CCS SS SCS HS HCS HB 3 -- MISSOURI SENIOR Rx PROGRAM

This bill establishes a Missouri Senior Rx Program for eligible
seniors who reside in Missouri.  In its main provisions, the
bill:

(1)  Repeals the current $200 prescription tax credit for
eligible seniors;

(2)  Revises the income level used to determine eligibility for
persons to receive Medicaid.  On or after July 1, 2002, the
income level is increased to 80% of the federal poverty level;
on July 1, 2003, the income level is increased to 90% of the
federal poverty level; and on July 1, 2004, the income level is
increased to 100% of the federal poverty level;

(3)  Allows the Department of Social Services to apply to the
federal Department of Health and Human Services for a Section
1115 Medicaid demonstration waiver or any other waivers which
are necessary to implement the increased income level for
persons eligible for Medicaid;

(4)  Establishes a 15-member Commission for the Missouri Senior
Rx Program within the Division of Aging in the Department of
Health and Senior Services.  The composition, appointment, and
selection of members and duties of the commission are contained
in the bill;

(5)  Establishes the Missouri Senior Rx Program within the
Division of Aging in the Department of Health and Senior
Services.  Various terms are defined;

(6)  Requires the commission to govern the program and to
solicit requests for proposals to administer the program from
private contractors.  The commission can administer the
pharmaceutical rebate program or contract with the Division of
Medical Services to administer the pharmaceutical rebate program;

(7)  Requires the commission to select a responsive,
cost-effective bid from the submitted proposals to administer
the program.  If no bids are received, the program will be
jointly administered by the Department of Health and Senior
Services and the Department of Social Services;

(8)  Sets eligibility criteria for participation in the
program.  Residents are eligible to apply to the program if they
are 65 years of age, have not received pharmaceutical benefits
for at least 6 months prior to applying to the program, have not
received Medicaid benefits, and meet income eligibility
guidelines.  Retirees who previously had health insurance before
retirement are not subject to the 6-month waiting period before
applying to the program.  Individuals who have benefits with a
actuarial value greater than or equal to the benefits in the
program are excluded from participation;

(9)  Establishes income eligibility levels for participation in
the program.  Individuals with an income up to $12,000 or
$17,000 are eligible to apply to the program.  Married couples
with an income up to $17,000 or $23,000 are eligible to apply to
the program;

(10)  Makes the program the payer of last resort and not an
entitlement;

(11)  Requires that seniors submit an annual application to the
Division of Aging or the division's designee.  The commission
will develop and implement a means test requiring applicants to
meet the income requirement of the program.  In addition,
eligible enrollees are required to pay an annual enrollment fee
of $25 or $35 based on marital status and income level.  The
enrollment fees can be adjusted as stated.  Information supplied
by applicants and enrollees is confidential;

(12)  Prohibits requiring applicants to accept Medicaid benefits
in lieu of participating in the program;

(13)  Requires that participants pay an annual deductible to
participate in the program.  Initial deductible amounts are $250
or $500 per participant, depending on marital status and
household income;

(14)  Requires that enrollees pay 40% of the purchase price of
prescription drugs;

(15)  Establishes an annual program benefit limit of $5,000 per
enrollee;

(16)  Allows the Department of Health and Senior Services to
enter into a contract with any private individual, corporation,
or agency to implement the program;

(17)  Requires the division to utilize Area Agencies on Aging,
senior citizen centers, and related entities to provide
outreach, enrollment assistance, and education relating to the
program.  The division and the third party administrator are
responsible for informing eligible seniors about pharmaceutical
company benefits and other information;

(18)  Requires the commission to submit quarterly reports to the
Governor, Senate Appropriations Committee, House of
Representatives Budget Committee, Speaker of the House of
Representatives, and President Pro Tem of the Senate;

(19)  Requires that program benefits be supported by moneys
appropriated by the General Assembly and other available funds;

(20)  Requires the commission to direct the third party
administrator to implement cost control measures if projected
costs exceed the current program appropriation;

(21)  Requires the program to cover eligible costs not covered
by a federal pharmaceutical assistance program if established;

(22)  Requires the commission to develop rules to implement the
program;

(23)  Makes any person who engages in fraudulent activities in
order to participate in the program guilty of a misdemeanor and
forfeits his or her rights to participate in the program;

(24)  Requires the program to be operational by July 1, 2002.
An initial enrollment period will be from April 1, 2002, through
May 30, 2002.  Beginning with the enrollment period for fiscal
year  2004, open enrollment periods will be held from January 1
through February 28;

(25)  Allows an individual a 30-day enrollment period outside
the established enrollment periods;

(26)  Requires that the program use generic prescription drugs
when available.  Enrollees may receive brand name prescription
drugs when a generic prescription drug is available only if both
the prescribing physician and the enrollee request the brand
name prescription drug, the enrollee pays the co-insurance on
the generic drug, and the enrollee pays the difference in price
between the brand name drug and the generic drug;

(27)  Requires that pharmacists participating in the program be
reimbursed for costs resulting from obtaining and dispensing
medications.  Reimbursement formulas for brand name and generic
medications are contained in the bill;

(28)  Requires the division to issue a certificate of
participation to pharmaceutical manufacturers who participate in
the program.  A manufacturer can apply for participation in the
program by submitting an application approved by the
commission.  The length of participation, renewal provisions,
and confidentiality provisions are contained in the bill;

(29)  Requires pharmaceutical manufacturers to provide rebates
under the program.  Rebates for brand name and generic
prescription drugs will be 15%.  Rebates will be used to fund
the program;

(30)  Prohibits a pharmaceutical manufacturer's status under the
current Medicaid program from being affected if the manufacturer
refuses to participate in the program;

(31)  Creates a Missouri Senior Rx Program Fund which will be
administered by the State Treasurer.  The revenue sources for
the fund are specified in the bill, and funds will not revert to
the General Revenue Fund;

(32) Establishes the Missouri Senior Rx Clearinghouse within the
commission, subject to appropriations.  The purposes of the
clearinghouse are specified in the bill; and

(33) Requires that the Missouri Senior Rx Program be
re-authorized every 4 years.

The bill contains an emergency clause.

Missouri House of Representatives
Last Updated October 19, 2001 at 4:30 pm