C.M.R. 10, 144, ch. 104, § 144-104-2, subsec. 144-104-2.04

Current through 2024-51, December 18, 2024

Subsection 144-104-2.04 - PARTICIPATION IN MEDICARE PART D

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

2.04-1 Authorized Representative

The Department may act as an authorized representative for or appoint a designee to act as an authorized representative for participants who are dually eligible for DEL and 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 participants;

c. establish rules by which participants 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 participants.

2.04-2 Participants Dually Eligible for 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, § 144-104-2, subsec. 144-104-2.04