Senate Bill 2720

AN ACT TO AUTHORIZE AND DIRECT THE DIVISION OF MEDICAID TO ENTER INTO CONTRACTS WITH PRIVATE INSURERS TO PROVIDE HEALTH INSURANCE COVERAGE TO ELIGIBLE PERSONS FOR PRESCRIPTION DRUGS AND PHARMACEUTICAL SERVICES WITH THE COST OF SUCH COVERAGE TO BE SUBSIDIZED BY THE STATE ON A SLIDING SCALE BASIS; TO PROVIDE ELIGIBILITY REQUIREMENTS; TO AUTHORIZE THE DIVISION OF MEDICAID TO ADOPT RULES TO ADMINISTER THE PROGRAM; TO CREATE THE SENIOR RX FUND; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. As used in this act:

(a) "Division" means Division of Medicaid, Office of the Governor.

(b) "Senior Rx Program Fund" is the fund to be used for the purchase of insurance coverage under the Public/Private Senior Rx Program.

SECTION 2. (1) The division shall enter into private contracts with private insurers who transact health insurance in this state to arrange for the availability, at a reasonable cost, of policies of health insurance that provide coverage to eligible persons for prescription drugs and pharmaceutical services.

(2) A person is eligible for a subsidy under the Public/Private Senior Rx Program who is:

(a) Sixty-five (65) years or older;

(b) A state resident;

(d) Without any prescription drug coverage; and

(e) Income eligible.

(3) Income eligibility:

(a) To become eligible for the Public/Private Senior Rx Program, an individual must have resources (as determined under 42 USC 1382(b) for the purposes of the supplemental security income program) that does not exceed twice the maximum amount of resources that an individual may have to obtain benefits under that program; and

(b) To be income eligible for the Public/Private Senior Rx Program and qualify for a subsidy, an individual must meet the qualifications under this subsection.

(c) A Public/Private Senior Rx Program participant is entitled to an annual grant from the Senior Rx Program fund to subsidize a portion of the cost of insurance to the extent determined by the participant's household income as follows:

Amount of Percent of Cost

Household Income But Not Over of Insurance

is Over Allowable as a Subsidy

$0 $12,700 100

$12,700 $14,800 90

$14,800 $17,000 80

$17,000 $19,100 50

$19,100 $21,500 25

(d) Individuals who meet all eligibility requirements for the Public/Private Senior Rx Program but whose household income exceeds the amount to qualify for a subsidy may participate in the program by purchasing prescription drug policies from participating private insurers at fair market value but may not receive any subsidy.

(e) The amount of any subsidy granted pursuant to this section must not exceed the annual cost of insurance that provides coverage for prescription drugs and pharmaceutical services.

SECTION 3. (1) A senior citizen who wishes to receive a subsidy pursuant to this act must file a request therefor with the division.

(2) The request must be made under oath and filed in such form and content, and accompanies by such proof, as the division may prescribe.

(3) The division shall, within forty five (45) days after receiving a request for a subsidy, examine the request, grant or deny it, and if granted, shall determine the amount of the subsidy to which the senior citizen is entitled.

(4) The division shall determine who is eligible to receive a subsidy pursuant to this act and pay the subsidy directly to an insurer with whom the division has entered into a contract pursuant to this act.

(5) Any subsidy granted pursuant to this act to a person who is not qualified for such a subsidy may be revoked by the division. If a subsidy is so revoked, the ineligible person shall make restitution to the division for any subsidy he has improperly received and the division shall take all proper actions to collect the amount of the subsidy as a debt.

(6) The division shall deny any request for a subsidy received pursuant to this act to which a person is not entitled or any amount in excess of that to which a person is entitled.

SECTION 4. The division may deny in total any request which it finds to have been filed with fraudulent intent. If any such request has been repaid and is afterward denied, the amount of the subsidy must be paid by the person who received the benefits of the subsidy to the division.

SECTION 5. Any amounts received by the division pursuant to this act shall be deposited with the State Treasurer for credit to the Senior Rx Program fund, which is hereby created in the State Treasury.

SECTION 6. Any person who is aggrieved by a decision of the division denying a request for a subsidy submitted pursuant to this act is entitled to judicial review thereof.

SECTION 7. The division is responsible for the administration of the Public/Private Senior Rx Program and may:

(a) Prescribe the content and form of a request for a subsidy required to be submitted pursuant to this act;

(b) Designate the proof that must be submitted with such a request;

(c) Adopt regulations to protect the confidentiality of information supplied by a senior citizen requesting a subsidy pursuant to this act; and

(d) Adopt such other regulations as may be required to carry out the provisions of this act.

SECTION 8. No person may publish, disclose or use any personal or confidential information contained in a request for a subsidy submitted pursuant to this act except for purposes relating to the administration of this act.

SECTION 9. The division shall, in cooperation with the State Tax Commission and the Mississippi Department of Human Services:

(a) Combine all possible administrative procedures required for determining those persons who are eligible for assistance under this act;

(b) Coordinate the collection of information required to carry out those provisions in a manner that requires persons requesting assistance to furnish information in as few reports as possible; and

(c) Design forms that may be used jointly by the Department of Health, the Department of Taxation and the various counties in this state to carry out the provisions of this act.

SECTION 10. This act shall take effect and be in force from and after July 1, 2002.