PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.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(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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