36-2974. Dual eligibles; qualifications for
coverage; enrollment
A. For purposes of this section all contractors and program contractors are
required to provide services to members.
B. For a member who is dually eligible the director may implement a policy
permitting a choice of contractors or program contractors to the extent the director
deems feasible consistent with the section 1115 waiver and federal law. If the director
does not implement a choice of contractor policy, the director may enroll the member, at
the time eligibility is determined, with an available contractor or program contractor
located in the geographic area of the member's residence.
C. The department shall assist the administration in the screening of all persons
who are applying to become eligible pursuant to section 36-2901, paragraph 6, subdivision
(a) and who are entitled to services under title XVIII but not title XVI of the social
security act to determine if the person meets the eligibility criteria of this
section. If a person is determined to be eligible pursuant to section 36-2901, paragraph
6, subdivision (a) and this article, the administration shall make the person dually
eligible. On determination of dual eligibility the administration shall enroll the person
pursuant to this article and notify the person of the dual eligibility.
D. The administration shall screen all persons who are entitled to services under
title XVIII of the social security act and who are applying to become eligible pursuant
to section 36-2901, paragraph 6, subdivision (a), as prescribed by title XVI of the
social security act or section 36-2931, paragraph 5, to determine if the person meets the
eligibility criteria of this section. If a person is determined to be eligible pursuant
to section 36-2901, paragraph 6, subdivision (a) or section 36-2931, paragraph 5 and this
article, the administration shall make the person dually eligible. On determination of
dual eligibility by the administration, the administration shall enroll the person
pursuant to this article and notify the person of the dual eligibility.
E. Calculation of income and resource eligibility requirements by the department
and the administration pursuant to this section shall be in accordance with title XIX of
the social security act, as amended.
F. Program contractors and contractors shall pay medicare deductibles, coinsurance
and copayment amounts for services provided to dual eligibles pursuant to this article
and as required by the administration for services that are provided by or under referral
from a primary care physician or primary care practitioner.
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