Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.10 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
The following definitions apply for purposes of this
				Part:
"Act" means the Senior Citizens and Disabled Persons Property
				Tax Relief and Pharmaceutical Assistance Act [320 ILCS 25 ].
"AIDS Drug Assistance Program" or "ADAP" means the program
				administered by the Illinois Department of Public Health (DPH) that provides
				pharmaceutical assistance for AIDS/HIV drugs for eligible Illinois
				citizens.
"AIDS Drug Assistance Program formulary" or "ADAP formulary"
				means the formulary developed and published by DPH for ADAP.
"Applicant" means any person in a household who has requested
				pharmaceutical assistance benefits on an application filed by an
				applicant.
"Beneficiary" means a person whose application for
				pharmaceutical assistance benefits under the Act has been approved by the
				Department on Aging.
"Brand name drug" means those drugs as defined in 89 Ill. Adm.
				Code
				140.440(g)(3)
				 when dispensed to an individual not enrolled
				in Medicare Part D. When dispensed to an individual enrolled in Medicare Part
				D, brand name drugs means those legend drugs defined as brand name drugs by the
				individual's Medicare Prescription Drug Plan (PDP).
"Coordinating Prescription Drug Plan" means a Medicare Part D
				Prescription Drug Plan that has signed a coordination agreement with the
				Department and to which the Department pays a per member/per month (PM/PM)
				payment for each Illinois Cares Rx beneficiary enrolled in that plan.
"Department" means the Illinois Department of Healthcare and
				Family Services.
"Director" means the Director of the Illinois Department of
				Healthcare and Family Services.
"Disabled person" means a person who is unable to engage in any
				substantial gainful activity by reason of medically determinable physical or
				mental impairment that can be expected to result in death or has lasted or can
				be expected to last for a continuous period of not less than 12 months.
				[320 ILCS 25/3.14
				]
"Disease" means a chronic and possibly recurrent illness of
				long duration, as distinguished from an acute illness that is of short duration
				with recovery due to limited medical treatment (such as in the case of colds,
				flu, pneumonia, bronchitis, or other similar illnesses).
"Domiciled" means having a fixed habitation at a permanent
				residence in Illinois at the time of filing the application and during the
				coverage year.
"Electronic application" means the electronic document set
				forth in 86 Ill. Adm. Code
				530.305(a).
"FPL" means the federal poverty income guideline as determined
				annually by the United States Department of Health and Human Services.
"Generic drug" means those legend drugs as defined in 89 Ill.
				Adm. Code
				140.440(g)(2)
				 when dispensed to individuals not enrolled
				in Medicare Part D. When dispensed to individuals enrolled in Medicare Part D,
				generic drugs means those legend drugs defined as generic drugs by the
				individual's Medicare Prescription Drug Plan (PDP).
"Household" means an applicant or an applicant and his or her
				spouse livingtogether in the same residence. [320 ILCS
				25/3.05 ]
"Household income" means the combined income of the members of
				a household for a year. [320 ILCS
				25/3.06 ]
"Illinois Cares Rx Plus" means the provision of benefits to
				individuals in eligibility group 2, 3 or 4, as defined in
				320 ILCS
				25/4(g).
"Illinois Cares Rx Basic" means the provision of benefits to
				individuals in eligibility group 1, as defined in
				320 ILCS
				25/4(g).
"Illinois Cares Rx Basic Covered Prescription Drug" means any
				drug included in the categories listed in Section
				119.80
				and prescribed as set forth in Section 119.80.
"Illinois Cares Rx Rebate" means an Illinois Cares Rx benefit
				in the form of a monthly monetary payment made to an individual enrolled in a
				third-party plan that provides a pharmacy benefit or a PDP that is not a
				Coordinating Medicare PDP. The payment is made in lieu of the covered services
				described in Section
				119.60.
"Income" means adjusted gross income, properly reportable for
				federal income tax purposes under the provisions of the Internal Revenue Code,
				modified as defined in
				320 ILCS 25/3.07.
"Non-Preferred Drug" means those drugs that are
				3rd tier or higher on an individual's Medicare Part
				D Prescription Drug Plan's (PDPs) formulary or are listed as non-preferred on
				the Department's Preferred Drug List.
"Over-the-counter items" means those pharmaceutical items that
				may be purchased off the shelf by the general public.
"Pharmaceutical product" means a brand name drug, a generic
				drug, or an over-the-counter item.
"Prescription Drug Plan" or "PDP" means a Medicare Part D
				Prescription Drug Plan.
"Program" means the Illinois Cares Rx Pharmaceutical Assistance
				Program provided for under the Act.
"Projected income" means household income expected to be
				received for a coverage year.