DAR File No. 28315

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-302-6

Application for Other Possible Benefits

NOTICE OF PROPOSED RULE

DAR File No.: 28315
Filed: 11/01/2005, 01:45
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is needed to add a requirement for medical assistance applicants and recipients to apply for and receive Medicare Part B benefits when it is likely that they are eligible for such benefits. It is intended to get everyone who could be eligible for Medicare Part B enrolled so that they will be able to enroll in Part D, the Medicare Prescription Drug benefits, so that these individuals will have access to affordable prescription drugs. In addition, because Medicaid must coordinate coverage for Medicare Part B services with Medicare, we need these individuals to enroll in Part B to assure that coordination of services. Without the Part B coverage, these individuals could not enroll in Part D, and in January 2006, they would also lose their prescription drug coverage under Medicaid because they are eligible to receive Medicare Part B benefits. By enrolling in Part B, they can then access Part D, and thereby continue to have coverage for prescription drugs.

Summary of the rule or change:

In Section R414-302-6, a provision is being added to require medical assistance applicants and recipients to apply for and receive Medicare Part B benefits if it is likely that they could be eligible for those benefits. The provision requires the state to pay the premiums and cost-sharing expenses for recipients enrolled in Medicare Part B. A citation is also being updated and the language clarified about what the citation covers.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 18

42 CFR 435.608, 2004 ed.

Anticipated cost or savings to:

the state budget:

$207,439 is the total cost for the state. This is based on a total cost of $387,697 after estimated federal match, offset by the state's share of savings on claims that Medicare will pay of $180,258.

local governments:

This rulemaking does not affect local government because it only affects individuals who could be eligible for Medicare.

other persons:

This rulemaking could represent a savings for recipients who will become enrolled in Medicare Part B and who also enroll in Part D because they will receive drug benefits under Medicare in 2006, which they will lose under Medicaid. If they did not enroll in Part B, they could not enroll in Part D and would have no drug coverage.

Compliance costs for affected persons:

There is no compliance cost for affected persons because the state will pay the Medicare Part B premiums and cost-sharing for individuals required to enroll in Part B.

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

This rule is necessary to support implementation of the Medicare Part D prescription drug coverage program. It should have a positive fiscal impact on those residents that qualify for the program and neutral for all others. David N. Sundwall, MD, 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:

12/15/2005

This rule may become effective on:

12/16/2005

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-302. Eligibility Requirements.

R414-302-6. Application for Other Possible Benefits.

The Department [adopts]requires applicants for and recipients of medical assistance to apply for and take all reasonable steps to receive other possible benefits as required by 42 CFR 435.608, [1997]2004 ed., which is incorporated by reference.

(2) Individuals who may be eligible for Medicare Part B benefits must apply for Medicare Part B and, if eligible, become enrolled in Medicare Part B to be eligible for Medicaid. The state pays the applicable monthly premium and cost-sharing expenses for Medicare Part B for individuals who are eligible for both Medicaid and Medicare Part B.

KEY: benefits, income

[June 28, 1999]2005

Notice of Continuation January 31, 2003

26-18

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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.