FIRST REGULAR SESSION
HOUSE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NO. 824
91ST GENERAL ASSEMBLY
TED WEDEL, Chief Clerk
AN ACT
To repeal section 135.095, RSMo 2000, and to enact in lieu thereof one new section relating to a pharmaceutical investment program for seniors, with an effective date.
Section A. Section 135.095, RSMo 2000, is repealed and one new section enacted in lieu thereof, to be known as section 208.550, to read as follows:
208.550. 1. As used in this section, the following terms mean:
(1) "Department", the department of social services;
(2) "Medicaid", the program for medical assistance established pursuant to Title XIX of the federal Social Security Act and administered by the department;
(3) "Missouri adjusted gross income", the amount of income reported on the Missouri income tax return, as defined in section 143.121, RSMo. For purposes of this section, any individual not required to file a Missouri income tax return shall calculate Missouri adjusted gross income on a form as prescribed by the director of the department of social services. For purposes of this section, Missouri adjusted gross income shall be the Missouri adjusted gross income of the applicant for the previous tax year;
(4) "Missouri resident", an individual who establishes residence for a period of six months in a settled or permanent home or domicile within the state of Missouri with the intention of remaining in this state. An individual is a resident of this state until the individual establishes a permanent residence outside this state;
(5) "Program", the pharmaceutical investment program for seniors (PIPS) established pursuant to this section.
2. The department of social services shall establish a "Pharmaceutical Investment Program for Seniors" to help defray the costs of prescription drugs for elderly Missouri residents. The following Missouri residents shall be eligible to participate in the program:
(1) Any person sixty-five years of age or older, with a Missouri adjusted gross income at or below twenty-five thousand dollars and a total family Missouri adjusted gross income of fifty thousand dollars or less who is not currently ineligible pursuant to subsection 3 of this section or receiving Medicaid benefits. Such person shall demonstrate that his or her estimated annual prescription drug costs will exceed one thousand five hundred dollars;
(2) For a married couple in which at least one spouse is sixty-five years of age or older, with an annual Missouri adjusted gross income at or below fifty thousand dollars, and neither person is currently ineligible pursuant to subsection 3 of this section or receiving Medicaid benefits:
(a) If only one spouse is sixty-five years of age or older, such spouse shall be eligible if his or her Missouri adjusted gross income is at or below twenty-five thousand dollars and his or her estimated annual prescription drug costs will exceed one thousand five hundred dollars;
(b) If both spouses are sixty-five years of age or older, both spouses shall be eligible if their estimated annual prescription drug costs will exceed three thousand dollars;
(3) Any person sixty-five years of age or older, with a Missouri adjusted gross income in excess of twenty-five thousand dollars and a total family Missouri adjusted gross income in excess of fifty thousand dollars who is not currently ineligible pursuant to subsection 3 of this section or receiving Medicaid benefits, if such person's estimated annual pharmaceutical costs will exceed ten percent of such person's Missouri adjusted gross income. Such person shall be eligible to participate in the program after such person has expended ten percent of his or her Missouri adjusted gross income; or
(4) A married couple in which both persons are sixty-five years of age or older, with a family Missouri adjusted gross income in excess of fifty thousand dollars who are not currently ineligible pursuant to subsection 3 of this section or receiving Medicaid benefits, if such couple's estimated annual pharmaceutical costs will exceed ten percent of such couple's family Missouri adjusted gross income. Such couple shall be eligible to participate in the program after such couple has expended ten percent of their family Missouri adjusted gross income.
3. Any person who has coverage for pharmaceutical benefits through a health benefit plan, as defined in section 376.1350, RSMo, including a Medicare supplement or Medicare-Choice plan, or through a self-funded employee benefit plan shall not be eligible to participate in the pharmaceutical investment program for seniors. The department shall define by rule those persons who shall be defined as eligible for comparable pharmaceutical benefits or who have income sufficient to purchase other pharmaceutical benefits. Persons eligible for comparable pharmaceutical benefits or who have income sufficient to purchase comparable pharmaceutical benefits shall not be eligible to participate in the pharmaceutical investment program created in this section.
4. Applicants for the program shall submit an annual application to the department, or the department's designee, that attests to the age, residence, annual household income and estimated annual prescription drug costs for an individual or couple, if married. The department shall prescribe by rule the form of the application for enrollment in the program.
