summary
Introduced
01/09/2025
01/09/2025
In Committee
03/21/2025
03/21/2025
Crossed Over
Passed
Dead
Introduced Session
Potential new amendment
104th General Assembly
Bill Summary
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to conduct a study on managed care pharmacy access standards. Provides that the study shall review the current access standards, with a focus on disproportionately impacted areas. Requires the Department to seek input from consumers of pharmacy services. Requires the Department to report its findings to the Governor and the General Assembly by January 1, 2026 and to publish the report on the Department's website. Provides that any retail pharmacy that is enrolled as an eligible retail pharmacy provider in the medical assistance program and is not sanctioned under investigation for fraud, waste, or abuse shall provide retail pharmacy services to any medical assistance recipient who resides in the same zip code as the pharmacy, regardless of whether the retail pharmacy is contracted to provide pharmacy services for the managed care organization that the recipient is enrolled with. Requires the managed care organization to pay the retail pharmacy the managed care organization's standard contractual rate. Effective immediately.
AI Summary
This bill amends the Illinois Public Aid Code to address pharmacy services and access standards in the state's Medicaid program. The bill requires the Department of Healthcare and Family Services to conduct a comprehensive study on managed care pharmacy access standards, with a specific focus on areas that are disproportionately impacted by current service models. The Department must seek input from pharmacy service consumers and submit a detailed report to the Governor and General Assembly by January 1, 2026, which must also be published on the Department's website. Additionally, the bill mandates that any retail pharmacy enrolled in the medical assistance program (and not under investigation for fraud, waste, or abuse) must provide pharmacy services to Medicaid recipients who live in the same zip code as the pharmacy, even if the pharmacy is not contracted with the recipient's specific managed care organization. In such cases, the managed care organization is required to pay the pharmacy its standard contractual rate. The legislation aims to improve pharmacy access and provide more flexibility for Medicaid recipients in obtaining their medications.
Committee Categories
Budget and Finance
Sponsors (1)
Last Action
House Committee Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee (on 03/21/2025)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.ilga.gov/legislation/BillStatus.asp?DocNum=4&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| House Amendment 001 | https://www.ilga.gov/legislation/104/HB/10400HB0004ham001.htm |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB0004.htm |
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