appropriate
immunizations as required under federal law.
(2) Health insurance premiums for family members,
either children or adults, in families whose household
income is above 150% of the federal poverty level shall be
payable monthly, subject to rules promulgated by the
Department for grace periods and advance payments, and
shall be as follows:
(A) $15 per month for one family member.
(B) $25 per month for 2 family members.
(C) $30 per month for 3 family members.
(D) $35 per month for 4 family members.
(E) $40 per month for 5 or more family members.
(3) Co-payments for children or adults in families
whose income is at or below 150% of the federal poverty
level, at a minimum and to the extent permitted under
federal law, shall be $2 for all medical visits and
prescriptions provided under this Act and up to $10 for
emergency room use for a non-emergency situation as defined
by the Department by rule and subject to federal approval.
(4) Co-payments for children or adults in families

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whose income is above 150% of the federal poverty level, at
a minimum and to the extent permitted under federal law
shall be as follows:
(A) $5 for medical visits.
(B) $3 for generic prescriptions and $5 for brand
name prescriptions.
(C) $25 for emergency room use for a non-emergency
situation as defined by the Department by rule.
(5) (Blank) The maximum amount of out-of-pocket
expenses for co-payments shall be $100 per family per year.
(6) Co-payments shall be maximized to the extent
permitted by federal law and are subject to federal
approval.
(b) Individuals enrolled in a privately sponsored health
insurance plan pursuant to subdivision (a)(1) of Section 25
shall be subject to the cost sharing provisions as stated in
the privately sponsored health insurance plan.
(Source: P.A. 94-48, eff. 7-1-05.)
Section 15. The Illinois Public Aid Code is amended by
changing Sections 5-2, 5-4.1, 5-5.12, 5A-10, 14-8, as follows:
(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
Sec. 5-2. Classes of Persons Eligible. Medical assistance
under this Article shall be available to any of the following
classes of persons in respect to whom a plan for coverage has

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been submitted to the Governor by the Illinois Department and
approved by him:
1. Recipients of basic maintenance grants under
Articles III and IV.
2. Persons otherwise eligible for basic maintenance
under Articles III and IV, excluding any eligibility
requirements that are inconsistent with any federal law or
federal regulation, as interpreted by the U.S. Department
of Health and Human Services, but who fail to qualify
thereunder on the basis of need or who qualify but are not
receiving basic maintenance under Article IV, and who have
insufficient income and resources to meet the costs of
necessary medical care, including but not limited to the
following:
(a) All persons otherwise eligible for basic
maintenance under Article III but who fail to qualify
under that Article on the basis of need and who meet
either of the following requirements:
(i) their income, as determined by the
Illinois Department in accordance with any federal
requirements, is equal to or less than 70% in
fiscal year 2001, equal to or less than 85% in
fiscal year 2002 and until a date to be determined
by the Department by rule, and equal to or less
than 100% beginning on the date determined by the
Department by rule, of the nonfarm income official

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poverty line, as defined by the federal Office of
Management and Budget and revised annually in
accordance with Section 673(2) of the Omnibus
Budget Reconciliation Act of 1981, applicable to
families of the same size; or
(ii) their income, after the deduction of
costs incurred for medical care and for other types
of remedial care, is equal to or less than 70% in
fiscal year 2001, equal to or less than 85% in
fiscal year 2002 and until a date to be determined
by the Department by rule, and equal to or less
than 100% beginning on the date determined by the
Department by rule, of the nonfarm income official
poverty line, as defined in item (i) of this
subparagraph (a).
(b) All persons who, excluding any eligibility
requirements that are inconsistent with any federal
law or federal regulation, as interpreted by the U.S.
Department of Health and Human Services, would be
determined eligible for such basic maintenance under
Article IV by disregarding the maximum earned income
permitted by federal law.
3. Persons who would otherwise qualify for Aid to the
Medically Indigent under Article VII.
4. Persons not eligible under any of the preceding
paragraphs who fall sick, are injured, or die, not having

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sufficient money, property or other resources to meet the
costs of necessary medical care or funeral and burial
expenses.
5.(a) Women during pregnancy, after the fact of
pregnancy has been determined by medical diagnosis, and
during the 60-day period beginning on the last day of the
pregnancy, together with their infants and children born
after September 30, 1983, whose income and resources are
insufficient to meet the costs of necessary medical care to
the maximum extent possible under Title XIX of the Federal
Social Security Act.
(b) The Illinois Department and the Governor shall
provide a plan for coverage of the persons eligible under
paragraph 5(a) by April 1, 1990. Such plan shall provide
ambulatory prenatal care to pregnant women during a
presumptive eligibility period and establish an income
eligibility standard that is equal to 133% of the nonfarm
income official poverty line, as defined by the federal
Office of Management and Budget and revised annually in
accordance with Section 673(2) of the Omnibus Budget
Reconciliation Act of 1981, applicable to families of the
same size, provided that costs incurred for medical care
are not taken into account in determining such income
eligibility.
(c) The Illinois Department may conduct a
demonstration in at least one county that will provide

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medical assistance to pregnant women, together with their
infants and children up to one year of age, where the
income eligibility standard is set up to 185% of the
nonfarm income official poverty line, as defined by the
federal Office of Management and Budget. The Illinois
Department shall seek and obtain necessary authorization
provided under federal law to implement such a
demonstration. Such demonstration may establish resource
standards that are not more restrictive than those
established under Article IV of this Code.
6. Persons under the age of 18 who fail to qualify as
dependent under Article IV and who have insufficient income
and resources to meet the costs of necessary medical care
to the maximum extent permitted under Title XIX of the
Federal Social Security Act.
7. Persons who are under 21 years of age and would
qualify as disabled as defined under the Federal
Supplemental Security Income Program, provided medical
service for such persons would be eligible for Federal
Financial Participation, and provided the Illinois
Department determines that:
(a) the person requires a level of care provided by
a hospital, skilled nursing facility, or intermediate
care facility, as determined by a physician licensed to
practice medicine in all its branches;
(b) it is appropriate to provide such care outside

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of an institution, as determined by a physician
licensed to practice medicine in all its branches;
(c) the estimated amount which would be expended
for care outside the institution is not greater than
the estimated amount which would be expended in an
institution.
8. Persons who become ineligible for basic maintenance
assistance under Article IV of this Code in programs
administered by the Illinois Department due to employment
earnings and persons in assistance units comprised of
adults and children who become ineligible for basic
maintenance assistance under Article VI of this Code due to
employment earnings. The plan for coverage for this class
of persons shall:
(a) extend the medical assistance coverage for up
to 12 months following termination of basic
maintenance assistance; and
(b) offer persons who have initially received 6
months of the coverage provided in paragraph (a) above,
the option of receiving an additional 6 months of
coverage, subject to the following:
(i) such coverage shall be pursuant to
provisions of the federal Social Security Act;
(ii) such coverage shall include all services
covered while the person was eligible for basic
maintenance assistance;

