HB 374: "An Act establishing the SeniorCare program and relating to that program; and providing for an effective date."

00 HOUSE BILL NO. 374 01 "An Act establishing the SeniorCare program and relating to that program; and 02 providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 05 to read: 06 SENIORCARE PROGRAM. (a) The SeniorCare program is established in the 07 Department of Health and Social Services. The SeniorCare program is authorized to provide 08 cash assistance and prescription drug benefits as specified in this section as far as practicable 09 under appropriations provided by law. 10 (b) The department shall 11 (1) administer the SeniorCare program established under (a) of this section; 12 and 13 (2) adopt regulations under AS 44.62 to carry out the purposes of the program. 14 (c) In order to be eligible for the program, an individual must

01 (1) be 65 years of age or older; 02 (2) be a resident of the State of Alaska; 03 (3) have income 04 (A) of not more than 135 percent of the federal poverty level for this 05 state to be eligible for cash assistance under (d) of this section or prescription drug 06 benefits under (e) of this section; or 07 (B) of more than 135 percent, but not more than 150 percent, of the 08 federal poverty level for this state for prescription drug benefits under (f) of this 09 section; 10 (4) meet other eligibility requirements specified in this section and in 11 regulations adopted under this section; and 12 (5) apply on a form provided by the department; the department may use an 13 abbreviated form for individuals who received payments under an assistance program for 14 seniors paying $120 a month and administered by the department on or before March 31, 15 2004. 16 (d) An eligible individual who meets the income standard of (c)(3)(A) of this section 17 is authorized to receive cash assistance of $120 per month as far as practicable under 18 appropriations available to the program. The department may prorate the amount of cash 19 assistance authorized to be paid under this section if the department estimates that 20 appropriations for the program are not sufficient to meet the demands for the program in a 21 fiscal year. 22 (e) In place of the cash assistance authorized in (d) of this section, an eligible 23 individual may make an irrevocable election to receive prescription drug benefits annually, 24 provided in the manner specified by the department in regulation. The total maximum 25 prescription drug benefits an individual may receive under this subsection in a fiscal year is 26 $1,600. An individual who has prescription drug coverage under AS 47.07 is not eligible to 27 receive prescription drug benefits under this subsection. 28 (f) An eligible individual who meets the income standard of (c)(3)(B) of this section 29 is authorized to receive only prescription drug benefits, as provided in this subsection. The 30 provisions of (e) of this section apply to prescription drug benefits provided under this 31 subsection except that the total maximum prescription drug benefits that an individual may

01 receive under this subsection in a fiscal year is $1,000. 02 (g) To receive prescription drug benefits under (e) or (f) of this section, an eligible 03 individual must assign to the department the individual's rights to payments under any other 04 prescription drug program for any prescription drug benefit paid under this section. Payment 05 may not be made under this section for any amount that would otherwise qualify for payment 06 under any other prescription drug benefit plan, except for prescription drug coverage received 07 from health care facilities that operated under the authority of 25 U.S.C. 450 - 458 (P.L. 93- 08 638). 09 (h) Except as otherwise provided in this subsection, the department is authorized to 10 pay under (e) and (f) of this section only for a prescription drug, insulin, and insulin syringes. 11 The department may not pay under (e) and (f) of this section for drugs used to treat obesity, 12 baldness, infertility, or impotence; drugs that are prohibited from receiving Medicaid funding 13 under AS 47.07; smoking cessation products; drugs used for symptomatic relief of coughs and 14 colds; oral vitamins; or brand name multi-source drugs if a therapeutically equivalent generic 15 drug is on the market. However, the department may pay for brand name multi-source drugs 16 if the prescriber writes on the prescription "The brand name drug is medically necessary" and 17 the prescriber states the reason that the brand name drug is medically necessary. The 18 department may also restrict coverage of drugs under (e) and (f) of this section to be 19 consistent with the preferred drug list implemented by the department for purposes of the 20 Medicaid program under AS 47.07. 21 (i) For any fiscal year in which prescription drug benefits under (e) and (f) of this 22 section are not available for a full 12 months, the commissioner may prorate the total 23 maximum amounts available under (e) and (f) of this section according to the number of 24 months for which those benefits are available. 25 (j) The department may not make payment or authorize a benefit under this section to 26 or on behalf of an individual residing in a public institution or nursing facility. 27 (k) An eligible individual who leaves the state may not receive cash assistance or 28 prescription drug benefits under this section during the absence, unless the individual 29 temporarily leaves for one of the following: 30 (1) medical treatment; or 31 (2) a vacation, business trip, or other absences of less than 30 days, unless the

01 individual has applied for and received a time extension from the department for special 02 circumstances. 03 (l) An individual who receives a determination under this section from the department 04 that denies, limits, or modifies prescription drug benefits or cash assistance under this section, 05 other than a determination under (d) or (i) of this section to prorate the amount of benefits or 06 assistance, may request a hearing before the department. The department shall adopt 07 regulations for the conduct of hearings under this subsection. The hearing process under this 08 subsection is not subject to AS 44.62.330 - 44.62.630. The decision of the department is a 09 final administrative order subject to appeal to the superior court. 10 (m) An individual who receives assistance or benefits under this section when not 11 entitled to them because the information provided by the individual was inaccurate or 12 incomplete is liable to the department for the value of the assistance or benefits improperly 13 provided to the individual. In a civil action brought by the state to recover from the individual 14 the value of assistance or benefits improperly provided under this section, the state may 15 recover from the individual the costs of investigation and prosecution of the civil action, 16 including attorney fees as determined under court rules. 17 (n) Cash assistance provided under this section is inalienable by assignment or 18 transfer and is exempt from garnishment, levy, or execution as provided in AS 09.38. 19 (o) In this section, 20 (1) "commissioner" means the commissioner of the Department of Health and 21 Social Services; 22 (2) "department" means the Department of Health and Social Services; 23 (3) "eligible individual" means an individual who meets the requirements of 24 this section and regulations adopted under this section for eligibility for the program; 25 (4) "program" means the SeniorCare program established in this section; 26 (5) "public institution" means a governmentally owned establishment that 27 furnishes food, shelter, and some additional treatment or services to 16 or more persons; 28 (6) "resident" has the meaning given "resident" in AS 47.25.430(a). 29 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 30 read: 31 TRANSITION: REGULATIONS. To the extent the regulations are not inconsistent

01 with this Act, regulations adopted by the Department of Health and Social Services in 2003 to 02 provide cash assistance of $120 per month to seniors before the effective date of this Act 03 remain in effect as valid regulations implementing this Act until the department adopts 04 regulations under this Act and those regulations take effect under AS 44.62. Upon the filing 05 of regulations adopted under this Act, the commissioner of the Department of Health and 06 Social Services shall notify the revisor of statutes of the effective date of the regulations and 07 shall post the regulations on the department's Internet website. 08 * Sec. 3. This Act is repealed on the date that the commissioner of the Department of 09 Health and Social Services certifies to the revisor of statutes that the commissioner received 10 notification from the United States Department of Health and Human Services that the 11 Medicare Part D benefit under P.L. 101-173 for prescription drugs for Medicare recipients is 12 operational for recipients in this state. 13 * Sec. 4. This Act takes effect April 1, 2004.