MEDICAID-PHARMACY ACCESS

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to permit medical assistance recipients, including those enrolled in managed care, to obtain pharmacy services from the pharmacy of their choice if the pharmacy is licensed under the Pharmacy Practice Act and accepts the professional dispensing fee for pharmacy services as determined by the Department. Provides that no managed care organization that contracts with the Department to provide services to recipients may restrict a recipient's access to pharmacy services to a selected group of pharmacies. Provides that if a managed care organization merges with or is acquired by another entity, the resulting entity may not restrict a recipient's access to pharmacy services to a selected group of pharmacies. Permits the Department to renegotiate with the resulting entity the terms of the managed care contract the Department had with the original managed care organization prior to the merger or acquisition. Requires the Department to contract with an independent research organization to conduct a study and submit a report on those managed care organizations that are contracted to provide services to recipients. Requires the report to include an analysis of pharmacy access for medical assistance recipients with the aim of identifying "pharmacy deserts"; an analysis of the costs and benefits of having managed care organizations administer health care services, including pharmacy services, to recipients; and other matters. Prohibits the Department from entering into any new contract with a managed care organization before the report has been received and analyzed by the Department and posted on its website. Effective immediately. Balanced Budget Note (Office of Management and Budget) Please be advised that the Balanced Budget Note Act does not apply to House Bill 591 as it is not a supplemental appropriation that increases or decreases appropriations. Under the Act, a balanced budget note must be prepared only for bills that change a general funds appropriation for the fiscal year in which the new bill is enacted. Judicial Note (Admin Office of the Illinois Courts) Based on a review of the bill, it has been determined that the proposed legislation would neither increase nor decrease the number of judges needed in the State of Illinois. Pension Note (Government Forecasting & Accountability) HB 591 will not have any impact on any public pension fund or retirement system in the State of Illinois. State Debt Impact Note (Government Forecasting & Accountability) HB 591 would not change the amount of authorization for any type of State-issued bond, and, therefore, would not affect the level of State indebtedness. Housing Affordability Impact Note (Housing Development Authority) This bill will have no effect on the cost of constructing, purchasing, owning, or selling a single-family residence. Home Rule Note (Dept. of Commerce & Economic Opportunity) This bill does not pre-empt home rule authority. State Mandates Fiscal Note (Dept. of Commerce & Economic Opportunity) This bill does not create a State Mandate. Fiscal Note (Dept. of Healthcare & Family Services) The bill would require the Department to accept claims from any provider licensed under the Pharmacy Practice Act for services provided to recipients under the Medicaid fee-for-service (FFS) program or through a contractual managed care organization (MCO) entity. There would be a significant impact to liability for the MCO capitation rates. This bill has a total fiscal impact of $186 million.