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(iii) no premium shall be charged for such
coverage; and
(iv) such coverage shall be suspended in the
event of a person's failure without good cause to
file in a timely fashion reports required for this
coverage under the Social Security Act and
coverage shall be reinstated upon the filing of
such reports if the person remains otherwise
eligible.
9. Persons with acquired immunodeficiency syndrome
(AIDS) or with AIDS-related conditions with respect to whom
there has been a determination that but for home or
community-based services such individuals would require
the level of care provided in an inpatient hospital,
skilled nursing facility or intermediate care facility the
cost of which is reimbursed under this Article. Assistance
shall be provided to such persons to the maximum extent
permitted under Title XIX of the Federal Social Security
Act.
10. Participants in the long-term care insurance
partnership program established under the Illinois
Long-Term Care Partnership Program Act who meet the
qualifications for protection of resources described in
Section 15 of that Act.
11. Persons with disabilities who are employed and
eligible for Medicaid, pursuant to Section

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1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
subject to federal approval, persons with a medically
improved disability who are employed and eligible for
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
the Social Security Act, as provided by the Illinois
Department by rule. In establishing eligibility standards
under this paragraph 11, the Department shall, subject to
federal approval:
(a) set the income eligibility standard at not
lower than 350% of the federal poverty level;
(b) exempt retirement accounts that the person
cannot access without penalty before the age of 59 1/2,
and medical savings accounts established pursuant to
26 U.S.C. 220;
(c) allow non-exempt assets up to $25,000 as to
those assets accumulated during periods of eligibility
under this paragraph 11; and
(d) continue to apply subparagraphs (b) and (c) in
determining the eligibility of the person under this
Article even if the person loses eligibility under this
paragraph 11.
12. Subject to federal approval, persons who are
eligible for medical assistance coverage under applicable
provisions of the federal Social Security Act and the
federal Breast and Cervical Cancer Prevention and
Treatment Act of 2000. Those eligible persons are defined

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to include, but not be limited to, the following persons:
(1) persons who have been screened for breast or
cervical cancer under the U.S. Centers for Disease
Control and Prevention Breast and Cervical Cancer
Program established under Title XV of the federal
Public Health Services Act in accordance with the
requirements of Section 1504 of that Act as
administered by the Illinois Department of Public
Health; and
(2) persons whose screenings under the above
program were funded in whole or in part by funds
appropriated to the Illinois Department of Public
Health for breast or cervical cancer screening.
"Medical assistance" under this paragraph 12 shall be
identical to the benefits provided under the State's
approved plan under Title XIX of the Social Security Act.
The Department must request federal approval of the
coverage under this paragraph 12 within 30 days after the
effective date of this amendatory Act of the 92nd General
Assembly.
In addition to the persons who are eligible for medical
assistance pursuant to subparagraphs (1) and (2) of this
paragraph 12, and to be paid from funds appropriated to the
Department for its medical programs, any uninsured person
as defined by the Department in rules residing in Illinois
who is younger than 65 years of age, who has been screened

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for breast and cervical cancer in accordance with standards
and procedures adopted by the Department of Public Health
for screening, and who is referred to the Department by the
Department of Public Health as being in need of treatment
for breast or cervical cancer is eligible for medical
assistance benefits that are consistent with the benefits
provided to those persons described in subparagraphs (1)
and (2). Medical assistance coverage for the persons who
are eligible under the preceding sentence is not dependent
on federal approval, but federal moneys may be used to pay
for services provided under that coverage upon federal
approval.
13. Subject to appropriation and to federal approval,
persons living with HIV/AIDS who are not otherwise eligible
under this Article and who qualify for services covered
under Section 5-5.04 as provided by the Illinois Department
by rule.
14. Subject to the availability of funds for this
purpose, the Department may provide coverage under this
Article to persons who reside in Illinois who are not
eligible under any of the preceding paragraphs and who meet
the income guidelines of paragraph 2(a) of this Section and
(i) have an application for asylum pending before the
federal Department of Homeland Security or on appeal before
a court of competent jurisdiction and are represented
either by counsel or by an advocate accredited by the

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federal Department of Homeland Security and employed by a
not-for-profit organization in regard to that application
or appeal, or (ii) are receiving services through a
federally funded torture treatment center. Medical
coverage under this paragraph 14 may be provided for up to
24 continuous months from the initial eligibility date so
long as an individual continues to satisfy the criteria of
this paragraph 14. If an individual has an appeal pending
regarding an application for asylum before the Department
of Homeland Security, eligibility under this paragraph 14
may be extended until a final decision is rendered on the
appeal. The Department may adopt rules governing the
implementation of this paragraph 14.
15. Family Care Eligibility.
(a) Through December 31, 2013, a A caretaker
relative who is 19 years of age or older when countable
income is at or below 185% of the Federal Poverty Level
Guidelines, as published annually in the Federal
Register, for the appropriate family size. Beginning
January 1, 2014, a caretaker relative who is 19 years
of age or older when countable income is at or below
133% of the Federal Poverty Level Guidelines, as
published annually in the Federal Register, for the
appropriate family size. A person may not spend down to
become eligible under this paragraph 15.
(b) Eligibility shall be reviewed annually.

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(c) Caretaker relatives enrolled under this
paragraph 15 in families with countable income above
150% and at or below 185% of the Federal Poverty Level
Guidelines shall be counted as family members and pay
premiums as established under the Children's Health
Insurance Program Act.
(d) Premiums shall be billed by and payable to the
Department or its authorized agent, on a monthly basis.
(e) The premium due date is the last day of the
month preceding the month of coverage.
(f) Individuals shall have a grace period through
30 days of coverage to pay the premium.
(g) Failure to pay the full monthly premium by the
last day of the grace period shall result in
termination of coverage.
(h) Partial premium payments shall not be
refunded.
(i) Following termination of an individual's
coverage under this paragraph 15, the following action
is required before the individual can be re-enrolled:
(1) A new application must be completed and the
individual must be determined otherwise eligible.
(2) There must be full payment of premiums due
under this Code, the Children's Health Insurance
Program Act, the Covering ALL KIDS Health
Insurance Act, or any other healthcare program

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administered by the Department for periods in
which a premium was owed and not paid for the
individual.
(3) The first month's premium must be paid if
there was an unpaid premium on the date the
individual's previous coverage was canceled.
The Department is authorized to implement the
provisions of this amendatory Act of the 95th General
Assembly by adopting the medical assistance rules in effect
as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
89 Ill. Admin. Code 120.32 along with only those changes
necessary to conform to federal Medicaid requirements,
federal laws, and federal regulations, including but not
limited to Section 1931 of the Social Security Act (42
U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
of Health and Human Services, and the countable income
eligibility standard authorized by this paragraph 15. The
Department may not otherwise adopt any rule to implement
this increase except as authorized by law, to meet the
eligibility standards authorized by the federal government
in the Medicaid State Plan or the Title XXI Plan, or to
meet an order from the federal government or any court.
16. Subject to appropriation, uninsured persons who
are not otherwise eligible under this Section who have been
certified and referred by the Department of Public Health
as having been screened and found to need diagnostic

