- Perfected -
SS/SS/SCS/SB 1371 - This act closes the standard drug benefit coverage gap for certain seniors that was created due to the enactment of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
MISSOURI SENIOR PRESCRIPTION DRUG PLAN - The "Missouri Senior Prescription Drug Plan" is created within the Department of Health and Senior Services. The plan shall be effective upon notice to the Revisor by the Commission that the Medicare Act of 2003 has been fully implemented.
APPROPRIATIONS FOR THE PLAN - This plan is not an entitlement and is only a payer of last resort. Benefits are limited to the amounts appropriated for the plan. If the costs exceed the amounts appropriated, then the Commission may request a supplemental appropriation to fund the plan or may direct the prescription drug plan (PDP) sponsors to implement cost-control measures, such as increasing the amount of co-insurance.
BENEFIT - Subject to appropriations and other available funds, the plan shall provide gap coverage up to a total benefit of $2138 for each eligible senior in the first year of the plan and thereafter, the amount shall be adjusted annually each year based upon the Medicare Act of 2003.
ELIGIBILITY - Individuals who are 65 and older and are a participant in the Medicare Part D benefit will be eligible for the plan if their income is:
-within 150% to 200% of the federal poverty level; or
-below 150% of the federal poverty level and they fail the asset test.
APPLICATIONS FOR THE PLAN - Applications for the Missouri Senior Prescription Drug Plan will be conducted jointly with applications for the Medicare Part D benefit. The enrollment period for the state plan shall correspond with the enrollment period for the federal program.
COVERAGE - The plan shall provide coverage for only the prescription drugs covered in the PDP sponsors' formulary under the federal program. The plan shall not include coverage for any of the following drugs:
-those used for anorexia and weight gain;
-those used to promote fertility;
-those used for cosmetic purposes or hair growth;
-those used for coughs or colds;
The plan shall also exclude any drugs that are not "reasonable and necessary" as defined pursuant to the federal program. For covered prescription drugs, the state plan shall not be charged an amount in excess of the price charged pursuant to the federal program.
MISSOURI SENIOR PRESCRIPTION DRUG PLAN COMMISSION - The "Missouri Senior Prescription Drug Plan Commission" is created and will be composed of twelve members. Members appointed by the Governor shall serve for three years, legislative members shall serve for their current term of office, and all other members shall serve for as long as they hold the position which made them eligible for appointment.
ADMINISTRATION OF THE COMMISSION - Members of the Commission shall receive no compensation, but may be reimbursed for any expenses incurred. The Commission may also employ administrative staff as necessary to assist the Commission.
DUTIES OF THE COMMISSION - The Commission shall have the authority to:
-contract with PDP sponsors for implementing and administering the plan and determining eligibility;
-adjust the fee payments with PDP sponsors;
-set and adjust co-insurance at different amounts;
-coordinate with the Missouri Senior Rx Commission to avoid any duplication in coverage and to ensure a smooth transition between the two programs;
-apply for federal waivers and grants;
-promulgate rules; and
-perform any other function necessary for the implementation of the plan.
MISSOURI SENIOR PRESCRIPTION DRUG PLAN CLEARINGHOUSE - The "Missouri Senior Prescription Drug Plan Clearinghouse" is created within the Commission. The purpose of the Clearinghouse is to assist all Missourians in accessing prescription drugs programs, to educate the public on quality drug programs, to maintain a toll-free number, and to provide information on eligibility, enrollment, and benefits for the plan on the Department's website.
TERMINATION OF THE MISSOURI SENIOR PRESCRIPTION DRUG PLAN - The Missouri Senior Prescription Drug Plan shall be subject to reauthorization every four years.
MISSOURI SENIOR RX PROGRAM - Applicants not currently participating in the program must submit an initial enrollment application to the Division. Initial applications will be accepted during an open enrollment period from January 1 through February 28 of each year. Current enrollees will automatically remain in the program unless they specifically opt-out during the open enrollment period. The Division shall establish procedures to verify an applicants' continued eligibility (This provision is identical to HB 894 (2004)).
MISSOURI SENIOR RX FUND - Moneys in the Missouri Senior Rx Fund shall be credited to the Missouri Senior Prescription Drug Plan Fund after notice is provided to the Revisor that the Medicare Act of 2003 has been fully implemented.
TERMINATION OF THE MISSOURI SENIOR RX PROGRAM - The Missouri Senior Rx Program shall terminate after notice is provided to the Revisor of Statutes that the Medicare Act of 2003 has been fully implemented.