Missouri Rx plan established, purpose--rulemaking authority.
208.782. 1. There is hereby established a state pharmaceuticalassistance program within the meaning of federal law at 42 U.S.C. Section1395 w-133(b), to be known as the "Missouri Rx Plan". The purpose of theMissouri Rx plan, established within the department of social services, isto provide certain pharmaceutical benefits to certain elderly and disabledresidents of this state, to facilitate coordination of benefits between theMissouri Rx plan and the federal Medicare Part D drug benefit programestablished by the Medicare Prescription Drug, Improvement andModernization Act of 2003, P.L. 108-173, and as well as to enroll suchindividuals in said program.
2. The Missouri Rx plan shall assist eligible elderly and disabledindividuals, including individuals qualified as dual eligibles by virtue oftheir eligibility for receipt of benefits under both the Medicaid andMedicare programs, in defraying the cost of medically necessaryprescription drugs through coordination with the Medicare Part D drugbenefit program. The Missouri Rx plan may select one or more prescriptiondrug plans, as approved by the federal Centers for Medicare and MedicaidServices, as the preferred plan for purposes of the coordination ofbenefits between the Missouri Rx plan and the Medicare Part D drug. Toensure Medicare eligible seniors receive a coordinated benefit, theMissouri Rx plan may preliminarily enroll or reenroll beneficiaries of theMissouri Rx plan into a preferred prescription drug plan or plans in theabsence of any action or application of the individual beneficiary seekingsuch enrollment, provided that each individual so enrolled shall bepromptly informed of:
(1) The procedures by which the individual may disenroll from thepreferred PDP;
(2) The existence of an alternative PDP or PDPs authorized to provideMedicare Part D benefits in the region in which the individual resides;
(3) The manner by which the individual may change his or herenrollment to an alternative, nonpreferred PDP or obtain assistance indoing so; and
(4) * Enrollment in a nonpreferred PDP will not adversely affecteither the individual's eligibility for enrollment in the Missouri Rx planor the amount of benefits the individual may be eligible to receive fromthe Missouri Rx plan. The enrollment authority under this section shallalso include the authority to withdraw individuals from nonpreferred plansin order to maximize the benefit to the individual.
3. The department shall promulgate rules and regulations, includingbenefit limits, as may be necessary to implement the Missouri Rx plan. Anyrule or portion of a rule, as that term is defined in section 536.010,RSMo, that is created under the authority delegated in this section shallbecome effective only if it complies with and is subject to all of theprovisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo.This section and chapter 536, RSMo, are nonseverable and if any of thepowers vested with the general assembly pursuant to chapter 536, RSMo, toreview, to delay the effective date, or to disapprove and annul a rule aresubsequently held unconstitutional, then the grant of rulemaking authorityand any rule proposed or adopted after August 28, 2005, shall be invalidand void.
4. The department may delegate administrative responsibilities asnecessary to implement the Missouri Rx plan. The department may designateor enter into contracts with other entities including but not limited toother states, governmental purchasing pools, or for-profit or nonprofitorganizations to assist in the administration of the program.
5. When requested by the department, other state agencies shallprovide assistance or information necessary for the administration of theprogram.
(L. 2005 S.B. 539)
Sunset date 8-28-11, unless reauthorized (see § 208.798)
*Word "That" appears in original rolls, a typographical error.
Missouri Rx plan established, purpose--rulemaking authority.
208.782. 1. There is hereby established a state pharmaceuticalassistance program within the meaning of federal law at 42 U.S.C. Section1395 w-133(b), to be known as the "Missouri Rx Plan". The purpose of theMissouri Rx plan, established within the department of social services, isto provide certain pharmaceutical benefits to certain elderly and disabledresidents of this state, to facilitate coordination of benefits between theMissouri Rx plan and the federal Medicare Part D drug benefit programestablished by the Medicare Prescription Drug, Improvement andModernization Act of 2003, P.L. 108-173, and as well as to enroll suchindividuals in said program.
2. The Missouri Rx plan shall assist eligible elderly and disabledindividuals, including individuals qualified as dual eligibles by virtue oftheir eligibility for receipt of benefits under both the Medicaid andMedicare programs, in defraying the cost of medically necessaryprescription drugs through coordination with the Medicare Part D drugbenefit program. The Missouri Rx plan may select one or more prescriptiondrug plans, as approved by the federal Centers for Medicare and MedicaidServices, as the preferred plan for purposes of the coordination ofbenefits between the Missouri Rx plan and the Medicare Part D drug. Toensure Medicare eligible seniors receive a coordinated benefit, theMissouri Rx plan may preliminarily enroll or reenroll beneficiaries of theMissouri Rx plan into a preferred prescription drug plan or plans in theabsence of any action or application of the individual beneficiary seekingsuch enrollment, provided that each individual so enrolled shall bepromptly informed of:
(1) The procedures by which the individual may disenroll from thepreferred PDP;
(2) The existence of an alternative PDP or PDPs authorized to provideMedicare Part D benefits in the region in which the individual resides;
(3) The manner by which the individual may change his or herenrollment to an alternative, nonpreferred PDP or obtain assistance indoing so; and
(4) * Enrollment in a nonpreferred PDP will not adversely affecteither the individual's eligibility for enrollment in the Missouri Rx planor the amount of benefits the individual may be eligible to receive fromthe Missouri Rx plan. The enrollment authority under this section shallalso include the authority to withdraw individuals from nonpreferred plansin order to maximize the benefit to the individual.