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evaluation or treatment, or both diagnostic evaluation and
treatment, for prostate or testicular cancer. For the
purposes of this paragraph 16, uninsured persons are those
who do not have creditable coverage, as defined under the
Health Insurance Portability and Accountability Act, or
have otherwise exhausted any insurance benefits they may
have had, for prostate or testicular cancer diagnostic
evaluation or treatment, or both diagnostic evaluation and
treatment. To be eligible, a person must furnish a Social
Security number. A person's assets are exempt from
consideration in determining eligibility under this
paragraph 16. Such persons shall be eligible for medical
assistance under this paragraph 16 for so long as they need
treatment for the cancer. A person shall be considered to
need treatment if, in the opinion of the person's treating
physician, the person requires therapy directed toward
cure or palliation of prostate or testicular cancer,
including recurrent metastatic cancer that is a known or
presumed complication of prostate or testicular cancer and
complications resulting from the treatment modalities
themselves. Persons who require only routine monitoring
services are not considered to need treatment. "Medical
assistance" under this paragraph 16 shall be identical to
the benefits provided under the State's approved plan under
Title XIX of the Social Security Act. Notwithstanding any
other provision of law, the Department (i) does not have a

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claim against the estate of a deceased recipient of
services under this paragraph 16 and (ii) does not have a
lien against any homestead property or other legal or
equitable real property interest owned by a recipient of
services under this paragraph 16.
In implementing the provisions of Public Act 96-20, the
Department is authorized to adopt only those rules necessary,
including emergency rules. Nothing in Public Act 96-20 permits
the Department to adopt rules or issue a decision that expands
eligibility for the FamilyCare Program to a person whose income
exceeds 185% of the Federal Poverty Level as determined from
time to time by the U.S. Department of Health and Human
Services, unless the Department is provided with express
statutory authority.
The Illinois Department and the Governor shall provide a
plan for coverage of the persons eligible under paragraph 7 as
soon as possible after July 1, 1984.
The eligibility of any such person for medical assistance
under this Article is not affected by the payment of any grant
under the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act or any distributions
or items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois
Income Tax Act. The Department shall by rule establish the
amounts of assets to be disregarded in determining eligibility
for medical assistance, which shall at a minimum equal the

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amounts to be disregarded under the Federal Supplemental
Security Income Program. The amount of assets of a single
person to be disregarded shall not be less than $2,000, and the
amount of assets of a married couple to be disregarded shall
not be less than $3,000.
To the extent permitted under federal law, any person found
guilty of a second violation of Article VIIIA shall be
ineligible for medical assistance under this Article, as
provided in Section 8A-8.
The eligibility of any person for medical assistance under
this Article shall not be affected by the receipt by the person
of donations or benefits from fundraisers held for the person
in cases of serious illness, as long as neither the person nor
members of the person's family have actual control over the
donations or benefits or the disbursement of the donations or
benefits.
(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.
8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123,
eff. 1-1-11; 96-1270, eff. 7-26-10; revised 9-16-10.)
(305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
Sec. 5-4.1. Co-payments. The Department may by rule provide
that recipients under any Article of this Code shall pay a fee
as a co-payment for services. Co-payments shall be maximized to
the extent permitted by federal law. Provided, however, that

09700SB1802ham001 - 25 - LRB097 09314 KTG 56358 a
any such rule must provide that no co-payment requirement can
exist for renal dialysis, radiation therapy, cancer
chemotherapy, or insulin, and other products necessary on a
recurring basis, the absence of which would be life
threatening, or where co-payment expenditures for required
services and/or medications for chronic diseases that the
Illinois Department shall by rule designate shall cause an
extensive financial burden on the recipient, and provided no
co-payment shall exist for emergency room encounters which are
for medical emergencies. The Department shall seek approval of
a State plan amendment that allows pharmacies to refuse to
dispense drugs in circumstances where the recipient does not
pay the required co-payment. In the event the State plan
amendment is rejected, co-payments may not exceed $3 for brand
name drugs, $1 for other pharmacy services other than for
generic drugs, and $2 for physician services, dental services,
optical services and supplies, chiropractic services, podiatry
services, and encounter rate clinic services. There shall be no
co-payment for generic drugs. Co-payments may not exceed $10
for emergency room use for a non-emergency situation as defined
by the Department by rule and subject to federal approval.
Co-payments may not exceed $3 for hospital outpatient and
clinic services.
(Source: P.A. 96-1501, eff. 1-25-11.)
(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)

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Sec. 5-5.12. Pharmacy payments.
(a) Every request submitted by a pharmacy for reimbursement
under this Article for prescription drugs provided to a
recipient of aid under this Article shall include the name of
the prescriber or an acceptable identification number as
established by the Department.
(b) Pharmacies providing prescription drugs under this
Article shall be reimbursed at a rate which shall include a
professional dispensing fee as determined by the Illinois
Department, plus the current acquisition cost of the
prescription drug dispensed. The Illinois Department shall
update its information on the acquisition costs of all
prescription drugs no less frequently than every 30 days.
However, the Illinois Department may set the rate of
reimbursement for the acquisition cost, by rule, at a
percentage of the current average wholesale acquisition cost.
(c) (Blank).
(d) The Department shall not impose requirements for prior
approval based on a preferred drug list for anti-retroviral,
anti-hemophilic factor concentrates, or any atypical
antipsychotics, conventional antipsychotics, or
anticonvulsants used for the treatment of serious mental
illnesses until 30 days after it has conducted a study of the
impact of such requirements on patient care and submitted a
report to the Speaker of the House of Representatives and the
President of the Senate. The Department shall review

09700SB1802ham001 - 27 - LRB097 09314 KTG 56358 a
utilization of narcotic medications in the medical assistance
program and impose utilization controls that protect against
abuse.
(e) When making determinations as to which drugs shall be
on a prior approval list, the Department shall include as part
of the analysis for this determination, the degree to which a
drug may affect individuals in different ways based on factors
including the gender of the person taking the medication.
(f) The Department shall cooperate with the Department of
Public Health and the Department of Human Services Division of
Mental Health in identifying psychotropic medications that,
when given in a particular form, manner, duration, or frequency
(including "as needed") in a dosage, or in conjunction with
other psychotropic medications to a nursing home resident, may
constitute a chemical restraint or an "unnecessary drug" as
defined by the Nursing Home Care Act or Titles XVIII and XIX of
the Social Security Act and the implementing rules and
regulations. The Department shall require prior approval for
any such medication prescribed for a nursing home resident that
appears to be a chemical restraint or an unnecessary drug. The
Department shall consult with the Department of Human Services
Division of Mental Health in developing a protocol and criteria
for deciding whether to grant such prior approval.
(g) The Department may by rule provide for reimbursement of
the dispensing of a 90-day supply of a generic, non-narcotic
maintenance medication in circumstances where it is cost

