2005 Connecticut Code - Sec. 17b-492. (Formerly Sec. 17a-343). Eligibility. Registration fee. Use of Medicare prescription drug discount card. Payment for original and replacement prescriptions. Application prior to exhausting other coverage. Regulations.

      Sec. 17b-492. (Formerly Sec. 17a-343). Eligibility. Registration fee. Use of Medicare prescription drug discount card. Payment for original and replacement prescriptions. Application prior to exhausting other coverage. Regulations. (a) Eligibility for participation in the program shall be limited to any resident (1) who is sixty-five years of age or older or who is disabled, (2) whose annual income, if unmarried, is less than twenty thousand eight hundred dollars, or whose annual income, if married, when combined with that of the resident's spouse is less than twenty-eight thousand one hundred dollars, (3) who is not insured under a policy which provides full or partial coverage for prescription drugs, except for a Medicare prescription drug discount card endorsed by the Secretary of Health and Human Services in accordance with Public Law 108-173, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, once a deductible amount is met, and (4) on and after September 15, 1991, who pays an annual thirty-dollar registration fee to the Department of Social Services. Effective January 1, 2002, the commissioner shall commence accepting applications from individuals who will become eligible to participate in the program as of April 1, 2002. On January 1, 1998, and annually thereafter, the commissioner shall increase the income limits established under this subsection over those of the previous fiscal year to reflect the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to the nearest one hundred dollars.

      (b) (1) Payment for a prescription under the program shall be made only if no other plan of insurance or assistance is available to an eligible person for such prescription at the time of dispensing, except for benefits received from an endorsed Medicare prescription drug discount card. The pharmacy shall make reasonable efforts to ascertain the existence of other insurance or assistance, including the subsidy provided by an endorsed Medicare prescription drug discount card. A Medicare prescription drug discount card beneficiary shall be responsible for the payment of any Medicare prescription drug discount card coinsurance requirements, provided such requirements do not exceed the ConnPACE program copayment requirements. If a Medicare prescription drug discount card beneficiary's coinsurance requirements exceed the ConnPACE copayment requirements, the Department of Social Services shall make payment to the pharmacy to cover costs in excess of the ConnPACE copayment amount. If the cost to such beneficiary exceeds the remaining available Medicare prescription drug discount card subsidy, the beneficiary shall not be responsible for any payment in excess of the amount of the ConnPACE program copayment requirement. In such cases, the Department of Social Services shall make payment to the pharmacy to cover costs in excess of the ConnPACE copayment amount.

      (2) Payment for a replacement prescription under the program shall be made only if the eligible person signs a statement, on such form as the commissioner prescribes and subject to penalty under section 17b-497, that the prescription drug is lost or was stolen or destroyed and the person has made a good faith effort to recover the prescription drug, except that payment for a replacement prescription shall not be made on behalf of a person more than twice in a calendar year. No copayment shall be required for such replacement prescription.

      (c) Any eligible resident who (1) is insured under a policy, including an endorsed Medicare prescription drug discount card, which provides full or partial coverage for prescription drugs, and (2) expects to exhaust such coverage, may apply to participate in the program prior to the exhaustion of such coverage. Such application shall be valid for the applicable income year. To be included in the program, on or after the date the applicant exhausts such coverage, the applicant or the applicant's designee shall notify the department that such coverage is exhausted and, if required by the department, shall submit evidence of exhaustion of coverage. Not later than ten days after an eligible resident submits such evidence, such resident shall be included in the program. The program shall, except for those beneficiaries with an endorsed Medicare prescription drug discount card, (A) cover prescriptions that are not covered by any other plan of insurance or assistance available to the eligible resident and that meet the requirements of this chapter, and (B) retroactively cover such prescriptions filled after or concurrently with the exhaustion of such coverage. Nothing in this subsection shall be construed to prevent a resident from applying to participate in the program as otherwise permitted by this chapter and regulations adopted pursuant to this chapter.

      (d) (1) As a condition of eligibility for participation in the ConnPACE program, a resident with an income at or below one hundred thirty-five per cent of the federal poverty level, who is Medicare Part A or Part B eligible, shall obtain annually an endorsed Medicare prescription drug discount card designated by the Commissioner of Social Services for use in conjunction with the ConnPACE program. The commissioner shall be the authorized representative of such resident for the purpose of enrolling a resident in the transitional assistance program of Public Law 108-173, the Medicare Prescription Drug Improvement and Modernization Act of 2003. As the authorized representative for this purpose, the commissioner may sign required forms and enroll such resident in an endorsed Medicare prescription drug discount card on his or her behalf. Such resident shall have the opportunity to select an endorsed Medicare prescription drug discount card designated by the commissioner for use in conjunction with the ConnPACE program, and shall be notified of such opportunity by the commissioner. In the event that such resident does not select an endorsed Medicare prescription drug discount card designated by the commissioner for use in conjunction with the ConnPACE program within a reasonable period of time, as determined by the commissioner, the department shall enroll the resident in an endorsed Medicare prescription drug discount card designated by the commissioner.

      (2) The commissioner may require, as a condition of eligibility for participation in the ConnPACE program, that a resident with an income above one hundred thirty-five per cent of the federal poverty level, who is Medicare Part A or Part B eligible, obtain an endorsed Medicare prescription drug discount card designated by the commissioner for use in conjunction with the ConnPACE program if obtaining such discount card is determined by the commissioner to be cost-effective to the state. In such an event, the commissioner may provide payment for any Medicare prescription drug discount card enrollment fees.

