SF 2447

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; expanding eligibility of 
  1.3             the prescription drug program; amending Minnesota 
  1.4             Statutes 1998, section 256.955, as amended. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  Minnesota Statutes 1998, section 256.955, as 
  1.7   amended by Laws 1999, chapter 245, is amended to read: 
  1.8      256.955 [SENIOR CITIZEN PRESCRIPTION DRUG PROGRAM.] 
  1.9      Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
  1.10  services shall establish and administer a senior 
  1.11  citizen prescription drug program.  Qualified senior 
  1.12  citizens individuals shall be eligible for prescription drug 
  1.13  coverage under the program beginning no later than January 1, 
  1.14  1999. 
  1.15     Subd. 2.  [DEFINITIONS.] (a) For purposes of this section, 
  1.16  the following definitions apply. 
  1.17     (b) "Health plan" has the meaning provided in section 
  1.18  62Q.01, subdivision 3. 
  1.19     (c) "Health plan company" has the meaning provided in 
  1.20  section 62Q.01, subdivision 4. 
  1.21     (d) "Qualified senior citizen individual" means an 
  1.22  individual age 65 or older who: 
  1.23     (1) is eligible as a qualified Medicare beneficiary 
  1.24  according to section 256B.057, subdivision 3 or 3a, or is 
  1.25  eligible under section 256B.057, subdivision 3 or 3a, and is 
  2.1   also eligible for medical assistance or general assistance 
  2.2   medical care with a spenddown as defined in section 256B.056, 
  2.3   subdivision 5.  Persons who are determined eligible for medical 
  2.4   assistance according to section 256B.0575, who are eligible for 
  2.5   medical assistance or general assistance medical care without a 
  2.6   spenddown, or who are enrolled in MinnesotaCare, are not 
  2.7   eligible for this program 65 years or older or meets the 
  2.8   definition of disabled under the supplemental security income 
  2.9   program; 
  2.10     (2) meets the income and asset limits in subdivision 2a; 
  2.11     (3) is not enrolled in prescription drug coverage under a 
  2.12  health plan; 
  2.13     (3) (4) is not enrolled in prescription drug coverage under 
  2.14  a Medicare supplement plan, as defined in sections 62A.31 to 
  2.15  62A.44, or policies, contracts, or certificates that supplement 
  2.16  Medicare issued by health maintenance organizations or those 
  2.17  policies, contracts, or certificates governed by section 1833 or 
  2.18  1876 of the federal Social Security Act, United States Code, 
  2.19  title 42, section 1395, et seq., as amended; 
  2.20     (4) (5) has not had coverage described in clauses (2) (3) 
  2.21  and (3) (4) for at least four months prior to application for 
  2.22  the program; and 
  2.23     (5) (6) is a permanent resident of Minnesota as defined in 
  2.24  section 256L.09. 
  2.25     Subd. 2a.  [INCOME AND ASSET LIMITS.] (a) For purposes of 
  2.26  determining eligibility under this section, an individual must 
  2.27  meet the requirements described in subdivision 2, paragraph (d), 
  2.28  and must meet the criteria of one of the following clauses:  
  2.29     (1) the individual must have income equal to or less than 
  2.30  120 percent of the federal poverty guidelines for the applicable 
  2.31  family size; or 
  2.32     (2) the individual must have income greater than 120 
  2.33  percent but equal to or less than 175 percent of the federal 
  2.34  poverty guidelines for the applicable family member and must own 
  2.35  no more than $10,000 in assets as an individual or no more than 
  2.36  $20,000 in assets as a couple or family, excluding the assets 
  3.1   excluded under section 256B.056, subdivision 3.  
  3.2      (b) Persons who are determined eligible for medical 
  3.3   assistance according to section 256B.0575, who are eligible for 
  3.4   medical assistance or general assistance medical care without a 
  3.5   spenddown, or who are enrolled in MinnesotaCare, are not 
  3.6   eligible for this program.  