09700SB1802ham001 - 28 - LRB097 09314 KTG 56358 a
effective.
(h) Effective July 1, 2011, the Department shall
discontinue coverage of select over-the-counter drugs,
including analgesics and cough and cold and allergy
medications.
(i) The Department shall seek any necessary waiver from the
federal government in order to establish a program limiting the
pharmacies eligible to dispense specialty drugs and shall issue
a Request for Proposals in order to maximize savings on these
drugs. The Department shall by rule establish the drugs
required to be dispensed in this program.
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
96-1501, eff. 1-25-11.)
(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, and any moneys remaining
in the Fund shall be refunded to hospital providers in
proportion to the amounts paid by them, if:
(1) The sum of the appropriations for State fiscal
years 2004 and 2005 from the General Revenue Fund for
hospital payments under the medical assistance program is
less than $4,500,000,000 or the appropriation for each of
State fiscal years 2006, 2007 and 2008 from the General
Revenue Fund for hospital payments under the medical

09700SB1802ham001 - 29 - LRB097 09314 KTG 56358 a
assistance program is less than $2,500,000,000 increased
annually to reflect any increase in the number of
recipients, or the annual appropriation for State fiscal
years 2009, 2010, 2011, 2013, and 2014 through 2014, from
the General Revenue Fund combined with the Hospital
Provider Fund as authorized in Section 5A-8 for hospital
payments under the medical assistance program, is less than
the amount appropriated for State fiscal year 2009,
adjusted annually to reflect any change in the number of
recipients, excluding State fiscal year 2009 supplemental
appropriations made necessary by the enactment of the
American Recovery and Reinvestment Act of 2009; or
(2) For State fiscal years prior to State fiscal year
2009, the Department of Healthcare and Family Services
(formerly Department of Public Aid) makes changes in its
rules that reduce the hospital inpatient or outpatient
payment rates, including adjustment payment rates, in
effect on October 1, 2004, except for hospitals described
in subsection (b) of Section 5A-3 and except for changes in
the methodology for calculating outlier payments to
hospitals for exceptionally costly stays, so long as those
changes do not reduce aggregate expenditures below the
amount expended in State fiscal year 2005 for such
services; or
(2.1) For State fiscal years 2009, 2010, 2011, 2013,
and 2014 through 2014, the Department of Healthcare and

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Family Services adopts any administrative rule change to
reduce payment rates or alters any payment methodology that
reduces any payment rates made to operating hospitals under
the approved Title XIX or Title XXI State plan in effect
January 1, 2008 except for:
(A) any changes for hospitals described in
subsection (b) of Section 5A-3; or
(B) any rates for payments made under this Article
V-A; or
(C) any changes proposed in State plan amendment
transmittal numbers 08-01, 08-02, 08-04, 08-06, and
08-07; or
(D) in relation to any admissions on or after
January 1, 2011, a modification in the methodology for
calculating outlier payments to hospitals for
exceptionally costly stays, for hospitals reimbursed
under the diagnosis-related grouping methodology;
provided that the Department shall be limited to one
such modification during the 36-month period after the
effective date of this amendatory Act of the 96th
General Assembly; or
(E) changes in hospital payment rates related to
potentially preventable readmissions as described in
Section 14-8 of this Code; or
(3) The payments to hospitals required under Section
5A-12 or Section 5A-12.2 are changed or are not eligible

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for federal matching funds under Title XIX or XXI of the
Social Security Act.
(b) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed if the assessment is
determined to be an impermissible tax under Title XIX of the
Social Security Act. Moneys in the Hospital Provider Fund
derived from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A-8 to the extent federal
financial participation is not reduced due to the
impermissibility of the assessments, and any remaining moneys
shall be refunded to hospital providers in proportion to the
amounts paid by them.
(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08; 96-8,
eff. 4-28-09; 96-1530, eff. 2-16-11.)
(305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
Sec. 14-8. Disbursements to Hospitals.
(a) For inpatient hospital services rendered on and after
September 1, 1991, the Illinois Department shall reimburse
hospitals for inpatient services at an inpatient payment rate
calculated for each hospital based upon the Medicare
Prospective Payment System as set forth in Sections 1886(b),
(d), (g), and (h) of the federal Social Security Act, and the
regulations, policies, and procedures promulgated thereunder,
except as modified by this Section. Payment rates for inpatient
hospital services rendered on or after September 1, 1991 and on

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or before September 30, 1992 shall be calculated using the
Medicare Prospective Payment rates in effect on September 1,
1991. Payment rates for inpatient hospital services rendered on
or after October 1, 1992 and on or before March 31, 1994 shall
be calculated using the Medicare Prospective Payment rates in
effect on September 1, 1992. Payment rates for inpatient
hospital services rendered on or after April 1, 1994 shall be
calculated using the Medicare Prospective Payment rates
(including the Medicare grouping methodology and weighting
factors as adjusted pursuant to paragraph (1) of this
subsection) in effect 90 days prior to the date of admission.
For services rendered on or after July 1, 1995, the
reimbursement methodology implemented under this subsection
shall not include those costs referred to in Sections
1886(d)(5)(B) and 1886(h) of the Social Security Act. The
additional payment amounts required under Section
1886(d)(5)(F) of the Social Security Act, for hospitals serving
a disproportionate share of low-income or indigent patients,
are not required under this Section. For hospital inpatient
services rendered on or after July 1, 1995, the Illinois
Department shall reimburse hospitals using the relative
weighting factors and the base payment rates calculated for
each hospital that were in effect on June 30, 1995, less the
portion of such rates attributed by the Illinois Department to
the cost of medical education.
(1) The weighting factors established under Section

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1886(d)(4) of the Social Security Act shall not be used in
the reimbursement system established under this Section.
Rather, the Illinois Department shall establish by rule
Medicaid weighting factors to be used in the reimbursement
system established under this Section.
(2) The Illinois Department shall define by rule those
hospitals or distinct parts of hospitals that shall be
exempt from the reimbursement system established under
this Section. In defining such hospitals, the Illinois
Department shall take into consideration those hospitals
exempt from the Medicare Prospective Payment System as of
September 1, 1991. For hospitals defined as exempt under
this subsection, the Illinois Department shall by rule
establish a reimbursement system for payment of inpatient
hospital services rendered on and after September 1, 1991.
For all hospitals that are children's hospitals as defined
in Section 5-5.02 of this Code, the reimbursement
methodology shall, through June 30, 1992, net of all
applicable fees, at least equal each children's hospital
1990 ICARE payment rates, indexed to the current year by
application of the DRI hospital cost index from 1989 to the
year in which payments are made. Excepting county providers
as defined in Article XV of this Code, hospitals licensed
under the University of Illinois Hospital Act, and
facilities operated by the Department of Mental Health and
Developmental Disabilities (or its successor, the

