36-2972. Rights, authority and
responsibilities of the director and the administration
A. Subject to continued federal financial participation as provided in sections
36-2919 and 36-2958, the director shall plan for and take all steps necessary to
implement the qualified medicare beneficiary program under title XIX of the social
security act, as amended.
B. The administration and the director have full operational responsibility for
this article. Except as provided in this article or required by federal law or the
section 1115 waiver, the provisions of articles 1 and 2 of this chapter are fully
applicable to this article and the director and administration have all the rights,
powers, duties and responsibilities accorded to the system under articles 1 and 2 of this
chapter. Services shall be delivered in accordance with federal law and the section 1115
waiver for articles 1 and 2 of this chapter.
C. The administration shall coordinate benefits provided under this article to
members so that costs for services payable by the system are costs avoided or recovered
from a third party payor. The director may require that program contractors, contractors
and noncontracting providers are responsible for the coordination of benefits for
services provided pursuant to this article. Benefit coordination requirements for
noncontracting providers are limited to coordination of benefits with standard health
insurance and disability or medicare supplemental health insurance policies and similar
programs for health coverage. The director shall require members to assign to the system
rights to all types of medical benefits to which the member is entitled.
D. Notwithstanding section 36-2911, the program contractors or contractors shall
pay all premiums, deductibles and coinsurance amounts for the member to obtain coverage
or secure services as required by the administration. For members not enrolled with a
contractor or program contractor the administration may pay the premiums, deductibles and
coinsurance amounts.
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