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<section article="ghg" article_name="Health - General" number="15-124.3" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Enrollee” means an individual who is enrolled in the Program.</text>
    </level>
    <level label="3">
      <text>“Medicare Modernization Act” means the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003.</text>
    </level>
    <level label="4">
      <text>“Medicare Part D prescription drug benefit” means the prescription drug benefit established by the Medicare Modernization Act under Part D of the federal Medicare Program.</text>
    </level>
    <level label="5">
      <text>“Prescription drug plan” means a private health plan that provides a Medicare Part D prescription drug benefit in accordance with the requirements of the Medicare Modernization Act.</text>
    </level>
    <level label="6">
      <text>“Program” means the Medicare Option Prescription Drug Program established under this section.</text>
    </level>
  </level>
  <level label="b">
    <text>There is a Medicare Option Prescription Drug Program within the Maryland Medical Assistance Program.</text>
  </level>
  <level label="c">
    <text>The purpose of the Program is to:</text>
    <level label="1">
      <text>Assist low–income Medicare eligible individuals to make a seamless transition to, and coordinate prescription drug coverage with, the Medicare Part D prescription drug benefit; and</text>
    </level>
    <level label="2">
      <text>Minimize the cost–sharing burden on the individuals.</text>
    </level>
  </level>
  <level label="d">
    <text>The Program shall be administered and operated by the Department as permitted by federal law or waiver.</text>
  </level>
  <level label="e">
    <level label="1">
      <text>The Program shall be open to any individual who:</text>
      <level label="i">
        <text>Is a resident of the State;</text>
      </level>
      <level label="ii">
        <text>Is a Medicare beneficiary;</text>
      </level>
      <level label="iii">
        <text>Is not enrolled in a Medicare Advantage Plan or other public or private insurance program, except for Medicaid and the Maryland Pharmacy Assistance Program, that provides prescription drug benefits at the time that the individual applies for enrollment in the Program;</text>
      </level>
      <level label="iv">
        <text>Has an annual household income below 150 percent of the federal poverty level; and</text>
      </level>
      <level label="v">
        <text>Meets the asset test established by the Medicare Modernization Act under Medicare Part D.</text>
      </level>
    </level>
    <level label="2">
      <text>Individuals who are dually eligible for Medicare and Medicaid, or Medicare and the Maryland Pharmacy Assistance Program, may be enrolled automatically in the Program, provided that they may elect to opt out of the Program.</text>
    </level>
    <level label="3">
      <text>Enrollment in the Program for individuals who are dually eligible for Medicare and Medicaid shall begin not later than the date on which the auto–enrollment period for the federal Medicare Part D Program begins.</text>
    </level>
    <level label="4">
      <text>The Department shall determine the procedures for automatic enrollment in, and election to opt out of, the Program.</text>
    </level>
    <level label="5">
      <text>Individuals who meet the eligibility requirements of paragraph (1) of this subsection but who are not dually eligible for Medicare and either Medicaid or the Maryland Pharmacy Assistance Program may apply for enrollment in the Medicare Option Prescription Drug Program by submitting an application to the Department.</text>
    </level>
  </level>
  <level label="f">
    <text>The Department may:</text>
    <level label="1">
      <text>Enter into a contract with one or more prescription drug plans to coordinate the prescription drug benefits provided under the Program and the Medicare Part D prescription drug benefit;</text>
    </level>
    <level label="2">
      <text>Require a pharmaceutical manufacturer to provide rebates in an amount not less than the rebates provided to the Medicaid Program under § 1927(c) of Title XIX of the Social Security Act (42 U.S.C. § 1396r–8) as a condition of the pharmaceutical manufacturer’s products being available to enrollees;</text>
    </level>
    <level label="3">
      <text>Enroll eligible individuals into a prescription drug plan under contract with the Department, with an opt–out provision at the individual’s discretion;</text>
    </level>
    <level label="4">
      <text>Specify procedures for individuals to apply for enrollment in the Program;</text>
    </level>
    <level label="5">
      <text>Contract with a private entity to assist in administration of the Program or negotiations with prescription drug plans; and</text>
    </level>
    <level label="6">
      <text>Pay all or part of the premiums, deductibles, coinsurance payments, and copayments required under the Medicare Part D Program for enrollees.</text>
    </level>
  </level>
  <level label="g">
    <text>Subject to available funds, the Program established under this subtitle shall provide benefits to the maximum number of individuals eligible for enrollment in the Program.</text>
  </level>
  <level label="h">
    <text>The Secretary shall adopt regulations to implement the Program.</text>
  </level>
</section>
