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Substitute House Bill No. 5041

Public Act No. 04-6

AN ACT CONCERNING THE USE OF MEDICARE PRESCRIPTION DRUG DISCOUNT CARDS IN THE CONNPACE PROGRAM.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 17b-492 of the general statutes, as amended by section 15 of public act 03-2 and section 58 of public act 03-3 of the June 30 special session, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Eligibility for participation in the program shall be limited to any resident (1) who is sixty-five years of age or older or who is disabled, (2) [(A)] whose annual income, if unmarried, [is less than thirteen thousand eight hundred dollars, except after April 1, 2002, such annual income] is less than twenty thousand eight hundred dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than [sixteen thousand six hundred dollars, except after April 1, 2002, such combined annual income is less than twenty-seven] twenty-eight thousand one hundred dollars, [or (B) in the event the program is granted a waiver to be eligible for federal financial participation, then, after July 1, 2002, whose annual income, if unmarried, is less than twenty-five thousand eight hundred dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than thirty-four thousand eight hundred dollars,] (3) who is not insured under a policy which provides full or partial coverage for prescription drugs, except for a Medicare prescription drug discount card endorsed by the Secretary of Health and Human Services in accordance with Public Law 108-173, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, once a deductible amount is met, (4) whose available assets are below one hundred thousand dollars if unmarried and one hundred twenty-five thousand dollars if married, (A) the asset limit for a married resident shall be determined by combining the value of assets available to both spouses, and (B) for purposes of this section, available assets are those that are considered available in determining eligibility in the Connecticut Home Care Program for the Elderly, and (5) on and after September 15, 1991, who pays an annual thirty-dollar registration fee to the Department of Social Services. Effective January 1, 2002, the commissioner shall commence accepting applications from individuals who will become eligible to participate in the program as of April 1, 2002. On January 1, 1998, and annually thereafter, the commissioner shall increase the income limits established under this subsection over those of the previous fiscal year to reflect the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to the nearest one hundred dollars.

(b) Payment for a prescription under the program shall be made only if no other plan of insurance or assistance is available to an eligible person for such prescription at the time of dispensing, except for benefits received from an endorsed Medicare prescription drug discount card. The pharmacy shall make reasonable efforts to ascertain the existence of other insurance or assistance, including the subsidy provided by an endorsed Medicare prescription drug discount card. A Medicare prescription drug discount card beneficiary shall be responsible for the payment of any Medicare prescription drug discount card coinsurance requirements, provided such requirements do not exceed the ConnPACE program copayment requirements. If a Medicare prescription drug discount card beneficiary's coinsurance requirements exceed the ConnPACE copayment requirements, the Department of Social Services shall make payment to the pharmacy to cover costs in excess of the ConnPACE copayment amount. If the cost to such beneficiary exceeds the remaining available Medicare prescription drug discount card subsidy, the beneficiary shall not be responsible for any payment in excess of the amount of the ConnPACE program copayment requirement. In such cases, the Department of Social Services shall make payment to the pharmacy to cover costs in excess of the ConnPACE copayment amount.

(c) Any eligible resident who (1) is insured under a policy, including an endorsed Medicare prescription drug discount card, which provides full or partial coverage for prescription drugs, and (2) expects to exhaust such coverage, may apply to participate in the program prior to the exhaustion of such coverage. Such application shall be valid for the applicable income year. To be included in the program, on or after the date the applicant exhausts such coverage, the applicant or the applicant's designee shall notify the department that such coverage is exhausted and, if required by the department, shall submit evidence of exhaustion of coverage. Not later than ten days after an eligible resident submits such evidence, such resident shall be included in the program. The program shall, except for those beneficiaries with an endorsed Medicare prescription drug discount card, (A) cover prescriptions that are not covered by any other plan of insurance or assistance available to the eligible resident and that meet the requirements of this chapter, and (B) retroactively cover such prescriptions filled after or concurrently with the exhaustion of such coverage. Nothing in this subsection shall be construed to prevent a resident from applying to participate in the program as otherwise permitted by this chapter and regulations adopted pursuant to this chapter.

(d) As a condition of eligibility for participation in the ConnPACE program, a resident with an income at or below one hundred thirty-five per cent of the federal poverty level, who is Medicare Part A or Part B eligible, shall obtain an endorsed Medicare prescription drug discount card designated by the Commissioner of Social Services for use in conjunction with the ConnPACE program. The commissioner may require, as a condition of eligibility for participation in the ConnPACE program, that a resident with an income above one hundred thirty-five per cent of the federal poverty level, who is Medicare Part A or Part B eligible, obtain an endorsed Medicare prescription drug discount card designated by the commissioner for use in conjunction with the ConnPACE program if obtaining such discount card is determined by the commissioner to be cost-effective to the state. In such an event, the commissioner may provide payment for any Medicare prescription drug discount card enrollment fees.

[(d)] (e) The Commissioner of Social Services may adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsection (c) of this section. Such regulations may provide for the electronic transmission of relevant coverage information between a pharmacist and the department or between an insurer and the department in order to expedite applications and notice. The commissioner may implement the policies and procedures necessary to carry out the provisions of this section while in the process of adopting such policies and procedures in regulation form, provided notice of intent to adopt the regulations is published not later than twenty days after the date of implementation. Such policies and procedures shall be valid until the time the final regulations are adopted.

Sec. 2. (NEW) (Effective from passage) On and after the effective date of this section, only a pharmacy, as defined in subsection (a) of section 17b-490 of the general statutes, that accepts all Medicare prescription drug discount cards that are (1) endorsed by the Secretary of Health and Human Services in accordance with Public Law 108-173, the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and (2) designated by the Commissioner of Social Services for use in conjunction with the ConnPACE program, may participate in the ConnPACE program. In addition, the commissioner may require, as a condition for such participation, that a pharmacy accept any endorsed drug discount card, if so required under federal law.

Approved March 30, 2004