5. Upon notification of eligibility, an enrollee may access the program by meeting the cost-sharing obligation through a monthly deductible calculated and based on one of the following:
(1) If the enrollee's Missouri adjusted gross income is at or below twelve thousand dollars for an individual or twenty-four thousand dollars for a couple, the monthly deductible is one-twelfth of eight hundred dollars for an individual or one-twelfth of sixteen hundred dollars for a couple;
(2) If the enrollee's Missouri adjusted gross income is between twelve thousand one dollars and sixteen thousand dollars for an individual or twenty-four thousand one dollars and thirty-two thousand dollars for a couple, the monthly deductible is one-twelfth of one thousand two hundred fifty dollars for an individual or one-twelfth of twenty-five hundred dollars for a couple; or
(3) If the enrollee's Missouri adjusted gross income is between sixteen thousand one dollars and twenty-five thousand dollars for an individual or thirty-two thousand one dollars and fifty thousand dollars for a couple, or the enrollee meets the requirements of subdivision (3) or (4) of subsection 2 of this section, the monthly deductible is one-twelfth of one thousand five hundred dollars for an individual or one-twelfth of three thousand dollars for a couple.
For any month in which the enrollee does not meet the deductible, the difference between the monthly deductible and the actual expenditure on prescription drugs shall be added to the next month's deductible.
6. Every applicant shall be assessed for Medicaid eligibility. Nothing in this section shall be construed as requiring an applicant to accept Medicaid benefits in lieu of participation in this program.
7. Enrollees shall pay a two dollar co-payment for a generic prescription drug or a brand name prescription drug when a recognized generic drug is not available and a fifteen dollar co-payment for a brand name prescription drug when a recognized generic prescription drug is available. Such co-payment shall be used to reduce the state's cost for the program. In addition, each enrollee shall pay an annual twenty-five dollar co-payment to offset the administrative costs of the program. Nothing in this subsection shall be construed as permitting therapeutic substitutions.
8. In providing program benefits, the department may enter into a contract with a private individual, corporation or agency to manage the program and take measures necessary to obtain the best available quarterly voluntary manufacturer rebate. The dispensing rate and ingredient reimbursement rate shall be equal to the Medicaid reimbursement rate.
9. The department shall collaborate with the division of aging in the department of health and utilize area agencies on aging, senior citizens centers and other senior focused entities to provide outreach, enrollment assistance and education services to potentially eligible seniors for the pharmaceutical investment program for seniors.
10. The department shall submit quarterly reports to the governor, the senate appropriations committee, and the house of representatives budget committee, the speaker of the house of representatives and the president pro tem of the senate, that include:
(1) Quantified data as to the number of program applicants and enrollees subsequently found eligible for Medicaid;
(2) An estimate of whether the current rate of expenditures will exceed the existing appropriation for the program in the current fiscal year; and
(3) Recommendations for changes to the deductibles and co-payments for enrollees in the program.
11. The program established in this section is not an entitlement. The pharmaceutical investment program for seniors is a payer of last resort. If the federal government establishes a pharmaceutical assistance program that covers program eligible seniors under Medicare or another program, the pharmaceutical insurance program for seniors shall cover only eligible costs not covered by the federal program.
12. The department may promulgate rules to implement the provisions of this section. No rule or portion of a rule promulgated pursuant to the authority of this section shall become effective unless it has been promulgated pursuant to chapter 536, RSMo.
[135.095. For all tax years beginning on or after January 1, 1999, but before January 1, 2005, a resident individual who has attained sixty-five years of age on or before the last day of the tax year shall be allowed, for the purpose of offsetting the cost of legend drugs, a maximum credit against the tax otherwise due pursuant to chapter 143, RSMo, not including sections 143.191 to 143.265, RSMo, of two hundred dollars. An individual shall be entitled to the maximum credit allowed by this section if the individual has a Missouri adjusted gross income of fifteen thousand dollars or less; provided that, no individual who receives full reimbursement for the cost of legend drugs from Medicare or Medicaid, or who is a resident of a local, state or federally funded facility shall qualify for the credit allowed pursuant to this section. If an individual's Missouri adjusted gross income is greater than fifteen thousand dollars, such individual shall be entitled to a credit equal to the greater of zero or the maximum credit allowed by this section reduced by two dollars for every hundred dollars such individual's income exceeds fifteen thousand dollars. The credit shall be claimed as prescribed by the director of the department of revenue. Such credit shall be considered an overpayment of tax and shall be refundable even if the amount of the credit exceeds an individual's tax liability.]
Section B. Section 208.550 of section A of this act shall become effective July 1, 2002.
Missouri House of Representatives