STATE OF HAWAII
DEPARTMENT OF HUMAN SERVICES
MED-QUEST DIVISION
NOTICE OF PUBLIC HEARING
Pursuant to sections 91-3 and 92-41, Hawaii Revised Statutes, notice is hereby given that the Department of Human Services will hold a public hearing to consider proposed amendments to existing rules, and the adoption of new rules of the Med-QUEST Division for the purpose of conforming to State and Federal Statutes.
The proposed amendments are based on State and Federal laws. Brief descriptions of the proposed changes are listed below.
CHAPTER 17-1722 SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS
CHANGES MADE:
Changes were made to Subchapter 12, State Pharmacy Assistance Program (SPAP), by the 2006 Legislature and signed as SLH 2006, Act 264 by the Governor. The revision to the statute increased the eligible income limit for the program participants from one hundred per cent of the federal poverty level (FPL) to one hundred fifty per cent of the federal poverty level. All or some of the required co-payments or co-insurance actually paid for eligible prescriptions covered under the Medicare Part D program will be covered by the State for persons with up to one-hundred fifty per cent of the FPL and are enrolled in a Medicare benchmark prescription drug plan.
1. §17-1722-116, General provisions. Subsection (a) is amended to add co-insurance for prescriptions under Medicare Part D, in addition to the co-payments, as what the SPAP program may pay for. A correction is made to a typographical error. Subsection (b) is amended to add benchmark to any CMS approved prescription drug plan that the Department shall work with to provide coordination of benefits between SPAP and the Medicare Part D Prescription Drug Benefit Program.
2. §17-1722-117, Definitions. This section is amended to add the definitions of the benchmark prescription drug plan, co-insurance, co-payment, Medicare Advantage Prescription Drug (MA-PD) plan and SLMB and to delete the definition of PACE.
3. §17-1722-118, Application requirements. Subsection (a) is amended by changing the federal poverty level from one hundred per cent to one hundred fifty per cent and to add SLMB as those who are automatically eligible for the SPAP program.
4. §17-1722-119, Eligibility requirements. Paragraph (2) is amended to correct a typographical error. Paragraph (3) is amended to change the Federal poverty level from one hundred per cent to one hundred fifty per cent. Paragraph (5) is amended to state that an individual cannot be receiving prescription drugs under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) through a retirement or union plan. Paragraph (6) is amended to state that an individual cannot have public assistance prescription coverage, with the exception of Medicare, Hawaii Rx Plus, and Medicaid. Paragraph (7) is amended to remove the provision that an individual cannot be enrolled in PACE as the PACE program terminated on July 1, 2007. Paragraph (8) is renumbered to (7) and amended to state that, to participate in SPAP, an individual cannot be enrolled in a government sponsored plan, in addition to, a private sector plan or any insurance that provides payments for prescription drugs. A new paragraph (8) is added to state that an individual shall be enrolled in a benchmark prescription drug plan established by CMS.
5. §17-1722-120, Benefits. Subsection (a) is amended to state that the SPAP program may pay all, or some of, the required co-payments or co-insurance actually paid for only drug claims defined as covered under the federal Medicare Part D Prescription Drug Benefit Program.
6. §17-1722-125, Termination. Subsection (a) paragraph (2) is amended to delete the provision that the participant no longer resides in the State as this is a duplicate eligibility requirement included in paragraph (1). Paragraph (3) is amended to delete the provision that an individual shall be terminated from SPAP when the individual has public assistance prescription coverage other than Medicare and Hawaii Rx Plus as this is a duplicate eligibility requirement included in paragraph (1). Paragraphs (4) through (8) are renumbered (2) through (6), respectively. Newly renumbered paragraph (6) is amended to state that an individual shall be terminated when there are insufficient funds in the SPAP special fund.
7. §17-1722-129, State pharmacy assistance program special fund. Subsection (b), paragraph (1) is amended to include co-insurance, in addition to co-payments required under the federal Medicare Part D Prescription Pharmacy Benefit Program, as being eligible for reimbursement payments to participating pharmacies.
A public hearing will be held at the following time and place:
Monday, December 10, 2007, 1:30 p.m., Liliuokalani Building, 1390 Miller Street, 2nd Floor Conference Rooms, Honolulu, Hawaii.
All interested parties are invited to attend the hearing and to state their views relative to the proposed rules either orally or in writing. Should written testimony be presented, five (5) copies shall be made available to the presiding officer at or before the public hearing to:
Department of Human Services
Med-QUEST Division
P. O. Box 700190
Kapolei, Hawaii 96709-0190
Residents of Hawaii, Kauai, Maui, and Molokai wishing to present oral testimonies may also contact the Med-QUEST Division on the respective islands no earlier than seven (7) days before the Honolulu hearing date to have their testimony recorded:
East Hawaii Section
88 Kanoelehua Avenue, Room 107
Hilo, Hawaii 96720 (933-0339)
West Hawaii Section
Lanihau Professional Center
75-5591 Palani Road, Ste. 3004
Kailua-Kona, Hawaii 96740 (327-4970)
Kauai Section
4473 Pahee Street, Suite A
Lihue, Hawaii 96766 (241-3575)
Maui Section
210 Imi Kala Street, Suite 101
Wailuku, Hawaii 96793 (243-5780)
Molokai Section
State Civic Center
65 Makaena Street, Room 110
Kaunakakai, Hawaii 96748 (553-1758)
Lanai Unit
Call toll free 1-800-894-5755
A copy of the proposed rules will be mailed at NO COST to any interested person by requesting a copy by writing to:
Department of Human Services
Med-QUEST Division
P. O. Box 700190
Kapolei, Hawaii 96709-0190
or by calling 692-8132. Neighbor island residents may request a copy of the proposed rules at NO COST by contacting the Med-QUEST Division Sections as noted above.
A copy of the proposed rule changes will be available for public viewing from the first working day that the legal notice appears in the Honolulu Star Bulletin, The Honolulu Advertiser, Hawaii Tribune Herald, West Hawaii Today, The Maui News, and The Garden Island, through the day the public hearing is held, from Monday – Friday between the hours of 7:45 a.m. to 4:30 p.m. at the appropriate Med-QUEST Division offices on their respective islands listed above. On Oahu, the proposed rules will be available at 601 Kamokila Boulevard, Room 518, Kapolei, Hawaii 96707 and 801 Dillingham Boulevard, 3rd Floor, Honolulu, Hawaii 96817.
Proposed rules are also available at the Virtual Rules Center located at the following website:
http://www.hawaii.gov/dhs/main/har/
Special accommodations (i.e. Sign Language Interpreter, large print, taped materials, or accessible parking) can be made, if requested at least seven (7) working days before the scheduled public hearing on Oahu by calling 692-8132. Neighbor island residents needing special accommodations should contact the Med-QUEST Division Sections on the respective islands with their requests.
DEPARTMENT OF HUMAN SERVICES
LILLIAN B. KOLLER, DIRECTOR
(SB05532673 11/8/07)