09700SB1802ham001 - 34 - LRB097 09314 KTG 56358 a
Department of Human Services) for hospital inpatient
services rendered on or after July 1, 1995, the Illinois
Department shall reimburse children's hospitals, as
defined in 89 Illinois Administrative Code Section
149.50(c)(3), at the rates in effect on June 30, 1995, and
shall reimburse all other hospitals at the rates in effect
on June 30, 1995, less the portion of such rates attributed
by the Illinois Department to the cost of medical
education. For inpatient hospital services provided on or
after August 1, 1998, the Illinois Department may establish
by rule a means of adjusting the rates of children's
hospitals, as defined in 89 Illinois Administrative Code
Section 149.50(c)(3), that did not meet that definition on
June 30, 1995, in order for the inpatient hospital rates of
such hospitals to take into account the average inpatient
hospital rates of those children's hospitals that did meet
the definition of children's hospitals on June 30, 1995.
(3) (Blank)
(4) Notwithstanding any other provision of this
Section, hospitals that on August 31, 1991, have a contract
with the Illinois Department under Section 3-4 of the
Illinois Health Finance Reform Act may elect to continue to
be reimbursed at rates stated in such contracts for general
and specialty care.
(5) In addition to any payments made under this
subsection (a), the Illinois Department shall make the

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adjustment payments required by Section 5-5.02 of this
Code; provided, that in the case of any hospital reimbursed
under a per case methodology, the Illinois Department shall
add an amount equal to the product of the hospital's
average length of stay, less one day, multiplied by 20, for
inpatient hospital services rendered on or after September
1, 1991 and on or before September 30, 1992.
(b) (Blank)
(b-3) Potentially preventable readmissions.
(1) For fee for service discharges occurring on or
after July 1, 2011, or on such later date as determined by
rule, the Illinois Department may establish, by rule, a
means of adjusting the rates of payment to hospitals that
have an excess number of medical assistance readmissions as
defined in accordance with the criteria set forth in
paragraph (3) of this subsection, as determined by a risk
adjusted comparison of the actual and expected number of
readmissions in a hospital as described in paragraph (4) of
this subsection, in accordance with paragraph (5) of this
subsection. It is intended that the rate adjustment under
this subsection, when combined with savings attributable
to a reduction in readmissions, shall not result in an
aggregate annual savings in excess of $40,000,000,
relative to the base year. In developing any rules under
this subsection, the Department shall consult with a
statewide association that represents hospitals in all

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areas of the State.
(2) Definitions. For purposes of this subsection:
(A) "Potentially preventable readmission" or "PPR"
means a readmission to a hospital that follows a prior
discharge from a hospital within a period to be defined
by rule, but not to exceed 30 days, and that is
clinically-related to the prior hospital admission.
(B) "Observed rate of readmission" means the
number of admissions in each hospital that were
actually followed by at least one PPR divided by the
total number of admissions.
(C) "Expected rate of readmission" means a risk
adjusted rate for each hospital that accounts for the
severity of illness and age of patients at the time of
discharge preceding the readmission.
(D) "Excess rate of readmission" means the
difference between the observed rates of potentially
preventable readmissions and the expected rate of
potentially preventable readmissions for each
hospital.
(E) "Behavioral health" means an admission that
includes a primary diagnosis of a major mental health
related condition, including, but not limited to,
chemical dependency and substance abuse.
(3) Readmission criteria.
(A) A readmission is a return hospitalization

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following a prior discharge that meets all of the
following criteria:
(i) The readmission could reasonably have been
prevented by the provision of appropriate care
consistent with accepted standards in the prior
discharge or during the post discharge follow-up
period.
(ii) The readmission is for a condition or
procedure related to the care during the prior
discharge or the care during the period
immediately following the prior discharge and
including, but not limited to, the following:
(aa) The same or closely related condition
or procedure as the prior discharge.
(bb) An infection or other complication of
care.
(cc) A condition or procedure indicative
of a failed surgical intervention.
(dd) An acute decompensation of a
coexisting chronic disease.
(B) Readmissions, for the purposes of determining
PPRs, excludes circumstances that include, but are not
limited to, the following:
(i) The original discharge was a
patient-initiated discharge and was Against
Medical Advice (AMA) and the circumstances of such

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discharge and readmission are documented in the
patient's medical record.
(ii) The original discharge was for the
purpose of securing treatment of a major or
metastatic malignancy, multiple trauma, human
immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS), injuries resulting from
violence, attempted suicide, transplants, multiple
complex clinical conditions, burns, neonatal, or
obstetrical admissions.
(iii) The readmission was a planned
readmission.
(iv) The original discharge resulted in the
patient being transferred to another acute care
hospital.
(4) Methodology.
(A) Rate adjustments for each hospital shall be
based on such hospital's Medicaid paid claims data for
discharges that occurred between July 1, 2008 and June
30, 2009, hereinafter referred to as the base year. The
Department shall complete an analysis of each
hospital's potentially preventable readmissions in
this base year and provide the results confidentially,
including patient specific data, to each hospital free
of charge at least 90 days prior to the effective date
of any rate adjustments under this subsection.

09700SB1802ham001 - 39 - LRB097 09314 KTG 56358 a
(B) For each hospital, the Department shall
calculate its observed rate of PPRs in the base year
and its expected rate of PPRs for the rate year
separately for behavioral health PPRs and all other
PPRs. The expected rate of PPRs shall be calculated for
the rate year, so that achieving the expected rate of
PPRs would result in an aggregate savings of
$40,000,000 annually, relative to the base year.
(C) Excess readmission rates are calculated based
on the difference between the observed rate of PPRs in
the rate year and the expected rate of PPRs for each
hospital. This rate shall be calculated separately for
behavioral health PPRs and all other PPRs. In the event
the observed rate of PPRs for a hospital is lower than
the expected rate of PPRs for that hospital, the excess
number of readmissions shall be set at zero.
(D) In the event the observed rate of PPRs for
hospitals in the aggregate in the rate year is lower
than the expected rate of PPRs, the aggregate annual
savings in excess of $40,000,000 shall be identified
and such amount shall be used only for programs to
improve care coordination or to preserve or enhance
behavioral health services.
(5) Payment Calculation. If the aggregate annual
savings attributable to a reduction in PPRs is less than
$40,000,000, each hospital with excess readmissions as

