SB 163-FN – FINAL VERSION
SENATE BILL 163-FN
This bill establishes the New Hampshire pharmaceutical assistance program which shall coordinate prescription drug coverage with the prescription drug benefits under the Medicare Prescription Drug, Improvement and Modernization Act of 2003. This bill grants the commissioner of the department of health and human services rulemaking authority for the purposes of the bill.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [
in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Five
AN ACT establishing the New Hampshire pharmaceutical assistance program.
Be it Enacted by the Senate and House of Representatives in General Court convened:
161-K:1 Definitions. In this chapter:
I. “Asset test” means the asset limits as defined by the Medicare Modernization Act.
II. “Commissioner” means the commissioner of the department of health and human services.
III. “Contractor” means the person, partnership, or corporate entity which has an approved contract with the department to administer the pharmaceutical assistance program as established under this chapter.
IV. “Department” means the department of health and human services.
V. “Enrollee” means a resident of this state who meets the conditions relating to eligibility for the New Hampshire pharmaceutical assistance program established under this chapter and whose application for enrollment has been approved by the department.
VI. “Federal poverty guidelines” means the federal poverty guidelines updated annually in the federal register by the United States Department of Health and Human Services under the authority of 42 U.S.C. section 9909(2).
VII. “Liquid assets” means assets used in the eligibility determination process as defined by the MMA.
VIII. “Medicaid dual eligible” or “dual eligible” means a person who is eligible for medicare and medicaid as defined by the Medicare Modernization Act.
IX. “Medicare Modernization Act” or “MMA” means the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
X. “Medicare Part D prescription drug benefit” means the prescription benefit provided under the Medicare Modernization Act, as it may vary from one PDP to another.
XI. “Participating pharmacy” means a pharmacy that elects to participate as a pharmaceutical provider and enters into a participating network agreement with the department.
XII. “Prescription drug plan” or “PDP” means non-governmental drug plans under contract with the Centers for Medicare and Medicaid Services to provide prescription benefits under the Medicare Modernization Act.
XIII. “Program” means the New Hampshire pharmaceutical assistance program established in this chapter.
XIV. “Resident” means a person who has lived within this state for a period of at least 90 consecutive days and who meets the conditions as set forth in RSA 161-K:5. An individual is a resident until the individual establishes a permanent residence outside of the state.
161-K:2 New Hampshire Pharmaceutical Assistance Program; Eligibility; Enrollment.
I. The commissioner is authorized to establish a New Hampshire pharmaceutical assistance program which shall be administered by the department. The program shall coordinate prescription drug coverage with the prescription drug benefit under the federal Medicare Modernization Act. Persons eligible for the drug benefits under this program are as follows:
(a) A resident who is 65 years of age or older, or is disabled and receiving a social security benefit and is enrolled in the medicare program.
(b) The resident has a household income at or below 150 percent of the federal poverty guidelines.
(c) The resident meets the asset test.
(d) The resident is not a member of a Medicare Advantage Plan that provides a prescription drug benefit.
(e) The resident is not a member of a retirement plan that is receiving a benefit under the MMA.
II. The department shall give initial enrollment priority to the medicaid dual eligible population. A second enrollment priority shall be offered to medicare eligible applicants with annual household incomes up to 150 percent of the federal poverty guidelines who also meet the asset test. Enrollment for medicaid dual eligible persons shall take effect no later than October 1, 2005. Medicaid dual eligible persons may be automatically enrolled into the program, with the provision that they may opt out of the program if they so choose. The department shall determine the procedures for automatic enrollment in, and election out of the program. Applicants meeting the qualifications set forth in this chapter may begin enrolling into the program as determined by the department.
III. An individual or married couple meeting the eligibility requirements in paragraph I who are not medicaid dual eligible may apply for enrollment in the program by submitting an application to the department that attests to the age, residence, household income, and liquid assets of the individual or couple.
161-K:3 Duties of the Department. In providing program benefits the department may:
I. Enter into a contract with one or more prescription drug plans to coordinate the prescription benefits of the program and the federal law.
