House of Representatives
SB 1137
AHCCCS; certified providers
Sponsors: Senator Allen
SB 1137 conforms state statutes with the Medicare Modernization Act of 2003 (MMA) by authorizing the Arizona Health Care Cost Containment System (AHCCCS) to certify Medicare health plans and requiring persons who are dually eligible for Medicaid and Medicare to begin receiving prescription drugs from Medicare authorized entities beginning January 1, 2006.
Current Status
SB 1137 was amended in the Committee on Health to authorize AHCCCS to determine eligibility for the low-income prescription drug subsidy. SB 1137 was amended in the Committee of the Whole to adopt the Health Committee amendment.
History
On December 8, 2003, President Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; Public Law 108-173. This legislation includes sweeping changes to the Medicare program. It will provide Medicare beneficiaries with some limited assistance paying for prescription drugs. However, the Medicare Act of 2003 also includes major restructuring of the traditional Medicare program, relying heavily on private insurance for the delivery of benefits. In addition, it increases beneficiary cost sharing responsibilities.
One of the major changes to the Medicare program was the addition of the new prescription drug benefit under Medicare Part D. Beginning January 1, 2006, prescription drug coverage for individuals who are dually eligible for both Medicaid and Medicare will be shifted from Medicaid (AHCCCS) health plans to the newly established Medicare Part D. SB 1137 conforms Arizona law with the MMA to require that dually eligible persons receive their prescription drugs through Medicare beginning on January 1, 2006.
According to AHCCCS, there are some AHCCCS health plans who will apply to become a certified Medicare health plan in order to offer the Medicare Part D prescription plan. AHCCCS is the state agency charged with certifying the financial solvency for health plans as required by Medicaid and Medicare. SB 1137 clarifies AHCCCS’s ability to certify Medicare health plans. This will allow some persons who are dually eligible to remain on their current Medicaid plan and still receive prescription drugs from a Medicare prescription plan as required by the MMA. SB 1137 provides an emergency clause because some AHCCCS health plans have already submitted applications to the Centers for Medicare and Medicaid Services in order to become authorized to offer Medicare prescription drug plans.
The Arizona Department of Health Services (DHS) is the agency charged with providing behavioral health services to qualified individuals in Arizona. The services provided by DHS often times include prescription drugs. Beginning January 1, 2006, the MMA will require individuals receiving behavioral health treatment who are dually eligible for Medicaid and Medicare to begin receiving available prescription drugs from a Medicare program. SB 1137 conforms statute to this requirement by stipulating that persons receiving behavioral health services through the Department of Health Services who have not been determined eligible for Medicare or its prescription drug benefit to apply for eligibility on an annual basis if a preliminary review indicates they may be eligible.
Provisions
· Allows for certification instead of licensure of health plans to ensure financial solvency by AHCCCS.
· Requires that, beginning January 1, 2006, persons who are dually eligible for Medicaid and Medicare obtain available medications through a Medicare licensed or certified Medicare Advantage prescription drug plan, a Medicare prescription drug plan or any other entity authorized by Medicare to provide a Medicare Part D prescription drug benefit.
· Clarifies that persons receiving behavioral health services must submit an application for KidsCare if a preliminary review indicates they may be eligible.
· Requires persons receiving behavioral health services through DHS who have not been determined eligible for Medicare or its prescription drug benefit to apply for eligibility on an annual basis if a preliminary review indicates they may be eligible.
· Provides an emergency clause and becomes effective upon the signature of the Governor.
· Makes technical and conforming changes.
Amendments
SB 1137 was amended in the Committee on Health as follows:
· Permits AHCCCS to establish an eligibility process to determine whether a Medicare low income subsidy is available for persons who apply for the prescription drug benefit.
SB 1137 was amended in the Committee of the Whole to adopt the Health Committee amendment.
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47th Legislature
First Regular Session 2 April 8, 2005
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