(320 ILCS 25/3.07) (from Ch. 67 1/2, par. 403.07)
Sec. 3.07.
"Income" means adjusted gross income, properly reportable for
federal income tax purposes under the provisions of the Internal Revenue Code,
modified by adding thereto the sum of the following amounts to the extent
deducted or excluded from gross income in the computation of adjusted gross
income:
(A) An amount equal to all amounts paid or accrued |
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as interest or dividends during the taxable year;
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(B) An amount equal to the amount of tax imposed by
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the Illinois Income Tax Act paid for the taxable year;
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(C) An amount equal to all amounts received during
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the taxable year as an annuity under an annuity, endowment or life insurance contract or under any other contract or agreement;
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(D) An amount equal to the amount of benefits paid
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under the Federal Social Security Act during the taxable year;
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(E) An amount equal to the amount of benefits paid
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under the Railroad Retirement Act during the taxable year;
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(F) An amount equal to the total amount of cash
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public assistance payments received from any governmental agency during the taxable year other than benefits received pursuant to this Act;
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(G) An amount equal to any net operating loss
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carryover deduction or capital loss carryover deduction during the taxable year;
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(H) For claim years beginning on or after January 1,
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2002, an amount equal to any benefits received under the Workers' Compensation Act or the Workers' Occupational Diseases Act during the taxable year.
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"Income" does not include any grant assistance received under the Nursing
Home Grant 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.
This amendatory Act of 1987 shall be effective for purposes of this
Section for tax years ending on or after December 31, 1987.
(Source: P.A. 91‑676, eff. 12‑23‑99; 92‑131, eff. 7‑23‑01; 92‑519, eff.
1‑1‑02.)
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(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 $14,000 for grant
years before the 1998 grant year, less than $16,000 for the 1998 and 1999
grant years, and less than (i) $21,218 for a household containing one person,
(ii) $28,480 for a household containing 2 persons, or (iii) $35,740 for a
household containing 3 or more persons for the 2000 grant year and thereafter
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 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.
(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 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.
(f) There is hereby established a program of pharmaceutical assistance
to the aged and disabled which shall be administered by the Department in
accordance with this Act, to consist of payments to authorized pharmacies, on
behalf of beneficiaries of the program, for the reasonable costs of covered
prescription drugs. Each beneficiary who pays $5 for an identification card
shall pay no additional prescription costs. Each beneficiary who pays $25 for
an identification card shall pay $3 per prescription. In addition, after a
beneficiary receives $2,000 in benefits during a State fiscal year, that
beneficiary shall also be charged 20% of the cost of each prescription for
which payments are made by the program during the remainder of the fiscal
year. To become a beneficiary under this program a person must: (1)
be (i) 65 years of age or older, or (ii) the surviving spouse of such
a claimant, who at the time of death received or was entitled to receive
benefits pursuant to this subsection, 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 benefits pursuant to this subsection, or (iii) disabled,
and (2) be domiciled in this State at the time he or she files
his or her claim, and (3) have a maximum household income of less
than $14,000 for grant years before the 1998 grant year, less than $16,000
for the 1998 and 1999 grant years, and less than (i) $21,218 for a household
containing one person, (ii) $28,480 for a household containing 2 persons, or
(iii) $35,740 for a household containing 3 more persons for the 2000 grant
year
and thereafter. In addition, each eligible person must (1) obtain an
identification card from the Department, (2) at the time the card is obtained,
sign a statement assigning to the State of Illinois benefits which may be
otherwise claimed under any private insurance plans, and (3) present the
identification card to the dispensing pharmacist.
The Department may adopt rules specifying
participation
requirements for the pharmaceutical assistance program, including copayment
amounts,
identification card fees, expenditure limits, and the benefit threshold after
which a 20% charge is imposed on the cost of each prescription, to be in
effect on and
after July 1, 2004.
Notwithstanding any other provision of this paragraph, however, the Department
may not
increase the identification card fee above the amount in effect on May 1, 2003
without
the express consent of the General Assembly.
To the extent practicable, those requirements shall be
commensurate
with the requirements provided in rules adopted by the Department of Healthcare and Family Services
to
implement the pharmacy assistance program under Section 5‑5.12a of the Illinois
Public
Aid Code.
