DAR File No. 27901

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-309

Medicare Drug Benefit Low-Income Subsidy Determination

NOTICE OF PROPOSED RULE

DAR File No.: 27901
Filed: 05/13/2005, 04:00
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is needed to put into place the requirements for the Department of Health to have Medicare Part D Drug Benefit Low-Income Subsidy applications available for individuals to access, and if required, to determine eligibility for the Medicare Part D Drug Benefit Low-Income Subsidies.

Summary of the rule or change:

This rule establishes that the Department of Health will make applications available at Medicaid offices for individuals who want to apply through Social Security Administration (SSA) for the Medicare Part D Drug Benefit Low-Income Subsidies, and will also complete a determination of eligibility for the Low-Income Subsidies, as required, in accordance with the federal regulations.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 18

Anticipated cost or savings to:

the state budget:

The state anticipates only minimal costs, which the Department will absorb, to provide SSA applications, to direct people to mail the applications to SSA, and if necessary, help complete applications for the Medicare Part D low-income subsidy. Other agencies should experience only minimal costs in providing the SSA applications to individuals who inquire about the low-income subsidy.

local governments:

Local governments are not affected by this rulemaking as this only affects individuals with Medicare.

other persons:

This does not affect other persons because it does not impose any costs or fees on others.

Compliance costs for affected persons:

There is no compliance cost for affected persons. They will not be charged for applications or assistance in completing applications for the Medicare Part D low-income subsidy.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule facilitates Medicare beneficiaries obtaining lower cost prescription drugs and should have a positive fiscal impact on Utah residents and businesses. A. Richard Melton, Acting Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/01/2005

This rule may become effective on:

07/02/2005

Authorized by:

Richard Melton, Deputy Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-309. Medicare Drug Benefit Low-Income Subsidy Determination.

R414-309-1. Authority and Purpose.

(1) This rule is authorized by Title 26, Chapter18, UCA.

(2) The Medicare Modernization Act requires the state to have the ability, upon request, to determine eligibility for the Medicare drug benefit low-income subsidies as set forth in 42 CFR 423.904. This rule sets forth the requirements for completing eligibility determinations for the Medicare Part D low-income subsidies.

R414-309-2. General Provisions.

(1) The Utah Department of Health shall make Medicare Part D Subsidy applications from the Social Security Administration available at State Medical Assistance Offices to individuals who want to apply for the Medicare drug benefit low-income subsidies, and may help individuals complete and send the form to the Social Security Administration.

(2) The Department shall apply the eligibility criteria for the Medicare drug benefit low-income subsidy programs as defined in 42 CFR 423.904 in making any determinations that the state is required to make and shall notify the applicant of that decision.

(3) If the Department determines that an applicant is not eligible for a Medicare drug benefit low-income subsidy, the applicant may appeal the Department's decision pursuant to the provisions of R410-14.

(4) As required by 42 CFR 423.904, the Department exchanges information on Medicare Part D subsidy applicants and eligible individuals with the Centers for Medicare and Medicaid Services and with the Social Security Administration.

KEY: Medicaid, eligibility

2005

26-18

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.