WSR 08-15-055

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed July 14, 2008, 8:32 a.m. , effective August 14, 2008 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The department is codifying this new requirement to be in compliance with recent state legislation (chapter 3, Laws of 2007). This legislation requires the department to pay medicare Part D copayment cost sharing for full-benefit, dual-eligible medicaid clients.

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

Adopted under notice filed as WSR 08-11-084 on May 20, 2008.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.

Date Adopted: July 3, 2008.

Stephanie E. Schiller

Rules Coordinator

3961.2
NEW SECTION
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.

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Washington State Code Reviser's Office