WSR 08-11-084



(Health and Recovery Services Administration)

[ Filed May 20, 2008, 8:38 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 07-17-144.

Title of Rule and Other Identifying Information: The department is creating WAC 388-517-0500 State payment of medicare prescription drug copayments for full-benefit, dual-eligible clients.

Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at or by calling (360) 664-6094), on June 24, 2008, at 10:00 a.m.

Date of Intended Adoption: Not earlier than June 25, 2008.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail, fax (360) 664-6185, by 5 p.m., on June 24, 2008.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by June 17, 2008, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Recent state legislation (chapter 3, Laws of 2007) requires the department to pay medicare Part D copayment cost sharing for full-benefit, dual-eligible medicaid clients. The department is codifying this new requirement.

Reasons Supporting Proposal: To be in compliance with state legislation.

Statutory Authority for Adoption: RCW 74.04.050, 74.08.090, and chapter 3, Laws of 2007.

Statute Being Implemented: Chapter 3, Laws of 2007.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of social and health services, governmental.

Name of Agency Personnel Responsible for Drafting: Wendy Boedigheimer, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1306; Implementation and Enforcement: Carole McRae, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1250.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the rules and determined that no new costs will be imposed on small businesses or nonprofit organization[(s)].

A cost-benefit analysis is not required under RCW 34.05.328. Rules are exempt per RCW 354.05.328 [34.05.328] (5)(b)(vii) relating only to client medical or financial eligibility.

May 9, 2008

Stephanie E. Schiller

Rules Coordinator

WAC 388-517-0500   State payment of Medicare prescription drug copayments for full-benefit dual-eligible clients.   This rule describes the conditions under which the department pays Medicare prescription drug copayments for full-benefit dual-eligible clients.

(1) Definitions:

(a) "Medicare Part D copayment" - A flat dollar amount that a Medicare beneficiary must pay toward the cost of each prescription drug received under the Medicare prescription drug program.

(b) "Full-benefit, dual-eligible person" - Someone who receives Medicaid services under the categorically needy (CN) or medically needy (MN) program and is a Medicare beneficiary.

(2) The department pays a full-benefit dual-eligible client's Medicare Part D copayment if:

(a) The copayment is for a prescription drug covered under the client's Medicare Part D plan; and

(b) The copayment rate is not more than the federal low-income subsidy copayment rate for a Medicare Part D covered drug; and

(c) The budget includes funding for Medicare Part D copayments.

(3) Pharmacies bill the department directly for Medicare Part D copayments for full-benefit, dual-eligible clients. The client is not responsible for copayments paid by the department as described in subsection (2) of this section.


Washington State Code Reviser's Office