Illinois 2023-2024 Regular Session

Illinois House Bill HB1029 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1029 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-36.3 new305 ILCS 5/5-36 rep. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall transition pharmacy services for managed care enrollees from the State's managed care medical assistance program back to the State's traditional fee-for-service program, thereby assuming direct responsibility for all pharmacy services provided under the Article. Provides that the transition back to a fee-for-service reimbursement model for pharmacy services shall be implemented by the Department upon the expiration of any managed care contracts the Department has with managed care organizations on the effective date of the amendatory Act. Provides that, to ensure managed care enrollees do not experience an interruption in pharmacy services during the transition from managed care to fee-for-service coverage, the Department must, at a minimum, do the following: add an additional pharmacist to its staff; stress-test its existing claims processing system; increase its capacity for prior authorizations; and educate the public and its help desk staff about the change in coverage for pharmacy services. Grants the Department rulemaking authority. Repeals a provision that permits the Department to enter into a contract with a third party on a fee-for-service reimbursement model for the purpose of administering pharmacy benefits for recipients not enrolled in a Medicaid managed care organization. Effective immediately. LRB103 04908 KTG 49918 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1029 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-36.3 new305 ILCS 5/5-36 rep. 305 ILCS 5/5-36.3 new 305 ILCS 5/5-36 rep. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall transition pharmacy services for managed care enrollees from the State's managed care medical assistance program back to the State's traditional fee-for-service program, thereby assuming direct responsibility for all pharmacy services provided under the Article. Provides that the transition back to a fee-for-service reimbursement model for pharmacy services shall be implemented by the Department upon the expiration of any managed care contracts the Department has with managed care organizations on the effective date of the amendatory Act. Provides that, to ensure managed care enrollees do not experience an interruption in pharmacy services during the transition from managed care to fee-for-service coverage, the Department must, at a minimum, do the following: add an additional pharmacist to its staff; stress-test its existing claims processing system; increase its capacity for prior authorizations; and educate the public and its help desk staff about the change in coverage for pharmacy services. Grants the Department rulemaking authority. Repeals a provision that permits the Department to enter into a contract with a third party on a fee-for-service reimbursement model for the purpose of administering pharmacy benefits for recipients not enrolled in a Medicaid managed care organization. Effective immediately. LRB103 04908 KTG 49918 b LRB103 04908 KTG 49918 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1029 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-36.3 new305 ILCS 5/5-36 rep. 305 ILCS 5/5-36.3 new 305 ILCS 5/5-36 rep.
4	4	305 ILCS 5/5-36.3 new
5	5	305 ILCS 5/5-36 rep.
6	6	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall transition pharmacy services for managed care enrollees from the State's managed care medical assistance program back to the State's traditional fee-for-service program, thereby assuming direct responsibility for all pharmacy services provided under the Article. Provides that the transition back to a fee-for-service reimbursement model for pharmacy services shall be implemented by the Department upon the expiration of any managed care contracts the Department has with managed care organizations on the effective date of the amendatory Act. Provides that, to ensure managed care enrollees do not experience an interruption in pharmacy services during the transition from managed care to fee-for-service coverage, the Department must, at a minimum, do the following: add an additional pharmacist to its staff; stress-test its existing claims processing system; increase its capacity for prior authorizations; and educate the public and its help desk staff about the change in coverage for pharmacy services. Grants the Department rulemaking authority. Repeals a provision that permits the Department to enter into a contract with a third party on a fee-for-service reimbursement model for the purpose of administering pharmacy benefits for recipients not enrolled in a Medicaid managed care organization. Effective immediately.
7	7	LRB103 04908 KTG 49918 b LRB103 04908 KTG 49918 b
8	8	LRB103 04908 KTG 49918 b
9	9	A BILL FOR
10	10	HB1029LRB103 04908 KTG 49918 b HB1029 LRB103 04908 KTG 49918 b
11	11	HB1029 LRB103 04908 KTG 49918 b
12	12	1 AN ACT concerning public aid.
