1998 Minnesota Statutes

     256.955 Senior citizen drug program. 

    Subdivision 1.    Establishment.  The commissioner of 
 human services shall establish and administer a senior citizen 
 drug program.  Qualified senior citizens shall be eligible for 
 prescription drug coverage under the program beginning no later 
 than January 1, 1999. 

    Subd. 2.    Definitions.  (a) For purposes of this 
 section, the following definitions apply. 

    (b) "Health plan" has the meaning provided in section 
 62Q.01, subdivision 3. 

    (c) "Health plan company" has the meaning provided in 
 section 62Q.01, subdivision 4. 

    (d) "Qualified senior citizen" means an individual age 65 
 or older who: 

    (1) is eligible as a qualified Medicare beneficiary 
 according to section 256B.057, subdivision 3 or 3a, or is 
 eligible under section 256B.057, subdivision 3 or 3a, and is 
 also eligible for medical assistance or general assistance 
 medical care with a spenddown as defined in section 256B.056, 
 subdivision 5.  Persons who are determined eligible for medical 
 assistance according to section 256B.0575, who are eligible for 
 medical assistance or general assistance medical care without a 
 spenddown, or who are enrolled in MinnesotaCare, are not 
 eligible for this program; 

    (2) is not enrolled in prescription drug coverage under a 
 health plan; 

    (3) is not enrolled in prescription drug coverage under a 
 Medicare supplement plan, as defined in sections 62A.31 to 
 62A.44, or policies, contracts, or certificates that supplement 
 Medicare issued by health maintenance organizations or those 
 policies, contracts, or certificates governed by section 1833 or 
 1876 of the federal Social Security Act, United States Code, 
 title 42, section 1395, et seq., as amended; 

    (4) has not had coverage described in clauses (2) and (3) 
 for at least four months prior to application for the program; 
 and 

    (5) is a permanent resident of Minnesota as defined in 
 section 256L.09. 

    Subd. 3.    Prescription drug coverage.  Coverage under 
 the program is limited to prescription drugs covered under the 
 medical assistance program as described in section 256B.0625, 
 subdivision 13, subject to a maximum deductible of $300 
 annually, except drugs cleared by the FDA shall be available to 
 qualified senior citizens enrolled in the program without 
 restriction when prescribed for medically accepted indication as 
 defined in the federal rebate program under section 1927 of 
 title XIX of the federal Social Security Act. 

    Subd. 4.    Application procedures and coordination with 
 medical assistance.  Applications and information on the 
 program must be made available at county social service 
 agencies, health care provider offices, and agencies and 
 organizations serving senior citizens.  Senior citizens shall 
 submit applications and any information specified by the 
 commissioner as being necessary to verify eligibility directly 
 to the county social service agencies:  

    (1) beginning January 1, 1999, the county social service 
 agency shall determine medical assistance spenddown eligibility 
 of individuals who qualify for the senior citizen drug program 
 of individuals; and 

    (2) program payments will be used to reduce the spenddown 
 obligations of individuals who are determined to be eligible for 
 medical assistance with a spenddown as defined in section 
 256B.056, subdivision 5. 

 Seniors who are eligible for medical assistance with a spenddown 
 shall be financially responsible for the deductible amount up to 
 the satisfaction of the spenddown.  No deductible applies once 
 the spenddown has been met.  Payments to providers for 
 prescription drugs for persons eligible under this subdivision 
 shall be reduced by the deductible.  

    County social service agencies shall determine an 
 applicant's eligibility for the program within 30 days from the 
 date the application is received. 

    Subd. 5.    Drug utilization review program.  The 
 commissioner shall utilize the drug utilization review program 
 as described in section 256B.0625, subdivision 13a.  

    Subd. 6.    Pharmacy reimbursement.  The commissioner 
 shall reimburse participating pharmacies for drug and dispensing 
 costs at the medical assistance reimbursement level, minus the 
 deductible required under subdivision 7. 

    Subd. 7.    Cost sharing.  (a) Enrollees shall pay an 
 annual premium of $120.  

    (b) Program enrollees must satisfy a $300 annual 
 deductible, based upon expenditures for prescription drugs, to 
 be paid as follows: 

    (1) $25 monthly deductible for persons with a monthly 
 spenddown; or 

    (2) $150 biannual deductible for persons with a six-month 
 spenddown.  

    Subd. 8.    Report.  The commissioner shall annually 
 report to the legislature on the senior citizen drug program.  
 The report must include demographic information on enrollees, 
 per-prescription expenditures, total program expenditures, 
 hospital and nursing home costs avoided by enrollees, any 
 savings to medical assistance and Medicare resulting from the 
 provision of prescription drug coverage under Medicare by health 
 maintenance organizations, other public and private options for 
 drug assistance to the senior population, any hardships caused 
 by the annual premium and deductible, and any recommendations 
 for changes in the senior drug program. 

    Subd. 9.    Program limitation.  This section shall be 
 repealed upon federal approval of the waiver to allow the 
 commissioner to provide prescription drug coverage for qualified 
 Medicare beneficiaries whose income is less than 150 percent of 
 the federal poverty guidelines. 

    HIST: 1997 c 225 art 4 s 2; 1997 c 251 s 30