Chapter 262

2004 -- S 2016 SUBSTITUTE A

Enacted 07/02/04

A N A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- PHARMACEUTICAL

ASSISTANCE TO THE ELDERLY ACT

Introduced By: Senators Roberts, Paiva-Weed, Perry, Goodwin, and Gibbs

Date Introduced: January 08, 2004

It is enacted by the General Assembly as follows:

     SECTION 1. Section 42-66.2-5 of the General Laws in Chapter 42-66.2 entitled

"Pharmaceutical Assistance to the Elderly Act" is hereby amended to read as follows:

42-66.2-5. Persons eligible. -- (a) Persons eligible for assistance under the provisions of

this chapter include any resident of the state who is at least sixty-five (65) years of age or at least

fifty-five (55) years of age and receiving social security disability benefits. State and consumer

co-payment shares for these persons shall be determined as follows:

      (1) For unmarried persons or married persons living separate and apart whose income for

the calendar year immediately preceding the year in which assistance is sought is:

      (i) Less than fifteen thousand nine hundred and thirty-two dollars ($15,932) the state

shall pay sixty percent (60%) of the cost of the prescriptions and the consumer shall pay forty

percent (40%) of the cost of the prescriptions;

      (ii) More than fifteen thousand nine hundred and thirty-two dollars ($15,932) and less

than twenty thousand dollars ($20,000), the state shall pay thirty percent (30%) of the cost of the

prescriptions and the consumer shall pay seventy percent (70%) of the cost of the prescriptions;

and

      (iii) More than twenty thousand dollars ($20,000) and less than thirty-five thousand

dollars ($35,000), the state shall pay fifteen percent (15%) of the cost of prescriptions and the

consumer shall pay eighty-five percent (85%) of the cost of prescriptions.

      (2) For married persons whose income for the calendar year immediately preceding the

year in which assistance is sought hereunder when combined with any income of the person's

spouse in the same year is:

      (i) Nineteen thousand nine hundred and sixteen dollars ($19,916) or less, the state shall

pay sixty percent (60%) of the cost of the prescriptions and the consumer shall pay forty percent

(40%) of the cost of the prescriptions;

      (ii) More than nineteen thousand nine hundred and sixteen dollars ($19,916) and less

than twenty-five thousand dollars ($25,000), the state shall pay thirty percent (30%) of the cost of

the prescriptions and the consumer shall pay seventy percent (70%) of the cost of prescriptions;

and

      (iii) More than twenty-five thousand dollars ($25,000) and less than forty thousand

dollars ($40,000), the state shall pay fifteen percent (15%) of the cost of prescriptions and the

consumer shall pay eighty-five percent (85%) of the cost of prescriptions.

      (3) Eligibility may also be determined by using income data for the ninety (90) days

prior to application for benefits and projecting that income on an annual basis. The income levels

shall not include those sums of money expended for medical and pharmaceutical that exceed

three percent (3%) of the applicant's annual income or three percent (3%) of the applicant's

preceding ninety (90) day income computed on an annual basis.

      (4) For persons on social security disability benefits who are: (i) unmarried or married

and living separate and apart with income for the calendar year immediately preceding the year in

which assistance is sought that is less than thirty-seven thousand one hundred and sixty-seven

dollars ($37,167); or (ii) married with income that is less than forty-two thousand four hundred

seventy-six dollars ($42,476), the state shall pay fifteen percent (15%) of the cost of prescriptions

and the consumer shall pay eighty-five percent (85%) of the cost.

      (b) On July 1 of each year, the maximum amount of allowable income for both

unmarried and married residents set forth in subsection (a) shall be increased by a percentage

equal to the percentage of the cost of living adjustment provided for social security recipients.

      (c) [Effective until December 31, 2003.]Notwithstanding the foregoing provisions of this

section, no person whose prescription drug expenses are paid or reimbursable, either in whole or

in part, by any other plan of assistance or insurance is eligible for assistance under this section,

until the person's prescription drug coverage for a specific covered prescription medication is

exhausted or the specific prescription medication is not covered by the plan during a benefit year,

and as provided in subsection (d). No person whose prescription drug expenses are paid or

reimbursable, either in whole or in part, by any other plan of assistance or insurance is eligible for

assistance under this section, until the person’s prescription drug coverage for a specific covered

prescription medication is exhausted or the specific prescription medication is not covered by the

plan during a benefit year, and as provided in subsection (d).

(c) [Effective December 31, 2003.]Notwithstanding the foregoing provisions of this

section, no person whose prescription drug expenses are paid or reimbursable, either in whole or

in part, by any other plan of assistance or insurance is eligible for assistance under this section,

until the person's prescription drug coverage is exhausted during a benefit year, and as provided

in subsection (d).

      (d) [Effective until December 31, 2003.]The fact that some of a person's prescription

drug expenses are paid or reimbursable under the provisions of medicare shall not disqualify that

person, if he or she is otherwise eligible, to receive assistance under this chapter. In those cases,

the state shall pay the eligible percentage of the cost of those prescriptions for qualified drugs for

which no payment or reimbursement is made by the federal government. The fact that some of a

person’s prescription drug expenses are paid or reimbursable under the provisions of the federal

medicare program shall not disqualify that person, if he or she is otherwise eligible, to receive

assistance under this chapter. In those cases, the state shall pay the eligible percentage of the cost

of those prescriptions for qualified drugs for which no payment or reimbursement is made by the

federal government.

(d) [Effective December 31, 2003.]The fact that some of a person's prescription drug

expenses are paid or reimbursable under the provisions of medicare, part B, shall not disqualify

that person, if he or she is otherwise eligible, to receive assistance under this chapter. In those

cases, the state shall pay sixty percent (60%) of the cost of those prescriptions for qualified drugs

for which no payment or reimbursement is made by the federal government.

      (e) Eligibility for receipt of any other benefit under any other provisions of the Rhode

Island general laws as a result of eligibility for the pharmaceutical assistance program authorized

under this section shall be limited to those persons whose income qualify them for a sixty percent

(60%) state co-payment share of the cost of prescriptions.

      (f) For all additional drugs, the consumer shall pay one hundred percent (100%) of the

cost of prescriptions as set forth in section 42-66.2-4.

     SECTION 2. This act shall take effect upon passage.

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LC00513/SUB A

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