(20 ILCS 2310/2310-260)
Sec. 2310-260. Payments for post transplant maintenance and retention.
(a) The Department shall establish and administer a program to pay recipients for drugs and other costs prescribed exclusively for post transplant maintenance and retention when those costs are not otherwise reimbursed. The Department shall establish eligibility standards and an application process by rule. Notwithstanding any other provision of this Code to the contrary, the Department may, by rule, require participants to pay a co-payment for the drugs covered under this program.
(b) Participation in the program shall be limited to persons whose household income is not greater than 400% of the federal poverty level as established by the federal Office of Management and Budget. The program shall be available only to eligible Illinois residents who have resided in Illinois for at least 12 months; however, a person shall not be excluded because that person received the transplant outside of the State of Illinois.
(c) The Department shall pay a maximum amount per transplant recipient based on the following:
(1) Available moneys in the Post Transplant
Maintenance and Retention Fund.
(2) Covered immunosuppressive drugs.
(3) The terms of any contract between the Department
and the provider.
The reimbursement rates shall be the same as the Medicaid reimbursement rate for the drug, minus any co-payment and other medical services.
(d) Payment shall be made under the program to or on behalf of a program-eligible recipient only for costs not reimbursed or eligible for reimbursement by any other third party or governmental entity, including, without limitation, private or group insurance, Medicaid, Medicare, and the Veterans Administration. The Director may, however, waive this requirement in individually considered cases if the Director determines that its enforcement will deny services to a class of post transplant patients because of conflicting State or federal laws or regulations.
(e) The Director may restrict or categorize reimbursements to meet budgetary limitations.
(f) The Director shall maintain an immunosuppressive drug formulary that shall include all drugs eligible for reimbursement by the program. The Director shall establish an internal review procedure for updating the formulary; the procedure shall allow the addition and deletion of allowable drugs to the formulary. The internal review procedure shall take place at least quarterly during a fiscal year.
(g) Payments made under the program established under this Section shall be made, subject to appropriations, from the Post Transplant Maintenance and Retention Fund, a special fund that is hereby created in the State Treasury. The following shall be deposited into the Fund: (i) amounts appropriated to the Department for that purpose, and (ii) gifts, grants, and donations for that purpose from public and private sources. Interest accruing on moneys in the Fund shall remain in the Fund. Moneys in the Fund may be used only by the Department to make payments for post transplant maintenance and retention under the program established under this Section.
(h) Moneys remaining in the Post Transplant Maintenance and Retention Fund at the end of the fiscal year may be used in the following fiscal year.
(Source: P.A. 91-873, eff. 7-1-00.)
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Last modified: February 18, 2015