3. The department shall promulgate rules and regulations, includingbenefit limits, as may be necessary to implement the Missouri Rx plan. Anyrule or portion of a rule, as that term is defined in section 536.010,RSMo, that is created under the authority delegated in this section shallbecome effective only if it complies with and is subject to all of theprovisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo.This section and chapter 536, RSMo, are nonseverable and if any of thepowers vested with the general assembly pursuant to chapter 536, RSMo, toreview, to delay the effective date, or to disapprove and annul a rule aresubsequently held unconstitutional, then the grant of rulemaking authorityand any rule proposed or adopted after August 28, 2005, shall be invalidand void.
4. The department may delegate administrative responsibilities asnecessary to implement the Missouri Rx plan. The department may designateor enter into contracts with other entities including but not limited toother states, governmental purchasing pools, or for-profit or nonprofitorganizations to assist in the administration of the program.
5. When requested by the department, other state agencies shallprovide assistance or information necessary for the administration of theprogram.
(L. 2005 S.B. 539)
Sunset date 8-28-11, unless reauthorized (see § 208.798)
*Word "That" appears in original rolls, a typographical error.
Missouri Rx plan established, purpose--rulemaking authority.
208.782. 1. There is hereby established a state pharmaceuticalassistance program within the meaning of federal law at 42 U.S.C. Section1395 w-133(b), to be known as the "Missouri Rx Plan". The purpose of theMissouri Rx plan, established within the department of social services, isto provide certain pharmaceutical benefits to certain elderly and disabledresidents of this state, to facilitate coordination of benefits between theMissouri Rx plan and the federal Medicare Part D drug benefit programestablished by the Medicare Prescription Drug, Improvement andModernization Act of 2003, P.L. 108-173, and as well as to enroll suchindividuals in said program.
2. The Missouri Rx plan shall assist eligible elderly and disabledindividuals, including individuals qualified as dual eligibles by virtue oftheir eligibility for receipt of benefits under both the Medicaid andMedicare programs, in defraying the cost of medically necessaryprescription drugs through coordination with the Medicare Part D drugbenefit program. The Missouri Rx plan may select one or more prescriptiondrug plans, as approved by the federal Centers for Medicare and MedicaidServices, as the preferred plan for purposes of the coordination ofbenefits between the Missouri Rx plan and the Medicare Part D drug. Toensure Medicare eligible seniors receive a coordinated benefit, theMissouri Rx plan may preliminarily enroll or reenroll beneficiaries of theMissouri Rx plan into a preferred prescription drug plan or plans in theabsence of any action or application of the individual beneficiary seekingsuch enrollment, provided that each individual so enrolled shall bepromptly informed of:
(1) The procedures by which the individual may disenroll from thepreferred PDP;
(2) The existence of an alternative PDP or PDPs authorized to provideMedicare Part D benefits in the region in which the individual resides;
(3) The manner by which the individual may change his or herenrollment to an alternative, nonpreferred PDP or obtain assistance indoing so; and
(4) * Enrollment in a nonpreferred PDP will not adversely affecteither the individual's eligibility for enrollment in the Missouri Rx planor the amount of benefits the individual may be eligible to receive fromthe Missouri Rx plan. The enrollment authority under this section shallalso include the authority to withdraw individuals from nonpreferred plansin order to maximize the benefit to the individual.
3. The department shall promulgate rules and regulations, includingbenefit limits, as may be necessary to implement the Missouri Rx plan. Anyrule or portion of a rule, as that term is defined in section 536.010,RSMo, that is created under the authority delegated in this section shallbecome effective only if it complies with and is subject to all of theprovisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo.This section and chapter 536, RSMo, are nonseverable and if any of thepowers vested with the general assembly pursuant to chapter 536, RSMo, toreview, to delay the effective date, or to disapprove and annul a rule aresubsequently held unconstitutional, then the grant of rulemaking authorityand any rule proposed or adopted after August 28, 2005, shall be invalidand void.
4. The department may delegate administrative responsibilities asnecessary to implement the Missouri Rx plan. The department may designateor enter into contracts with other entities including but not limited toother states, governmental purchasing pools, or for-profit or nonprofitorganizations to assist in the administration of the program.
5. When requested by the department, other state agencies shallprovide assistance or information necessary for the administration of theprogram.
(L. 2005 S.B. 539)
Sunset date 8-28-11, unless reauthorized (see § 208.798)
*Word "That" appears in original rolls, a typographical error.
