46th legislature - STATE OF NEW MEXICO - first session, 2003

RELATING TO PRESCRIPTION DRUGS; CREATING A PRESCRIPTION DRUG PROGRAM FOR SENIORS; ENACTING SECTIONS OF THE NMSA 1978; MAKING AN APPROPRIATION.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

Section 1. SHORT TITLE.--This act may be cited as the "Senior Rx Act".

Section 2. SENIOR RX PROGRAM CREATED.--

A. The department of health shall enter into a contract with a private insurer that transacts health or prescription drug insurance in the state to arrange for the availability, at a reasonable cost, of policies that provide coverage for prescription drugs and pharmaceutical services. The department of health may contract with more than one private insurer as may be necessary for access, delivery or cost.

B. The department of health shall not permit the insurer to impose a formulary that is more restrictive than a formulary the insurer concurrently offers in the commercial marketplace.

C. Subject to the availability of state funds, a person who purchases an insurance policy pursuant to Subsection A of this section is entitled to a subsidy grant from the senior Rx fund to cover a portion of the cost of that insurance if the person meets the eligibility criteria established by the department of health.

D. The amount of a subsidy granted by the Senior Rx Act shall not exceed the lesser of the annual cost of an insurance policy pursuant to Subsection A of this section or five hundred dollars ($500) per year.

Section 3. ELIGIBILITY.--A person is eligible to participate in the senior Rx program if the person:

A. is at least sixty-two years of age at the time of enrollment;

B. is ineligible for medicaid;

C. is ineligible for or unable to purchase other prescription drug coverage under a public or private insurance plan or program; and

D. has been domiciled in the state for at least one year prior to the date of enrollment.

Section 4. SUBSIDY GRANT.--

A. The department of health shall establish a schedule of available subsidy grants to assist an eligible person to purchase insurance for prescription drugs. The department of health shall establish a sliding scale for the subsidy grants based on a percentage of the federal poverty guidelines published annually by the federal department of health and human services. The department of health shall consider the number of persons in and the total income of the household in which the applicant resides.

B. The department of health shall pay the subsidy directly to the insurer with whom the department of health has entered into a contract pursuant to Section 2 of the Senior Rx Act. The department of health shall notify the eligible person for whom the subsidy grant is paid.

C. A subsidy granted pursuant to Section 2 of the Senior Rx Act to a person who is subsequently found to be not qualified for a subsidy grant may be revoked by the department of health. The person shall make restitution to the department of health for a subsidy grant that the department of health determines should be revoked and the department of health may take appropriate action to collect the amount of the subsidy grant as a debt. An amount received by the department of health pursuant to restitution or recovery shall be deposited in the senior Rx fund.

Section 5. APPLICATION PROCESS.--

A. A person who wishes to receive a subsidy grant pursuant to the Senior Rx Act shall file a request with the department of health.

B. The request shall be filed in form and content as the department of health may prescribe, including verifiable proof of domicile and income.

C. The department of health shall, within thirty days after receiving a request for a subsidy grant, examine the request, grant or deny it, and if granted, determine the amount of the subsidy for which the person is eligible. The department of health shall notify the applicant in writing of the decision to grant or deny the application.

D. A person who is aggrieved by a decision of the department of health denying the request for a subsidy grant may request a hearing for a reconsideration of the denial by a person not involved in the original decision.

Section 6. SENIOR RX FUND CREATED.--The "senior Rx fund" is created in the state treasury. The department of health shall administer the fund to carry out the provisions of the Senior Rx Act. The department of health is authorized to transfer federal, state or other public or private funds that may be received as matching funds for the senior Rx fund.

Section 7. APPROPRIATION.--Five million dollars ($5,000,000) is appropriated from the tobacco settlement program fund to the senior Rx fund for expenditure in fiscal year 2004 for the department of health to carry out the provisions of the Senior Rx Act. Any unexpended or unencumbered balance remaining at the end of fiscal year 2004 shall revert to the tobacco settlement program fund.