  3.7      Subd. 3.  [PRESCRIPTION DRUG COVERAGE.] Coverage under the 
  3.8   program shall be limited to those prescription drugs that: 
  3.9      (1) are covered under the medical assistance program as 
  3.10  described in section 256B.0625, subdivision 13; and 
  3.11     (2) are provided by manufacturers that have fully executed 
  3.12  senior drug rebate agreements with the commissioner and comply 
  3.13  with such agreements. 
  3.14     Subd. 4.  [APPLICATION PROCEDURES AND COORDINATION WITH 
  3.15  MEDICAL ASSISTANCE.] Applications and information on the program 
  3.16  must be made available at county social service agencies, health 
  3.17  care provider offices, and agencies and organizations serving 
  3.18  senior citizens and the disabled.  Senior citizens Individuals 
  3.19  shall submit applications and any information specified by the 
  3.20  commissioner as being necessary to verify eligibility directly 
  3.21  to the county social service agencies:  
  3.22     (1) beginning January 1, 1999, the county social service 
  3.23  agency shall determine medical assistance spenddown eligibility 
  3.24  of individuals who qualify for the senior citizen prescription 
  3.25  drug program of individuals; and 
  3.26     (2) program payments will be used to reduce the spenddown 
  3.27  obligations of individuals who are determined to be eligible for 
  3.28  medical assistance with a spenddown as defined in section 
  3.29  256B.056, subdivision 5. 
  3.30  Seniors Individuals who are eligible for medical assistance 
  3.31  with a spenddown shall be financially responsible for the 
  3.32  deductible amount up to the satisfaction of the spenddown.  No 
  3.33  deductible applies once the spenddown has been met.  Payments to 
  3.34  providers for prescription drugs for persons eligible under this 
  3.35  subdivision shall be reduced by the deductible.  
  3.36     County social service agencies shall determine an 
  4.1   applicant's eligibility for the program within 30 days from the 
  4.2   date the application is received.  Eligibility begins the month 
  4.3   after approval. 
  4.4      Subd. 5.  [DRUG UTILIZATION REVIEW PROGRAM.] The 
  4.5   commissioner shall utilize the drug utilization review program 
  4.6   as described in section 256B.0625, subdivision 13a.  
  4.7      Subd. 6.  [PHARMACY REIMBURSEMENT.] The commissioner shall 
  4.8   reimburse participating pharmacies for drug and dispensing costs 
  4.9   at the medical assistance reimbursement level, minus the 
  4.10  deductible required under subdivision 7. 
  4.11     Subd. 7.  [COST SHARING.] Program enrollees must satisfy a 
  4.12  $420 annual deductible, based upon expenditures for prescription 
  4.13  drugs, to be paid in $35 monthly increments. 
  4.14     Subd. 8.  [REPORT.] The commissioner shall annually report 
  4.15  to the legislature on the senior citizen prescription drug 
  4.16  program.  The report must include demographic information on 
  4.17  enrollees, per-prescription expenditures, total program 
  4.18  expenditures, hospital and nursing home costs avoided by 
  4.19  enrollees, any savings to medical assistance and Medicare 
  4.20  resulting from the provision of prescription drug coverage under 
  4.21  Medicare by health maintenance organizations, other public and 
  4.22  private options for drug assistance to the senior population, 
  4.23  any hardships caused by the annual deductible, and any 
  4.24  recommendations for changes in the senior prescription drug 
  4.25  program. 
  4.26     Subd. 9.  [PROGRAM LIMITATION.] The commissioner shall 
  4.27  administer the senior prescription drug program so that the 
  4.28  costs total no more than funds appropriated plus the drug rebate 
  4.29  proceeds.  Senior Prescription drug program rebate revenues are 
  4.30  appropriated to the commissioner and shall be expended to 
  4.31  augment funding of the senior prescription drug program.  New 
  4.32  enrollment shall cease if the commissioner determines that, 
  4.33  given current enrollment, costs of the program will exceed 
  4.34  appropriated funds and rebate proceeds.  This section shall be 
  4.35  repealed upon federal approval of the waiver to allow the 
  4.36  commissioner to provide prescription drug coverage for qualified 
  5.1   Medicare beneficiaries whose income is less than 150 percent of 
  5.2   the federal poverty guidelines.