Whenever a generic equivalent for a covered prescription drug is available,
the Department shall reimburse only for the reasonable costs of the generic
equivalent, less the co‑pay established in this Section, unless (i) the covered
prescription drug contains one or more ingredients defined as a narrow
therapeutic index drug at 21 CFR 320.33, (ii) the prescriber indicates on the
face of the prescription "brand medically necessary", and (iii) the prescriber
specifies that a substitution is not permitted. When issuing an oral
prescription for covered prescription medication described in item (i) of this
paragraph, the prescriber shall stipulate "brand medically necessary" and
that a substitution is not permitted. If the covered prescription drug and its
authorizing prescription do not meet the criteria listed above, the beneficiary
may purchase the non‑generic equivalent of the covered prescription drug by
paying the difference between the generic cost and the non‑generic cost plus
the beneficiary co‑pay.
Any person otherwise eligible for pharmaceutical assistance under this
Act whose covered drugs are covered by any public program for assistance in
purchasing any covered prescription drugs shall be ineligible for assistance
under this Act to the extent such costs are covered by such other plan.
The fee to be charged by the Department for the identification card shall
be equal to $5 per coverage year for persons below the official poverty line
as defined by the United States Department of Health and Human Services and
$25 per coverage year for all other persons.
In the event that 2 or more persons are eligible for any benefit under
this Act, and are members of the same household, (1) each such person shall
be entitled to participate in the pharmaceutical assistance program, provided
that he or she meets all other requirements imposed by this subsection
and (2) each participating household member contributes the fee required
for that person by the preceding paragraph for the purpose
of obtaining an identification card.
The provisions of this subsection (f), other than this paragraph, are inoperative after December 31, 2005. Beneficiaries who received benefits under the program established by this subsection (f) are not entitled, at the termination of the program, to any refund of the identification card fee paid under this subsection.
(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. The program under this subsection replaces and supersedes the program established under subsection (f), which shall end at midnight on December 31, 2005.
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;
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(2) be domiciled in this State; and
(3) enroll with a qualified Medicare Part D
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Prescription Drug Plan if eligible and apply for all available subsidies under Medicare Part D; and
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(4) have a maximum household income of (i) less than
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$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. If any income eligibility limit set forth in items (i) through (iii) is less than 200% of the Federal Poverty Level for any year, the income eligibility limit for that year for households of that size shall be income equal to or less than 200% of the Federal Poverty Level.
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All individuals enrolled as of December 31, 2005, in the
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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 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.
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To the extent permitted by federal law, the Department
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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.
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Beneficiaries under the program established under this
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subsection shall be divided into the following 5 eligibility groups:
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(A) Eligibility Group 1 shall consist of
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beneficiaries who are not eligible for Medicare Part D coverage and who are:
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(i) disabled and under age 65; or
(ii) age 65 or older, with incomes over 200% of
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the Federal Poverty Level; or
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(iii) age 65 or older, with incomes at or below
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200% of the Federal Poverty Level and not eligible for federally funded means‑tested benefits due to immigration status.
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(B) Eligibility Group 2 shall consist of
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beneficiaries otherwise described in Eligibility Group 1 but who are eligible for Medicare Part D coverage.
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(C) Eligibility Group 3 shall consist of
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beneficiaries 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 eligible for Medicare Part D coverage.
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(D) Eligibility Group 4 shall consist of
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beneficiaries 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.
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If the State applies and receives federal approval
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for a waiver under Title XIX of the Social Security Act, persons in Eligibility Group 4 shall continue to receive benefits through the approved waiver, and Eligibility Group 4 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.
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(E) On and after January 1, 2007, Eligibility Group
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5 shall consist of beneficiaries who are otherwise described in Eligibility Group 1 but are eligible for Medicare Part D and have a diagnosis of HIV or AIDS.
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The program established under this subsection shall cover
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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 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, 3, and 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. For individuals in Eligibility Group 5, 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. If the drug is included in the formulary of the Illinois AIDS Drug Assistance Program, individuals in Eligibility Group 5 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.
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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.
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Notwithstanding Section 3.15, for purposes of the program
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established under this subsection, the term "covered prescription drug" has the following meanings:
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For Eligibility Group 1, "covered prescription drug"
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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 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.
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For Eligibility Group 2, "covered prescription drug"
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means those drugs covered for Eligibility Group 1 that are also covered by the Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled.
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For Eligibility Group 3, "covered prescription drug"
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means those drugs covered by the Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled.
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For Eligibility Group 4, "covered prescription drug"
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means those drugs covered by the Medical Assistance Program under Article V of the Illinois Public Aid Code.
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For Eligibility Group 5, "covered prescription drug"
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means: (1) those drugs covered for Eligibility Group 1 that are also covered by the Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled; and (2) those drugs included in the formulary of the Illinois AIDS Drug Assistance Program operated by the Illinois Department of Public Health that are also covered by the Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled.