II. Require that pharmaceutical manufacturers provide medicaid level, or greater, rebates in order for the manufacturer’s products to be available to the enrollees of the program. These rebates shall be no less than those provided to medicaid under Title XIX of the federal Social Security Act.
III. Preliminarily enroll or re-enroll beneficiaries into a preferred Medicare Part D plan, or disenroll such beneficiaries from another non-preferred PDP with an “opt out” provision for the individual. Individuals that opt out of the preferred PDP shall remain enrolled in the program unless they choose to disenroll from such program.
IV. Prescribe the application and enrollment procedures for prospective enrollees.
V. Select, in accordance with applicable state law, a contractor to assist in administration of the program or negotiate program administrative functions with a preferred PDP plan. Program benefits shall begin January 1, 2006. For persons meeting the eligibility requirements in RSA 161-K:2, the program may pay all or some of the deductibles, co-insurance payments, premiums, and co-payments required under the Medicare Part D pharmacy benefit program.
161-K:4 Limitations on Benefits; Program as Payor of Last Resort.
I. Benefits provided under this program shall be limited to the amount of appropriations.
II. The program shall be the payor of last resort, and is meant to cover costs for participants that are not covered by the Medicare Part D program.
III. Except for dual eligibles during the transition period during which they are being moved from medicaid to a Medicare Part D program, applicants who are qualified for coverage of payments for prescription drugs under a public assistance program are ineligible for the program as long as they are so qualified.
IV. Applicants who are qualified for full coverage of payments for prescription drugs under another plan of assistance or insurance are ineligible to receive benefits from the program as long as they are eligible to receive pharmacy benefits from such other plan.
V. Applicants who are qualified for partial payments for prescription drugs under another insurance plan are eligible for the program, but may receive reduced assistance from the program.
161-K:5 Residence Criteria.
I. A resident is a person who has lived within this state for a period of at least 90 consecutive days immediately preceding the date the applicant’s application to participate in the program is received by the department. The applicant shall have or intend to have a fixed place of abode in this state, with the present intent of maintaining a permanent home in this state for the indefinite future. The burden of establishing proof of residence within this state is on the applicant. A resident shall also include those persons residing in long-term care institutions located within this state.
II. The department shall create standards for documenting proof of residence in this state. Documents used to show proof of residence shall show the applicant’s name and address.
161-K:6 Rulemaking. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to:
I. The application process.
II. The procedure for entering into contracts for the administration of the program.
III. Enrollment procedures.
IV. Forms and content of forms required by this chapter.
294:2 Certain Prescription Drug Coverage Required. The department of health and human services shall provide “wrap-around” prescription drug coverage to persons who are “dual eligible” for the Medicare and Medicaid programs. For the purposes of this section:
I. On and after the effective date of the Medicare Part D program, no Medicaid prescription drug coverage shall be provided to a Medicaid recipient eligible for Medicare Part D for prescription drugs that are included in the definition of Medicare Part D drugs set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
II. The department of health and human services shall provide “wrap-around” Medicaid coverage for those prescription drugs which are excluded from the definition of Medicare Part D drugs, but are covered by Medicaid prescription drug coverage.
294:3 Repeal. Section 2 of this act, relative to “wrap-around” prescription drug coverage, is hereby repealed.
I. The department of health and human services’ initial plan for the New Hampshire pharmaceutical assistance program as authorized under section 1 of this act shall not take effect until it is approved by both the fiscal committee and the Centers for Medicare and Medicaid Services. The department of health and human services shall certify the date both approvals have been made to the director of the office of legislative services.
II. Section 3 of this act shall take effect on the date the pharmaceutical assistance program authorized under section 1 of this act is approved by the Centers for Medicare and Medicaid Services, as certified by the department of health and human services to the director of the office of legislative services.
294:5 Effective Date.
I. Section 3 of this act shall take effect as provided in section 4 of this act.
II. The remainder of this act shall take effect upon its passage.
(Approved: July 26, 2005)
(Effective Date: I. Section 3 shall take effect as provided in section 4.
II. Remainder shall take effect July 26, 2005)