PROPOSAL
Maryland Register
Issue Date: November 28, 2016
Volume 43 • Issue 24 • Pages 1355—1357
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.60 Senior Prescription Drug Assistance Program
Authority: Health-General Article, §15-1005(b)(1), Annotated Code of Maryland
Notice of Proposed Action
[16-303-P]
The Secretary of Health and Mental Hygiene proposes to amend Regulations .01—.08 under COMAR 10.09.60 Senior Prescription Drug Assistance Program.
Statement of Purpose
The purpose of this action is to update the regulations regarding the administration of the Senior Prescription Drug Assistance Program which was transferred from the Board of Directors of the Maryland Health Insurance Plan to the Department of Health and Mental Hygiene on July 1, 2016, in accordance with H.B. 489 (Termination of Maryland Health Insurance Plan, Transfer of Senior Prescription Drug Assistance Program, and Funding for State Reinsurance Program), Ch. 321, Acts of 2016.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through December 28, 2016. A public hearing has not been scheduled.
.01 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) 'Administrator' means the third party that contracts with the [Board] Department to administer the Program.
(2) (text unchanged)
(3) ['Board' means the Board of Directors of the Maryland Health Insurance Plan.] “Department” means the Maryland Department of Health and Mental Hygiene.
(4) (text unchanged)
(5) 'Enrollee' means an individual enrolled in the Senior Prescription Drug Assistance Program.
[(6) 'Fund' means the Maryland Health Insurance Plan Fund established under Insurance Article, §14-504, Annotated Code of Maryland.]
[(7)] (6) (text unchanged)
[(8) 'Plan' means the Maryland Health Insurance Plan.]
[(9)] (7) (text unchanged)
[(10)] (8) 'Program' means the Senior Prescription Drug Assistance Program established under [Insurance Article, Title 14, Subtitle 5, Part II] Health-General Article, Title 15, Subtitle 10, Annotated Code of Maryland.
[(11)] (9) 'Program Fund' means the [segregated account of the Fund that is dedicated to the Senior Prescription Drug Assistance Program] Fund established under Insurance Article, §15-1004, Annotated Code of Maryland.
[(12)] (10) 'Reasonable administrative expenses' means administrative expenses including, but not limited to, marketing, advertising, mailing, printing, and fully allocated costs for administration of the Program[, not exceeding 10 percent of total revenues].
[(13)] (11) (text unchanged)
.02 Eligibility, Enrollment, and Disenrollment.
A.—C. (text unchanged)
D. Maximum Capacity of Program.
(1) The Administrator may not enroll additional individuals at a time when the Program's total enrollment reaches the level authorized by the [Board] Department.
(2) (text unchanged)
(3) If, after the Program reaches its maximum capacity as established by the [Board] Department, the number of individuals enrolled decreases, the Administrator may recommence enrolling eligible individuals in the Program as specified in this regulation, until the Program's enrollment again reaches the authorized maximum.
(4) The [Board] Department may direct the Administrator to limit enrollment based on the amount of money remaining in the Program Fund.
E. (text unchanged)
.03 Outreach Program.
A. The [Board] Department shall develop and implement an outreach program targeted at eligible individuals.
B. The [Board] Department shall publicize the existence and eligibility requirements of the Program through the following entities:
(1)—(6) (text unchanged)
(7) Any other entity that the [Board] Department determines is appropriate.
C. (text unchanged)
D. The [Board] Department shall ensure that the entities used to publicize the existence of the Program under §B of this regulation, have sufficient Program applications and enrollment materials for distribution.
E. Mail-In Application.
(1) The [Board] Department shall develop a mail-in application for the Program.
(2) (text unchanged)
F. Any outreach performed by the [Board] Department on behalf of the Program shall be funded through the Program Fund.
.04 Administrator.
A. Administrator Contract. The Administrator and the [Board] Department shall execute an Administrator contract specifying the terms under which the Administrator shall operate the Program, including but not limited to an agreement by the Administrator to:
(1) (text unchanged)
(2) Submit a detailed quarterly financial accounting of the Program, including the identification of all revenue and cost items to the [Board] Department;
(3) (text unchanged)
(4) Collect and submit to the [Board] Department, data regarding the costs for program enrollees.
B. Program Operation. The Administrator shall operate the Program in a manner consistent with:
(1) (text unchanged)
(2) The Administrator contract governing operation of the Program that is executed between the [Board] Department and the Administrator; and
(3) (text unchanged)
C. (text unchanged)
.05 Program Description Booklet.
A. (text unchanged)
B. The Program description booklet is subject to approval by the [Plan] Department.
C. (text unchanged)
.06 Prescription Drug Benefit Subsidy.
A. The Program shall:
(1) Provide a prescription drug benefit subsidy, as determined by the [Board] Department, that may pay all or some of the deductibles, coinsurance payments, premiums, and copayments under the federal Medicare Part D Pharmaceutical Assistance Program for enrollees of the Program; and
(2) (text unchanged)
B. (text unchanged)
C. The [Board] Department shall determine annually:
(1)—(3) (text unchanged)
[D. On or before January 1 of each year, the Board, in accordance with State Government Article, §2-1246, Annotated Code of Maryland, shall report to the General Assembly on:
(1) The number of individuals on the waiting list for the Program; and
(2) To the extent that the Board is able to collect the information:
(a) The number of enrollees with out-of-pocket prescription drug costs that exceed $2,250, broken down for each fiscal quarter; and
(b) The total annual out-of-pocket prescription drug costs for enrollees.]
.07 Contracts with Prescription Drug Plan Sponsors.
A. The [Plan] Department may enter into contracts with prescription drug plan sponsors who have been approved by the Centers for Medicare and Medicaid Services to offer Medicare Part D plans in the State.
B. A prescription drug plan sponsor that enters into a contract with the [Plan] Department shall agree to perform its obligations in a manner that complies with:
(1)—(4) (text unchanged)
C. A contract entered into with the [Plan] Department shall include provisions that require the prescription drug plan sponsor to:
(1)—(6) (text unchanged)
(7) Share enrollment data and information with the [Plan] Department;
(8) Report data and enrollment information as required by the [Plan] Department;
(9) Reconcile Program and member payments with enrollment data; and
(10) Transmit information to appropriate third-parties, including the Administrator and the Centers for Medicare and Medicaid Services[; and].
[(11) Enroll auto-assigned Program members to a Medicare Part D prescription drug plan.]
.08 Program Fund.
A.—B. (text unchanged)
C. The amount deposited by the nonprofit health service plan under §C of this regulation:
(1) Shall be determined by the [Board] Department based on enrollment, expenditures, and revenue for the previous year; and
(2) (text unchanged)
D. The [Board] Department shall provide funds to the Administrator, in accordance with the contract with the Administrator, for the cost of the State subsidy and administrative expenses incurred on behalf of the Program.
E. The Administrator shall:
(1) Permit inspection of its papers, books, and records pertaining to its operation of the Program by the [Board] Department or its designee; and
(2) Cooperate with any inspections and audits performed on the Administrator or the Program by the [Board] Department or its designee.
VAN T. MITCHELL
Secretary of Health and Mental Hygiene
