C.M.R. 10, 144, ch. 104, § 144-104-4, subsec. 144-104-4.04

Current through 2024-51, December 18, 2024

Subsection 144-104-4.04 - PARTICIPATION IN MEDICARE PART D WRAP BENEFITS

Participants must exhaust other pharmacy benefits including Medicare Part D and Maine Care before using benefits under this Section.

4.04-1Authorized Representative

The Department may act as an authorized representative for or appoint a designee to act as an authorized representative for participants who are eligible for Medicare Part D.

As an authorized representative, the Department may:

a. deem eligible and enroll and reenroll participants in a Medicare Part D plan;

b. apply for Medicare Part D benefits and subsidies on behalf of enrollees;

c. establish rules by which enrollees may opt out of participation in Medicare Part D; and

d. at its discretion, file exceptions and appeals pertaining to Medicare Part D eligibility or benefits on behalf of enrollees.

4.04-2Coverage of Drugs Excluded from Coverage under Medicare Part D

For participants who are eligible for Medicare Part D, the Department may provide coverage of drugs excluded by Medicare Part D to the same extent that coverage is available to participants who are not eligible for Medicare Part D.

C.M.R. 10, 144, ch. 104, § 144-104-4, subsec. 144-104-4.04