2012 Connecticut General Statutes
Title 17b - Social Services
Chapter 319ff - Connecticut Pharmaceutical Assistance Contract to the Elderly and the Disabled Program
Section 17b-492 - (Formerly Sec. 17a-343). Eligibility. Application period. Registration fee. ConnPACE program requirements. Payment for original and replacement prescriptions. Application prior to exhausting 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 current annual income at the time of application or redetermination, 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 eligible for Medicare or insured under a policy which provides full or partial coverage for prescription drugs once a deductible is met, and (4) on and after September 15, 1991, who pays an annual forty-five-dollar registration fee to the Department of Social Services. The commissioner shall not consider as income Aid and Attendance pension benefits granted to a veteran, as defined in section 27-103, or the surviving spouse of such veteran. On January 1, 2012, 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. On and after October 1, 2009, new applications to participate in the ConnPACE program may be accepted only from the fifteenth day of November through the thirty-first day of December each year, except that individuals may apply within thirty-one days of (A) reaching sixty-five years of age, or (B) becoming eligible for Social Security Disability Income or Supplemental Security Income.

(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. The pharmacy shall make reasonable efforts to ascertain the existence of other insurance or assistance.

(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.

(c) Any eligible resident who (1) is insured under a policy, 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 (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) 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; P.A. 05-280, S. 22; Nov. 2 Sp. Sess. P.A. 05-2, S. 3, 4; Nov. 2 Sp. Sess. P.A. 05-3, S. 2; P.A. 09-2, S. 15; Sept. Sp. Sess. P.A. 09-5, S. 33, 47; P.A. 10-26, S. 4; 10-179, S. 59; P.A. 11-44, S. 89; P.A. 12-208, S. 4.)

History: P.A. 87-3 restated eligibility to include the disabled, changed the income limits to $13,300 for unmarried persons and $16,000 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 $13,800 for unmarried persons and $16,600 for married persons and added a $15 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 $15 to an annual fee of $25, 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 $25 to $30, effective February 28, 2003; June 30 Sp. Sess. P.A. 03-3 added new Subsec. (a)(4) limiting program eligibility to unmarried individuals with available assets below $100,000 and married individuals with assets below $125,000, 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, 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 $20,800 for unmarried persons and increasing the combined income level for married persons to $28,100, 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 135% 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; P.A. 05-280 amended Subsec. (a) by changing “annual income” to “current annual income at the time of application or redetermination” in Subdiv. (2), repositioning “once a deductible is met” and adding reference to coverage under Medicare Part D in Subdiv. (3) and deleting provision re accepting applications from persons eligible for program, amended Subsec. (b) by adding “or benefits provided under Medicare Part D” in Subdiv. (1), adding new Subdiv. (2) re Medicare Part D, redesignating existing Subdiv. (2) as Subdiv. (3) and amending same by deleting provision re no copayment required for replacement prescription, amended Subsec. (d) by making technical changes and adding language re provisions of Subdivs. (1) and (2) to remain in effect until effective date of the Medicare Part D program, added new Subsecs. (e) and (f) re Medicare Part D and redesignated existing Subsec. (e) as Subsec. (g), effective July 1, 2005; Nov. 2 Sp. Sess. P.A. 05-2 amended Subsec. (b)(2) by deleting former Subpara. (A) re department’s authority to pay for a prescription drug at the lowest price established by the Medicare Part D plan for a preferred drug in the same therapeutic class and category, with the client responsible for any cost differential, and by redesignating existing Subparas. (B) and (C) as Subparas. (A) and (B), and amended Subsec. (f) by providing that applicant or recipient, prior to selecting a Medicare Part D plan, shall have the opportunity to consult with commissioner or commissioner’s designated agent concerning selection of a plan that best meets the prescription drug needs of such applicant or recipient, effective December 1, 2005; Nov. 2 Sp. Sess. P.A. 05-3 amended Subsec. (f) by changing “shall” to “may” re commissioner’s acting as authorized representative of a ConnPACE applicant or recipient, adding provision clarifying commissioner’s authority to enroll such applicant or recipient in a Medicare Part D plan, and deleting provision re commissioner’s authority to sign required forms on behalf of such applicant or recipient, effective December 1, 2005; P.A. 09-2 amended Subsec. (f) to add provision re facilitating enrollment in Medicare savings program and to make conforming changes, effective April 1, 2009; Sept. Sp. Sess. P.A. 09-5 amended Subsec. (a) by increasing registration fee from $30 to $45, by changing date commissioner is to begin increasing income limits from January 1, 1998, to January 1, 2012, and by adding provision specifying when new applications may be accepted and amended Subsec. (f) by adding provision requiring certain applicants to enroll in a benchmark plan and inserting references to benchmark plan, effective October 5, 2009; P.A. 10-26 made a technical change in Subsec. (f), effective May 10, 2010; P.A. 10-179 amended Subsec. (a) by changing last day to receive new applications for ConnPACE program from 30th to 31st day of December, effective May 7, 2010; P.A. 11-44 amended Subsec. (a)(3) by adding provision limiting eligibility to resident not eligible for Medicare and deleting exception re Medicare prescription drug discount card, amended Subsec. (b)(1) by deleting exception re Medicare prescription drug discount card or Medicare Part D benefits, deleted former Subsec. (b)(2) re responsibilities of Medicare Part D beneficiary, redesignated existing Subsec. (b)(3) as Subsec. (b)(2), amended Subsec. (c) by deleting provisions re Medicare prescription drug discount card, deleted former Subsecs. (d), (e) and (f) re Medicare Part D and redesignated existing Subsec. (g) as Subsec. (d), effective July 1, 2011; P.A. 12-208 amended Subsec. (a) to add provision re income disregard for veterans’ Aid and Attendance pension benefits, effective July 1, 2012.