SF 876

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to human services; eliminating the annual fee 
  1.3             and expanding eligibility for the prescription drug 
  1.4             program; increasing the asset limit for eligibility 
  1.5             for qualified Medicare beneficiaries; amending 
  1.6             Minnesota Statutes 1998, sections 256.955; and 
  1.7             256B.057, subdivision 3. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 1998, section 256.955, is 
  1.10  amended to read: 
  1.11     256.955 [SENIOR CITIZEN PRESCRIPTION DRUG PROGRAM.] 
  1.12     Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
  1.13  services shall establish and administer a senior 
  1.14  citizen prescription drug program.  Qualified senior citizens 
  1.15  individuals shall be eligible for prescription drug coverage 
  1.16  under the program beginning no later than January 1, 1999. 
  1.17     Subd. 2.  [DEFINITIONS.] (a) For purposes of this section, 
  1.18  the following definitions apply. 
  1.19     (b) "Health plan" has the meaning provided in section 
  1.20  62Q.01, subdivision 3. 
  1.21     (c) "Health plan company" has the meaning provided in 
  1.22  section 62Q.01, subdivision 4. 
  1.23     (d) "Qualified senior citizen individual" means an 
  1.24  individual age 65 or older who: 
  1.25     (1) is eligible as a qualified Medicare beneficiary 
  1.26  according to section 256B.057, subdivision 3 or 3a, or is 
  2.1   eligible under section 256B.057, subdivision 3 or 3a, and is 
  2.2   also eligible for medical assistance or general assistance 
  2.3   medical care with a spenddown as defined in section 256B.056, 
  2.4   subdivision 5.  Persons who are determined eligible for medical 
  2.5   assistance according to section 256B.0575, who are eligible for 
  2.6   medical assistance or general assistance medical care without a 
  2.7   spenddown, or who are enrolled in MinnesotaCare, are not 
  2.8   eligible for this program; 
  2.9      (2) is not enrolled in prescription drug coverage under a 
  2.10  health plan; 
  2.11     (3) is not enrolled in prescription drug coverage under a 
  2.12  Medicare supplement plan, as defined in sections 62A.31 to 
  2.13  62A.44, or policies, contracts, or certificates that supplement 
  2.14  Medicare issued by health maintenance organizations or those 
  2.15  policies, contracts, or certificates governed by section 1833 or 
  2.16  1876 of the federal Social Security Act, United States Code, 
  2.17  title 42, section 1395, et seq., as amended; 
  2.18     (4) has not had coverage described in clauses (2) and (3) 
  2.19  for at least four months prior to application for the program; 
  2.20  and 
  2.21     (5) is a permanent resident of Minnesota as defined in 
  2.22  section 256L.09. 
  2.23     Subd. 3.  [PRESCRIPTION DRUG COVERAGE.] Coverage under the 
  2.24  program is limited to prescription drugs covered under the 
  2.25  medical assistance program as described in section 256B.0625, 
  2.26  subdivision 13, subject to a maximum deductible of $300 
  2.27  annually, except drugs cleared by the FDA shall be available to 
  2.28  qualified senior citizens individuals enrolled in the program 
  2.29  without restriction when prescribed for medically accepted 
  2.30  indication as defined in the federal rebate program under 
  2.31  section 1927 of title XIX of the federal Social Security Act. 
  2.32     Subd. 4.  [APPLICATION PROCEDURES AND COORDINATION WITH 
  2.33  MEDICAL ASSISTANCE.] Applications and information on the program 
  2.34  must be made available at county social service agencies, health 
  2.35  care provider offices, and agencies and organizations serving 
  2.36  senior citizens.  Senior citizens shall submit Applications and 
  3.1   any information specified by the commissioner as being necessary 
  3.2   to verify eligibility shall be submitted directly to the county 
  3.3   social service agencies:  
  3.4      (1) beginning January 1, 1999, the county social service 
  3.5   agency shall determine medical assistance spenddown eligibility 
  3.6   of individuals who qualify for the senior citizen prescription 
  3.7   drug program of individuals; and 
  3.8      (2) program payments will be used to reduce the spenddown 
  3.9   obligations of individuals who are determined to be eligible for 
  3.10  medical assistance with a spenddown as defined in section 
  3.11  256B.056, subdivision 5. 
