CHAPTER 650
S.P. 777 - L.D. 2113
An Act to Improve Access to Prescription Drugs for Persons who are Elderly or Disabled
Emergency preamble. Whereas, Acts of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, the inability of persons who are elderly and disabled to purchase prescription drugs is a risk to the health of those persons and a detriment to the families, communities and businesses of this State; and
Whereas, the availability of prescription drugs for this population will strengthen the State as a whole; and
Whereas, a Medicaid waiver could offer the State the opportunity to match state funds with federal funds and thereby expand the prescription drug program for elderly and disabled persons beginning as soon as a waiver is granted; and
Whereas, in the judgment of the Legislature, these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety; now, therefore,
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §3174-G, sub-§1-A, as amended by PL 1999, c. 790, Pt. A, §25, is repealed.
Sec. 2. 22 MRSA §3174-G, sub-§1-B, as amended by PL 1999, c. 731, Pt. KK, §1, is further amended to read:
1-B. Funding. State funds necessary to implement subsection 1-A 1-C must include General Fund appropriations and Other Special Revenue allocations from the Fund for a Healthy Maine to the elderly low-cost drug program operated pursuant to section 254, including rebates received in that program from pharmaceutical manufacturers, that are no longer needed in that program as a result of the Medicaid waiver obtained pursuant to subsection 1-A 1-C.
Sec. 3. 22 MRSA §3174-G, sub-§1-C is enacted to read:
1-C. Prescription drug waiver program. Except as provided in paragraph G, the department shall apply to the federal Centers for Medicare and Medicaid Services for a waiver or amend a pending or current waiver under the Medicaid program authorizing the department to use federal matching dollars to enhance the prescription drug benefits available to persons who qualify for the elderly low-cost drug program established under section 254. The program created pursuant to the waiver is the prescription drug waiver program, referred to in this subsection as the "program."
A. As funds permit, the department has the authority to establish income eligibility levels for the program up to and including 200% of the federal nonfarm income official poverty level, except that for individuals in households that spend at least 40% of income on unreimbursed direct medical expenses for prescription medications, the income eligibility level is increased by 25%.
B. To the extent reasonably achievable under the federal waiver process, the program must include the full range of prescription drugs provided under the Medicaid program on the effective date of this subsection and must limit copayments and cost sharing for participants. If cost sharing above the nominal cost sharing for the Medicaid program is determined to be necessary, the department may use a sliding scale to minimize the financial burden on lower-income participants.
C. Coverage under the program may not be less beneficial to persons who meet the qualifications of section 254 than the coverage available under that section on September 30, 2001.
D. In determining enrollee benefits under the program, to the extent possible, the department shall give equitable treatment to coverage of prescription medications for cancer, Alzheimer's disease and behavioral health.
E. The department is authorized to provide funding for the program by using funds appropriated or allocated to provide prescription drugs under sections 254 and 258.
F. The department is authorized to amend the waiver or adjust program requirements as neces-sary to take advantage of enhanced federal matching funds that may become available.
G. If, upon thorough analysis, the department determines that a waiver under this subsection is not feasible or would not significantly benefit participants in the elderly low-cost drug program, the department may decide not to pursue the waiver. Within 30 days of a decision not to proceed with a waiver and before taking action on that decision, the department shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters and shall provide a detailed analysis of the reasons for reaching that decision.
Sec. 4. Report. The Department of Human Services shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters regarding the status of the waiver request pursuant to the Maine Revised Statutes, Title 22, section 3174-G, subsection 1-C on or before January 12, 2003. The report must include information on cost sharing, including copayments, under the waiver program and on benefits for enrollees in the program.
Emergency clause. In view of the emergency cited in the preamble, this Act takes effect when approved.
Effective April 9, 2002.
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