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House Bill No. 7702

November 2 Special Session, Public Act No. 05-2

AN ACT CONCERNING IMPLEMENTATION OF THE MEDICARE PART D PROGRAM.

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

Section 1. Section 19 of public act 05-280 is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) As used in this section, "full benefit dually eligible Medicare Part D beneficiary" means a person who has coverage for Medicare Part D drugs and is eligible for full medical assistance benefits pursuant to section 17b-261, under any category of eligibility.

(b) On and after the effective date of the Medicare Part D program established pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, no Medicaid prescription drug coverage shall be provided to a Medicaid recipient eligible for Medicare Part D for Medicare Part D [Drugs] drugs, as defined in said act. Medicaid coverage [will] shall be provided to a full benefit dually eligible Medicare Part D beneficiary for prescription drugs that are not Medicare Part D drugs, as defined in said act.

(c) The department shall be responsible for payment on behalf of a full benefit dually eligible Medicare Part D beneficiary of any Medicare Part D prescription drug copayments imposed pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Sec. 2. (NEW) (Effective from passage) There is established a fund to be known as the "Medicare Part D Supplemental Needs Fund" which shall be an account within the General Fund under the Department of Social Services. The Commissioner of Social Services shall, within available appropriations, designate moneys to said fund. Moneys available in said fund shall be utilized by the Department of Social Services to provide financial assistance to Medicare Part D beneficiaries who are enrolled in the ConnPACE program or who are full benefit dually eligible Medicare Part D beneficiaries, as defined in section 19 of public act 05-280, as amended by this act, and who lack the financial means to obtain medically necessary nonformulary prescription drugs. A beneficiary requesting such financial assistance from the department shall be required to make a satisfactory showing of the medical necessity of obtaining such nonformulary prescription drug to the department. The department may require as a condition of receiving such financial assistance that a beneficiary establish, to the satisfaction of the department, that the beneficiary has made good faith efforts to: (1) Enroll in a Medicare Part D plan recommended by the commissioner or the commissioner's agent; and (2) utilize the exception process established by the prescription drug plan in which the beneficiary is enrolled. The department shall expeditiously review all requests for financial assistance pursuant to this section and shall notify the beneficiary as to whether the request for financial assistance has been granted not later than two hours after receiving the request from the beneficiary. The commissioner shall implement policies and procedures to administer the provisions of this section and to ensure that all requests for, and determinations made concerning financial assistance available pursuant to this section are expeditiously processed.

Sec. 3. Subdivision (2) of subsection (b) of section 17b-492 of the general statutes, as amended by section 22 of public act 05-280, is repealed and the following is substituted in lieu thereof (Effective from passage):

(2) A Medicare Part D beneficiary shall be responsible for the payment of Medicare Part D copayments, coinsurance and deductible requirements for Medicare Part D covered prescription drugs, as defined in Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, to the extent such requirements do not exceed the ConnPACE program copayment requirements. The Department of Social Services shall pay Medicare Part D monthly beneficiary premiums on behalf of the beneficiary. If a Medicare Part D beneficiary's out-of-pocket copayment, coinsurance or deductible requirements exceed the ConnPACE copayment requirements, the department shall make payment to the pharmacy to cover costs in excess of the ConnPACE copayment amount. The department shall be responsible for payment of a Medicare Part D covered prescription drug obtained during the gap in standard Medicare Part D coverage. To the extent permitted under said act, such payment may be made by the department for a prescription at (A) [the lowest price established by the Medicare Part D plan for a preferred drug in the same therapeutic class and category that is dispensed by a preferred pharmacy with the client responsible for any cost differential beyond the department's payment; (B)] the lower of the price that would be paid under the ConnPACE program or the negotiated price established by the beneficiary's Medicare Part D plan pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, or [(C)] (B) in consultation with the Secretary of the Office of Policy and Management, at the price that would be paid under the ConnPACE program. Payment shall be made under the ConnPACE program for prescription drugs that are not Medicare Part D drugs, as defined in said act.

Sec. 4. Subsection (f) of section 17b-492 of the general statutes, as amended by section 22 of public act 05-280, is repealed and the following is substituted in lieu thereof (Effective from passage):

(f) The Commissioner of Social Services shall be the authorized representative of a ConnPACE applicant or recipient for the purpose of submitting an application to the Social Security Administration to obtain the low income subsidy benefit provided under Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. As the authorized representative for this purpose, the commissioner may also sign required forms and enroll the applicant or recipient in a Medicare Part D plan on the applicant or recipient's behalf. The applicant or recipient shall have the opportunity to select a Medicare Part D plan and shall be notified of such opportunity by the commissioner. The applicant or recipient, prior to selecting a Medicare Part D plan, shall have the opportunity to consult with the commissioner, or the commissioner's designated agent, concerning the selection of a Medicare Part D plan that best meets the prescription drug needs of such applicant or recipient. In the event that such applicant or recipient does not select a Medicare Part D plan within a reasonable period of time, as determined by the commissioner, the commissioner shall enroll the applicant or recipient in a Medicare Part D plan designated by the commissioner in accordance with said act. The applicant or recipient shall appoint the commissioner as such applicant's or recipient's representative for the purpose of appealing any denial of Medicare Part D benefits and for any other purpose allowed under said act and deemed necessary by the commissioner.

Sec. 5. Section 17b-274c of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Commissioner of Social Services may establish a voluntary mail order option for any maintenance prescription drug covered under the Medicaid, state-administered general assistance, ConnPACE or Connecticut AIDS drug assistance programs.

(b) Notwithstanding any provision of the general statutes or regulations adopted pursuant thereto, the Commissioner of Social Services may provide a voluntary mail order option, regardless of a mail order pharmacy's location, for any prescription drug covered under the Medicare Part D program established pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Sec. 6. (Effective from passage) The sum of five million dollars appropriated to the Department of Social Services in section 1 of public act 05-251, for Medicaid, for the fiscal year ending June 30, 2006, shall be transferred to the Medicare Part D Supplemental Needs Fund established pursuant to section 2 of this act.

Sec. 7. (Effective from passage) The sum of one million dollars appropriated to the Department of Social Services in section 1 of public act 05-251, for Medicaid, for the fiscal year ending June 30, 2006, shall be transferred to the other expenses account and shall be available for expenditure by the Department of Social Services to provide additional resources for current and comprehensive consultative enrollment services to persons who are initially selecting a Medicare Part D plan or currently enrolled in a plan who need to change plans in order to obtain prescription drug benefits that better meet their needs.

Approved December 1, 2005