13	13	2 Be it enacted by the People of the State of Illinois,
14	14	3 represented in the General Assembly:
15	15	4 Section 5. The Illinois Public Aid Code is amended by
16	16	5 adding Section 5-36.3 as follows:
17	17	6 (305 ILCS 5/5-36.3 new)
18	18	7 Sec. 5-36.3. Pharmacy services; fee-for-service coverage.
19	19	8 Notwithstanding any other law to the contrary, the Department
20	20	9 shall transition pharmacy services for managed care enrollees
21	21	10 from the State's managed care medical assistance program back
22	22	11 to the State's traditional fee-for-service program, thereby
23	23	12 assuming direct responsibility for all pharmacy services
24	24	13 provided under this Article. The transition back to a
25	25	14 fee-for-service reimbursement model for pharmacy services
26	26	15 shall be implemented by the Department upon the expiration of
27	27	16 any managed care contracts the Department has with managed
28	28	17 care organizations on the effective date of this amendatory
29	29	18 Act of the 103rd General Assembly. To ensure managed care
30	30	19 enrollees do not experience an interruption in pharmacy
31	31	20 services during the transition from managed care to
32	32	21 fee-for-service coverage, the Department must, at a minimum,
33	33	22 do the following:
34	34	23 (1) add an additional pharmacist to its staff who is
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36	36
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38	38	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1029 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
39	39	305 ILCS 5/5-36.3 new305 ILCS 5/5-36 rep. 305 ILCS 5/5-36.3 new 305 ILCS 5/5-36 rep.
40	40	305 ILCS 5/5-36.3 new
41	41	305 ILCS 5/5-36 rep.
42	42	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall transition pharmacy services for managed care enrollees from the State's managed care medical assistance program back to the State's traditional fee-for-service program, thereby assuming direct responsibility for all pharmacy services provided under the Article. Provides that the transition back to a fee-for-service reimbursement model for pharmacy services shall be implemented by the Department upon the expiration of any managed care contracts the Department has with managed care organizations on the effective date of the amendatory Act. Provides that, to ensure managed care enrollees do not experience an interruption in pharmacy services during the transition from managed care to fee-for-service coverage, the Department must, at a minimum, do the following: add an additional pharmacist to its staff; stress-test its existing claims processing system; increase its capacity for prior authorizations; and educate the public and its help desk staff about the change in coverage for pharmacy services. Grants the Department rulemaking authority. Repeals a provision that permits the Department to enter into a contract with a third party on a fee-for-service reimbursement model for the purpose of administering pharmacy benefits for recipients not enrolled in a Medicaid managed care organization. Effective immediately.
43	43	LRB103 04908 KTG 49918 b LRB103 04908 KTG 49918 b
44	44	LRB103 04908 KTG 49918 b
45	45	A BILL FOR
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51	51	305 ILCS 5/5-36.3 new
52	52	305 ILCS 5/5-36 rep.
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56	56	LRB103 04908 KTG 49918 b
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66	66	HB1029 LRB103 04908 KTG 49918 b
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69	69	HB1029- 2 -LRB103 04908 KTG 49918 b HB1029 - 2 - LRB103 04908 KTG 49918 b
70	70	HB1029 - 2 - LRB103 04908 KTG 49918 b
71	71	1 licensed to practice pharmacy under the Pharmacy Practice
72	72	2 Act;
73	73	3 (2) stress-test its existing claims processing system;
74	74	4 (3) increase its capacity for prior authorizations;
75	75	5 and
76	76	6 (4) educate the public and its help desk staff about
77	77	7 the change in coverage for pharmacy services.
78	78	8 The Department may adopt any rules necessary to implement
79	79	9 this Section.
80	80	10 (305 ILCS 5/5-36 rep.)
81	81	11 Section 10. The Illinois Public Aid Code is amended by
82	82	12 repealing Section 5-36.
83	83	13 Section 99. Effective date. This Act takes effect upon
84	84	14 becoming law.
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90	90	HB1029 - 2 - LRB103 04908 KTG 49918 b