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identified in subparagraph (c) of paragraph (4) of this
subsection shall have its payment rate adjusted by a
readmission adjustment factor in order to achieve the
$40,000,000 in aggregate savings. This adjustment may be
made on a quarterly basis. In no event shall the
application of the readmission adjustment factor to a
hospital result in an annual savings attributable to a
reduction in readmissions of more than 2% of the hospital's
total annual payments under this Code for inpatient
services.
(6) Reporting. On a quarterly basis, the Department
shall issue a report free of charge to each hospital that
includes, but is not limited to, its observed rate of PPRs,
its expected rate of PPRs, and its readmission adjustment
factor for prior quarters. The Department shall also
provide such information on a quarterly basis for all
hospitals free of charge to a statewide association that
represents hospitals located in all areas of the State.
(b-5) Excepting county providers as defined in Article XV
of this Code, hospitals licensed under the University of
Illinois Hospital Act, and facilities operated by the Illinois
Department of Mental Health and Developmental Disabilities (or
its successor, the Department of Human Services), for
outpatient services rendered on or after July 1, 1995 and
before July 1, 1998 the Illinois Department shall reimburse
children's hospitals, as defined in the Illinois

09700SB1802ham001 - 41 - LRB097 09314 KTG 56358 a
Administrative Code Section 149.50(c)(3), at the rates in
effect on June 30, 1995, less that portion of such rates
attributed by the Illinois Department to the outpatient
indigent volume adjustment and shall reimburse all other
hospitals at the rates in effect on June 30, 1995, less the
portions of such rates attributed by the Illinois Department to
the cost of medical education and attributed by the Illinois
Department to the outpatient indigent volume adjustment. For
outpatient services provided on or after July 1, 1998,
reimbursement rates shall be established by rule.
(c) In addition to any other payments under this Code, the
Illinois Department shall develop a hospital disproportionate
share reimbursement methodology that, effective July 1, 1991,
through September 30, 1992, shall reimburse hospitals
sufficiently to expend the fee monies described in subsection
(b) of Section 14-3 of this Code and the federal matching funds
received by the Illinois Department as a result of expenditures
made by the Illinois Department as required by this subsection
(c) and Section 14-2 that are attributable to fee monies
deposited in the Fund, less amounts applied to adjustment
payments under Section 5-5.02.
(d) Critical Care Access Payments.
(1) In addition to any other payments made under this
Code, the Illinois Department shall develop a
reimbursement methodology that shall reimburse Critical
Care Access Hospitals for the specialized services that

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qualify them as Critical Care Access Hospitals. No
adjustment payments shall be made under this subsection on
or after July 1, 1995.
(2) "Critical Care Access Hospitals" includes, but is
not limited to, hospitals that meet at least one of the
following criteria:
(A) Hospitals located outside of a metropolitan
statistical area that are designated as Level II
Perinatal Centers and that provide a disproportionate
share of perinatal services to recipients; or
(B) Hospitals that are designated as Level I Trauma
Centers (adult or pediatric) and certain Level II
Trauma Centers as determined by the Illinois
Department; or
(C) Hospitals located outside of a metropolitan
statistical area and that provide a disproportionate
share of obstetrical services to recipients.
(e) Inpatient high volume adjustment. For hospital
inpatient services, effective with rate periods beginning on or
after October 1, 1993, in addition to rates paid for inpatient
services by the Illinois Department, the Illinois Department
shall make adjustment payments for inpatient services
furnished by Medicaid high volume hospitals. The Illinois
Department shall establish by rule criteria for qualifying as a
Medicaid high volume hospital and shall establish by rule a
reimbursement methodology for calculating these adjustment

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payments to Medicaid high volume hospitals. No adjustment
payment shall be made under this subsection for services
rendered on or after July 1, 1995.
(f) The Illinois Department shall modify its current rules
governing adjustment payments for targeted access, critical
care access, and uncompensated care to classify those
adjustment payments as not being payments to disproportionate
share hospitals under Title XIX of the federal Social Security
Act. Rules adopted under this subsection shall not be effective
with respect to services rendered on or after July 1, 1995. The
Illinois Department has no obligation to adopt or implement any
rules or make any payments under this subsection for services
rendered on or after July 1, 1995.
(f-5) The State recognizes that adjustment payments to
hospitals providing certain services or incurring certain
costs may be necessary to assure that recipients of medical
assistance have adequate access to necessary medical services.
These adjustments include payments for teaching costs and
uncompensated care, trauma center payments, rehabilitation
hospital payments, perinatal center payments, obstetrical care
payments, targeted access payments, Medicaid high volume
payments, and outpatient indigent volume payments. On or before
April 1, 1995, the Illinois Department shall issue
recommendations regarding (i) reimbursement mechanisms or
adjustment payments to reflect these costs and services,
including methods by which the payments may be calculated and

09700SB1802ham001 - 44 - LRB097 09314 KTG 56358 a
the method by which the payments may be financed, and (ii)
reimbursement mechanisms or adjustment payments to reflect
costs and services of federally qualified health centers with
respect to recipients of medical assistance.
(g) If one or more hospitals file suit in any court
challenging any part of this Article XIV, payments to hospitals
under this Article XIV shall be made only to the extent that
sufficient monies are available in the Fund and only to the
extent that any monies in the Fund are not prohibited from
disbursement under any order of the court.
(h) Payments under the disbursement methodology described
in this Section are subject to approval by the federal
government in an appropriate State plan amendment.
(i) The Illinois Department may by rule establish criteria
for and develop methodologies for adjustment payments to
hospitals participating under this Article.
(j) Hospital Residing Long Term Care Services. In addition
to any other payments made under this Code, the Illinois
Department may by rule establish criteria and develop
methodologies for payments to hospitals for Hospital Residing
Long Term Care Services.
(k) Critical Access Hospital outpatient payments. In
addition to any other payments authorized under this Code, the
Illinois Department shall reimburse critical access hospitals,
as designated by the Illinois Department of Public Health in
accordance with 42 CFR 485, Subpart F, for outpatient services

09700SB1802ham001 - 45 - LRB097 09314 KTG 56358 a
at an amount that is no less than the cost of providing such
services, based on Medicare cost principles. Payments under
this subsection shall be subject to appropriation.
(Source: P.A. 96-1382, eff. 1-1-11.)
Section 20. The Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act is
amended by changing Section 4 as follows:
(320 ILCS 25/4) (from Ch. 67 1/2, par. 404)
Sec. 4. Amount of Grant.
(a) In general. Any individual 65 years or older or any
individual who will become 65 years old during the calendar
year in which a claim is filed, and any surviving spouse of
such a claimant, who at the time of death received or was
entitled to receive a grant pursuant to this Section, which
surviving spouse will become 65 years of age within the 24
months immediately following the death of such claimant and
which surviving spouse but for his or her age is otherwise
qualified to receive a grant pursuant to this Section, and any
disabled person whose annual household income is less than the
income eligibility limitation, as defined in subsection (a-5)
and whose household is liable for payment of property taxes
accrued or has paid rent constituting property taxes accrued
and is domiciled in this State at the time he or she files his
or her claim is entitled to claim a grant under this Act. With