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An individual in Eligibility Group 3 or 4 may opt to
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receive a $25 monthly payment in lieu of the direct coverage described in this subsection.
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Any person otherwise eligible for pharmaceutical
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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.
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The Department of Healthcare and Family Services shall
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establish by rule the methods by which it will provide for the 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.
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For a pharmacy to be reimbursed under the program
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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.
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The Department of Healthcare and Family Services or the
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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.
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(Source: P.A. 93‑130, eff. 7‑10‑03; 94‑86, eff. 1‑1‑06; 94‑909, eff. 6‑23‑06.)
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(320 ILCS 25/6) (from Ch. 67 1/2, par. 406)
Sec. 6. Administration.
(a) In general. Upon receipt of a timely filed claim, the Department
shall determine whether the claimant is a person entitled to a grant under
this Act and the amount of grant to which he is entitled under this Act.
The Department may require the claimant to furnish reasonable proof of the
statements of domicile, household income, rent paid, property taxes accrued
and other matters on which entitlement is based, and may withhold payment
of a grant until such additional proof is furnished.
(b) Rental determination. If the Department finds that the gross rent
used in the computation by a claimant of rent constituting property taxes
accrued exceeds the fair rental value for the right to occupy that
residence, the Department may determine the fair rental value for that
residence and recompute rent constituting property taxes accrued accordingly.
(c) Fraudulent claims. The Department shall deny claims which have been
fraudulently prepared or when it finds that the claimant has acquired title
to his residence or has paid rent for his residence primarily for the
purpose of receiving a grant under this Act.
(d) Pharmaceutical Assistance.
The Department shall allow all pharmacies licensed under the Pharmacy
Practice Act of 1987 to participate as authorized pharmacies unless they
have been removed from that status for cause pursuant to the terms of this
Section. The Director of the Department may enter
into a written contract with any State agency, instrumentality or political
subdivision, or a fiscal intermediary for the purpose of making payments to
authorized pharmacies for covered prescription drugs and coordinating the
program of pharmaceutical assistance established by this Act with other
programs that provide payment for covered prescription drugs. Such
agreement shall establish procedures for properly contracting for pharmacy
services, validating reimbursement claims, validating compliance of
dispensing pharmacists with the contracts for participation required under
this Section, validating the reasonable costs of covered prescription
drugs, and otherwise providing for the effective administration of this Act.
The Department shall promulgate rules and regulations to implement and
administer the program of pharmaceutical assistance required by this Act,
which shall include the following:
(1) Execution of contracts with pharmacies to
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dispense covered prescription drugs. Such contracts shall stipulate terms and conditions for authorized pharmacies participation and the rights of the State to terminate such participation for breach of such contract or for violation of this Act or related rules and regulations of the Department;
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(2) Establishment of maximum limits on the size of
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prescriptions, new or refilled, which shall be in amounts sufficient for 34 days, except as otherwise specified by rule for medical or utilization control reasons;
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(3) Establishment of liens upon any and all causes
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of action which accrue to a beneficiary as a result of injuries for which covered prescription drugs are directly or indirectly required and for which the Director made payment or became liable for under this Act;
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(4) Charge or collection of payments from third
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parties or private plans of assistance, or from other programs of public assistance for any claim that is properly chargeable under the assignment of benefits executed by beneficiaries as a requirement of eligibility for the pharmaceutical assistance identification card under this Act;
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(4.5) Provision for automatic enrollment of
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beneficiaries into a Medicare Discount Card program authorized under the federal Medicare Modernization Act of 2003 (P.L. 108‑391) to coordinate coverage including Medicare Transitional Assistance;
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(5) Inspection of appropriate records and audit of
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participating authorized pharmacies to ensure contract compliance, and to determine any fraudulent transactions or practices under this Act;
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(6) Annual determination of the reasonable costs of
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covered prescription drugs for which payments are made under this Act, as provided in Section 3.16;
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(7) Payment to pharmacies under this Act in
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accordance with the State Prompt Payment Act.
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The Department shall annually report to the Governor and the General
Assembly by March 1st of each year on the administration of pharmaceutical
assistance under this Act. By the effective date of this Act the
Department shall determine the reasonable costs of covered prescription
drugs in accordance with Section 3.16 of this Act.
(Source: P.A. 92‑651, eff. 7‑11‑02; 93‑841, eff. 7‑30‑04.)
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