      (e) The Commissioner of Social Services may adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsection (c) of this section. Such regulations may provide for the electronic transmission of relevant coverage information between a pharmacist and the department or between an insurer and the department in order to expedite applications and notice. The commissioner may implement the policies and procedures necessary to carry out the provisions of this section while in the process of adopting such policies and procedures in regulation form, provided notice of intent to adopt the regulations is published not later than twenty days after the date of implementation. Such policies and procedures shall be valid until the time the final regulations are adopted.

      (P.A. 85-573, S. 7, 18; P.A. 87-3, S. 4, 9; June Sp. Sess. P.A. 91-8, S. 47, 63; P.A. 92-196, S. 3, 4; P.A. 93-262, S. 1, 87; P.A. 95-160, S. 1, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 128, 165; P.A. 98-194, S. 1, 2; June Sp. Sess. P.A. 01-2, S. 22, 69; June Sp. Sess. P.A. 01-9, S. 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 16; P.A. 03-2, S. 15; June 30 Sp. Sess. P.A. 03-3, S. 58; P.A. 04-6, S. 1; 04-101, S. 2; 04-104, S. 2; 04-258, S. 12.)

      History: P.A. 87-3 restated eligibility to include the disabled, changed the income limits to thirteen thousand three hundred dollars for unmarried persons and sixteen thousand for married, provided for annual adjustments and restated Subsec. (b) re ineligibility; Sec. 17-514 transferred to Sec. 17a-343 in 1991; June Sp. Sess. P.A. 91-8 changed the income limits to thirteen thousand eight hundred dollars for unmarried persons and sixteen thousand six hundred dollars for married persons and added a fifteen dollar registration fee; P.A. 92-196 amended Subsec. (a) by limiting eligibility to those not insured under a policy providing full or partial prescription coverage once a deductible is met; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department on aging, effective July 1, 1993; Sec. 17a-343 transferred to Sec. 17b-492 in 1995; P.A. 95-160 increased the registration fee of fifteen dollars to an annual fee of twenty-five dollars, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) to require the commissioner to increase the income limits to reflect any annual inflation adjustment in Social Security income after January 1, 1998, effective July 1, 1997; P.A. 98-194 added Subsecs. (c) and (d), extending program to eligible residents who exhaust prescription drug insurance coverage, effective July 1, 1998; June Sp. Sess. P.A. 01-2 amended Subsec. (a) to make a technical change for purposes of gender neutrality, to change annual income limits applicable after April 1, 2002, or in the case of a federal waiver, after July 1, 2002, and to require the commissioner, effective January 1, 2002, to commence accepting applications from individuals who will become eligible to participate in the program as of April 2, 2002, and amended Subsec. (c) to make technical changes, effective July 1, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp. Sess. P.A. 01-2 but without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (a) by deleting requirement that commissioner adopt regulations re increased eligibility income limits, effective September 1, 2002; P.A. 03-2 amended Subsec. (a)(4) to increase annual registration fee from twenty-five dollars to thirty dollars, effective February 28, 2003; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (a) by adding new Subdiv. (4) limiting program eligibility to unmarried individuals with available assets below one hundred thousand dollars and married individuals with assets below one hundred twenty-five thousand dollars, and providing that asset limit for married individuals be determined by combining value of assets available to both spouses and that for purposes of section "available assets" are those considered available under the Connecticut Home Care Program for the Elderly, and by redesignating existing Subdiv. (4) as Subdiv. (5), effective August 20, 2003; P.A. 04-6 amended Subsec. (a)(2)(A) by deleting Subpara. (A) designator, increasing income eligibility level to twenty thousand eight hundred dollars for unmarried persons and increasing the combined income level for married persons to twenty-eight thousand one hundred dollars, deleted Subsec. (a)(2)(B) re income levels in the event of waiver being granted, amended Subsecs. (a) to (c), inclusive, by adding provisions re use of Medicare prescription drug discount cards by program beneficiaries, added new Subsec. (d) requiring that persons with income at or below one hundred thirty-five per cent of the federal poverty level obtain Medicare prescription drug discount card as a condition of program eligibility, and redesignated existing Subsec. (d) as Subsec. (e) and added provisions authorizing commissioner to implement policies and procedures relative to section while in process of adopting such policies and procedures as regulation, effective March 30, 2004; P.A. 04-101 amended Subsec. (d) to insert Subdiv. (1) and (2) designators and, in Subdiv. (1), inserted "annually" re requirement to obtain a discount card, required that the commissioner be the authorized representative of a resident in enrolling the resident in the transitional assistance program, authorized the commissioner to enroll the resident and allowed the resident to select an endorsed discount card, effective April 28, 2004; P.A. 04-104 amended Subsec. (b) to designate existing provisions as Subdiv. (1) and add Subdiv. (2) re payment for replacement prescriptions, effective July 1, 2004; P.A. 04-258 eliminated former Subsec. (a)(4) re asset limits used in making program eligibility determinations and redesignated existing Subsec. (a)(5) as new Subsec. (a)(4), effective June 1, 2004.