09700SB1802ham001 - 46 - LRB097 09314 KTG 56358 a
respect to claims filed by individuals who will become 65 years
old during the calendar year in which a claim is filed, the
amount of any grant to which that household is entitled shall
be an amount equal to 1/12 of the amount to which the claimant
would otherwise be entitled as provided in this Section,
multiplied by the number of months in which the claimant was 65
in the calendar year in which the claim is filed.
(a-5) Income eligibility limitation. For purposes of this
Section, "income eligibility limitation" means an amount for
grant years 2008 and thereafter:
(1) less than $22,218 for a household containing one
person;
(2) less than $29,480 for a household containing 2
persons; or
(3) less than $36,740 for a household containing 3 or
more persons.
For 2009 claim year applications submitted during calendar
year 2010, a household must have annual household income of
less than $27,610 for a household containing one person; less
than $36,635 for a household containing 2 persons; or less than
$45,657 for a household containing 3 or more persons.
The Department on Aging may adopt rules such that on
January 1, 2011, and thereafter, the foregoing household income
eligibility limits may be changed to reflect the annual cost of
living adjustment in Social Security and Supplemental Security
Income benefits that are applicable to the year for which those

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benefits are being reported as income on an application.
If a person files as a surviving spouse, then only his or
her income shall be counted in determining his or her household
income.
(b) Limitation. Except as otherwise provided in
subsections (a) and (f) of this Section, the maximum amount of
grant which a claimant is entitled to claim is the amount by
which the property taxes accrued which were paid or payable
during the last preceding tax year or rent constituting
property taxes accrued upon the claimant's residence for the
last preceding taxable year exceeds 3 1/2% of the claimant's
household income for that year but in no event is the grant to
exceed (i) $700 less 4.5% of household income for that year for
those with a household income of $14,000 or less or (ii) $70 if
household income for that year is more than $14,000.
(c) Public aid recipients. If household income in one or
more months during a year includes cash assistance in excess of
$55 per month from the Department of Healthcare and Family
Services or the Department of Human Services (acting as
successor to the Department of Public Aid under the Department
of Human Services Act) which was determined under regulations
of that Department on a measure of need that included an
allowance for actual rent or property taxes paid by the
recipient of that assistance, the amount of grant to which that
household is entitled, except as otherwise provided in
subsection (a), shall be the product of (1) the maximum amount

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computed as specified in subsection (b) of this Section and (2)
the ratio of the number of months in which household income did
not include such cash assistance over $55 to the number twelve.
If household income did not include such cash assistance over
$55 for any months during the year, the amount of the grant to
which the household is entitled shall be the maximum amount
computed as specified in subsection (b) of this Section. For
purposes of this paragraph (c), "cash assistance" does not
include any amount received under the federal Supplemental
Security Income (SSI) program.
(d) Joint ownership. If title to the residence is held
jointly by the claimant with a person who is not a member of
his or her household, the amount of property taxes accrued used
in computing the amount of grant to which he or she is entitled
shall be the same percentage of property taxes accrued as is
the percentage of ownership held by the claimant in the
residence.
(e) More than one residence. If a claimant has occupied
more than one residence in the taxable year, he or she may
claim only one residence for any part of a month. In the case
of property taxes accrued, he or she shall prorate 1/12 of the
total property taxes accrued on his or her residence to each
month that he or she owned and occupied that residence; and, in
the case of rent constituting property taxes accrued, shall
prorate each month's rent payments to the residence actually
occupied during that month.

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(f) (Blank).
(g) Effective January 1, 2006, there is hereby established
a program of pharmaceutical assistance to the aged and
disabled, entitled the Illinois Seniors and Disabled Drug
Coverage Program, which shall be administered by the Department
of Healthcare and Family Services and the Department on Aging
in accordance with this subsection, to consist of coverage of
specified prescription drugs on behalf of beneficiaries of the
program as set forth in this subsection.
To become a beneficiary under the program established under
this subsection, a person must:
(1) be (i) 65 years of age or older or (ii) disabled;
and
(2) be domiciled in this State; and
(3) enroll with a qualified Medicare Part D
Prescription Drug Plan if eligible and apply for all
available subsidies under Medicare Part D; and
(4) for the 2006 and 2007 claim years, have a maximum
household income of (i) less than $21,218 for a household
containing one person, (ii) less than $28,480 for a
household containing 2 persons, or (iii) less than $35,740
for a household containing 3 or more persons; and
(5) for the 2008 claim year, have a maximum household
income of (i) less than $22,218 for a household containing
one person, (ii) $29,480 for a household containing 2
persons, or (iii) $36,740 for a household containing 3 or

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more persons; and
(6) for 2009 claim year applications submitted during
calendar year 2010, have annual household income of less
than (i) $27,610 for a household containing one person;
(ii) less than $36,635 for a household containing 2
persons; or (iii) less than $45,657 for a household
containing 3 or more persons; and .
(7) as of September 1, 2011, have a maximum household
income at or below 200% of the federal poverty level.
The Department of Healthcare and Family Services may adopt
rules such that on January 1, 2011, and thereafter, the
foregoing household income eligibility limits may be changed to
reflect the annual cost of living adjustment in Social Security
and Supplemental Security Income benefits that are applicable
to the year for which those benefits are being reported as
income on an application.
All individuals enrolled as of December 31, 2005, in the
pharmaceutical assistance program operated pursuant to
subsection (f) of this Section and all individuals enrolled as
of December 31, 2005, in the SeniorCare Medicaid waiver program
operated pursuant to Section 5-5.12a of the Illinois Public Aid
Code shall be automatically enrolled in the program established
by this subsection for the first year of operation without the
need for further application, except that they must apply for
Medicare Part D and the Low Income Subsidy under Medicare Part
D. A person enrolled in the pharmaceutical assistance program

09700SB1802ham001 - 51 - LRB097 09314 KTG 56358 a
operated pursuant to subsection (f) of this Section as of
December 31, 2005, shall not lose eligibility in future years
due only to the fact that they have not reached the age of 65.
To the extent permitted by federal law, the Department may
act as an authorized representative of a beneficiary in order
to enroll the beneficiary in a Medicare Part D Prescription
Drug Plan if the beneficiary has failed to choose a plan and,
where possible, to enroll beneficiaries in the low-income
subsidy program under Medicare Part D or assist them in
enrolling in that program.
Beneficiaries under the program established under this
subsection shall be divided into the following 4 eligibility
groups:
(A) Eligibility Group 1 shall consist of beneficiaries
who are not eligible for Medicare Part D coverage and who
are:
(i) disabled and under age 65; or
(ii) age 65 or older, with incomes over 200% of the
Federal Poverty Level; or
(iii) age 65 or older, with incomes at or below
200% of the Federal Poverty Level and not eligible for
federally funded means-tested benefits due to
immigration status.
(B) Eligibility Group 2 shall consist of beneficiaries
who are eligible for Medicare Part D coverage.
(C) Eligibility Group 3 shall consist of beneficiaries