  3.12  Seniors Individuals who are eligible for medical assistance 
  3.13  with a spenddown shall be financially responsible for the 
  3.14  deductible amount up to the satisfaction of the spenddown.  No 
  3.15  deductible applies once the spenddown has been met.  Payments to 
  3.16  providers for prescription drugs for persons eligible under this 
  3.17  subdivision shall be reduced by the deductible.  
  3.18     County social service agencies shall determine an 
  3.19  applicant's eligibility for the program within 30 days from the 
  3.20  date the application is received. 
  3.21     Subd. 5.  [DRUG UTILIZATION REVIEW PROGRAM.] The 
  3.22  commissioner shall utilize the drug utilization review program 
  3.23  as described in section 256B.0625, subdivision 13a.  
  3.24     Subd. 6.  [PHARMACY REIMBURSEMENT.] The commissioner shall 
  3.25  reimburse participating pharmacies for drug and dispensing costs 
  3.26  at the medical assistance reimbursement level, minus the 
  3.27  deductible required under subdivision 7. 
  3.28     Subd. 7.  [COST SHARING.] (a) Enrollees shall pay an annual 
  3.29  premium of $120.  
  3.30     (b) Program enrollees must satisfy a $300 annual 
  3.31  deductible, based upon expenditures for prescription drugs, to 
  3.32  be paid as follows: 
  3.33     (1) $25 monthly deductible for persons with a monthly 
  3.34  spenddown; or 
  3.35     (2) $150 biannual deductible for persons with a six-month 
  3.36  spenddown.  
  4.1      Subd. 8.  [REPORT.] The commissioner shall annually report 
  4.2   to the legislature on the senior citizen prescription drug 
  4.3   program.  The report must include demographic information on 
  4.4   enrollees, per-prescription expenditures, total program 
  4.5   expenditures, hospital and nursing home costs avoided by 
  4.6   enrollees, any savings to medical assistance and Medicare 
  4.7   resulting from the provision of prescription drug coverage under 
  4.8   Medicare by health maintenance organizations, other public and 
  4.9   private options for drug assistance to the senior population, 
  4.10  any hardships caused by the annual premium and deductible, and 
  4.11  any recommendations for changes in the senior prescription drug 
  4.12  program. 
  4.13     Subd. 9.  [PROGRAM LIMITATION.] This section shall be 
  4.14  repealed upon federal approval of the waiver to allow the 
  4.15  commissioner to provide prescription drug coverage for qualified 
  4.16  Medicare beneficiaries whose income is less than 150 percent of 
  4.17  the federal poverty guidelines. 
  4.18     Sec. 2.  Minnesota Statutes 1998, section 256B.057, 
  4.19  subdivision 3, is amended to read: 
  4.20     Subd. 3.  [QUALIFIED MEDICARE BENEFICIARIES.] A person who 
  4.21  is entitled to Part A Medicare benefits, whose income is equal 
  4.22  to or less than 85 100 percent of the federal poverty 
  4.23  guidelines, and whose assets are no more than twice the asset 
  4.24  limit used to determine eligibility for the supplemental 
  4.25  security income program who individually owns no more than 
  4.26  $10,000 in assets or as a couple or family owns no more than 
  4.27  $20,000 in assets, excluding the assets that are excluded under 
  4.28  section 256B.056, subdivision 3, is eligible for medical 
  4.29  assistance reimbursement of Part A and Part B premiums, Part A 
  4.30  and Part B coinsurance and deductibles, and cost-effective 
  4.31  premiums for enrollment with a health maintenance organization 
  4.32  or a competitive medical plan under section 1876 of the Social 
  4.33  Security Act.  The income limit shall be increased to 90 percent 
  4.34  of the federal poverty guidelines on January 1, 1990; and to 100 
  4.35  percent on January 1, 1991.  Reimbursement of the Medicare 
  4.36  coinsurance and deductibles, when added to the amount paid by 
  5.1   Medicare, must not exceed the total rate the provider would have 
  5.2   received for the same service or services if the person were a 
  5.3   medical assistance recipient with Medicare coverage.  Increases 
  5.4   in benefits under Title II of the Social Security Act shall not 
  5.5   be counted as income for purposes of this subdivision until the 
  5.6   first day of the second full month following publication of the 
  5.7   change in the federal poverty guidelines.