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age 65 or older, with incomes at or below 200% of the
Federal Poverty Level, who are not barred from receiving
federally funded means-tested benefits due to immigration
status and are not eligible for Medicare Part D coverage.
If the State applies and receives federal approval for
a waiver under Title XIX of the Social Security Act,
persons in Eligibility Group 3 shall continue to receive
benefits through the approved waiver, and Eligibility
Group 3 may be expanded to include disabled persons under
age 65 with incomes under 200% of the Federal Poverty Level
who are not eligible for Medicare and who are not barred
from receiving federally funded means-tested benefits due
to immigration status.
(D) Eligibility Group 4 shall consist of beneficiaries
who are otherwise described in Eligibility Group 2 who have
a diagnosis of HIV or AIDS.
Notwithstanding anything in this paragraph to the
contrary, the Department of Healthcare and Family Services may
establish by emergency rule changes in cost-sharing necessary
to conform the cost of the program to the amounts appropriated
for State fiscal year 2012 and future fiscal years. The program
established under this subsection shall cover the cost of
covered prescription drugs in excess of the beneficiary
cost-sharing amounts set forth in this paragraph that are not
covered by Medicare. In 2006, beneficiaries shall pay a
co-payment of $2 for each prescription of a generic drug and $5

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for each prescription of a brand-name drug. In future years,
beneficiaries shall pay co-payments equal to the co-payments
required under Medicare Part D for "other low-income subsidy
eligible individuals" pursuant to 42 CFR 423.782(b). For
individuals in Eligibility Groups 1, 2, and 3, once the program
established under this subsection and Medicare combined have
paid $1,750 in a year for covered prescription drugs, the
beneficiary shall pay 20% of the cost of each prescription in
addition to the co-payments set forth in this paragraph. For
individuals in Eligibility Group 4, once the program
established under this subsection and Medicare combined have
paid $1,750 in a year for covered prescription drugs, the
beneficiary shall pay 20% of the cost of each prescription in
addition to the co-payments set forth in this paragraph unless
the drug is included in the formulary of the Illinois AIDS Drug
Assistance Program operated by the Illinois Department of
Public Health and covered by the Medicare Part D Prescription
Drug Plan in which the beneficiary is enrolled. If the drug is
included in the formulary of the Illinois AIDS Drug Assistance
Program and covered by the Medicare Part D Prescription Drug
Plan in which the beneficiary is enrolled, individuals in
Eligibility Group 4 shall continue to pay the co-payments set
forth in this paragraph after the program established under
this subsection and Medicare combined have paid $1,750 in a
year for covered prescription drugs.
For beneficiaries eligible for Medicare Part D coverage,

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the program established under this subsection shall pay 100% of
the premiums charged by a qualified Medicare Part D
Prescription Drug Plan for Medicare Part D basic prescription
drug coverage, not including any late enrollment penalties.
Qualified Medicare Part D Prescription Drug Plans may be
limited by the Department of Healthcare and Family Services to
those plans that sign a coordination agreement with the
Department.
For Notwithstanding Section 3.15, for purposes of the
program established under this subsection, the term "covered
prescription drug" has the following meanings:
For Eligibility Group 1, "covered prescription drug"
means: (1) any cardiovascular agent or drug; (2) any
insulin or other prescription drug used in the treatment of
diabetes, including syringe and needles used to administer
the insulin; (3) any prescription drug used in the
treatment of arthritis; (4) any prescription drug used in
the treatment of cancer; (5) any prescription drug used in
the treatment of Alzheimer's disease; (6) any prescription
drug used in the treatment of Parkinson's disease; (7) any
prescription drug used in the treatment of glaucoma; (8)
any prescription drug used in the treatment of lung disease
and smoking-related illnesses; (9) any prescription drug
used in the treatment of osteoporosis; and (10) any
prescription drug used in the treatment of multiple
sclerosis. The Department may add additional therapeutic

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classes by rule. The Department may adopt a preferred drug
list within any of the classes of drugs described in items
(1) through (10) of this paragraph. The specific drugs or
therapeutic classes of covered prescription drugs shall be
indicated by rule.
For Eligibility Group 2, "covered prescription drug"
means those drugs covered by the Medicare Part D
Prescription Drug Plan in which the beneficiary is
enrolled.
For Eligibility Group 3, "covered prescription drug"
means those drugs covered by the Medical Assistance Program
under Article V of the Illinois Public Aid Code.
For Eligibility Group 4, "covered prescription drug"
means those drugs covered by the Medicare Part D
Prescription Drug Plan in which the beneficiary is
enrolled.
An individual in Eligibility Group 1, 2, 3, or 4 may opt to
receive a $25 monthly payment in lieu of the direct coverage
described in this subsection.
Any person otherwise eligible for pharmaceutical
assistance under this subsection whose covered drugs are
covered by any public program is ineligible for assistance
under this subsection to the extent that the cost of those
drugs is covered by the other program.
The Department of Healthcare and Family Services shall
establish by rule the methods by which it will provide for the

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coverage called for in this subsection. Those methods may
include direct reimbursement to pharmacies or the payment of a
capitated amount to Medicare Part D Prescription Drug Plans.
For a pharmacy to be reimbursed under the program
established under this subsection, it must comply with rules
adopted by the Department of Healthcare and Family Services
regarding coordination of benefits with Medicare Part D
Prescription Drug Plans. A pharmacy may not charge a
Medicare-enrolled beneficiary of the program established under
this subsection more for a covered prescription drug than the
appropriate Medicare cost-sharing less any payment from or on
behalf of the Department of Healthcare and Family Services.
The Department of Healthcare and Family Services or the
Department on Aging, as appropriate, may adopt rules regarding
applications, counting of income, proof of Medicare status,
mandatory generic policies, and pharmacy reimbursement rates
and any other rules necessary for the cost-efficient operation
of the program established under this subsection.
(h) A qualified individual is not entitled to duplicate
benefits in a coverage period as a result of the changes made
by this amendatory Act of the 96th General Assembly.
(Source: P.A. 95-208, eff. 8-16-07; 95-644, eff. 10-12-07;
95-876, eff. 8-21-08; 96-804, eff. 1-1-10; revised 9-16-10.)
Section 99. Effective date. This Act takes effect upon
becoming law.".