Md. Code Regs. 10.09.60.07

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.60.07 - Contracts with Prescription Drug Plan Sponsors

A. The Department may enter into contracts with prescription drug plan sponsors who have been approved by the Centers for Medicare and Medicaid Services to offer Medicare Part D plans in the State.

B. A prescription drug plan sponsor that enters into a contract with the Department shall agree to perform its obligations in a manner that complies with:

(1) Medicare Part D and any federal regulations adopted to implement Medicare Part D;

(2) The Program;

(3) The terms and conditions of the contract; and

(4) Guidance from the Centers for Medicare and Medicaid Services.

C. A contract entered into with the Department shall include provisions that require the prescription drug plan sponsor to:

(1) Coordinate with the Program in identifying member enrollees;

(2) Accept the premium subsidy on behalf of member enrollees;

(3) Apply the premium subsidy to the member enrollee's total premium costs;

(4) Separately bill member enrollees for any premium owed in excess of the premium subsidy paid by the Program;

(5) Account for the subsidies received from the Program;

(6) Communicate in writing with member enrollees, including notifying member enrollees of their enrollment status;

(7) Share enrollment data and information with the Department;

(8) Report data and enrollment information as required by the Department;

(9) Reconcile Program and member payments with enrollment data; and

(10) Transmit information to appropriate third-parties, including the Administrator and the Centers for Medicare and Medicaid Services .

Md. Code Regs. 10.09.60.07

Regulations .07 adopted as an emergency provision effective July 1, 2003 (30:16 Md. R. 1072); adopted permanently effective August 18, 2003 (30:16 Md. R. 1075)
Regulations .07 Maryland Pharmacy Program repealed and new Regulations .01-.24 Primary Adult Care Program-Eligibility adopted as an emergency provision effective July 1, 2006 (33:15 Md. R. 1274); adopted permanently effective September 25, 2006 (33:19 Md. R. 1560)
Regulation .07 amended effective April 1, 2009 (36:6 Md. R. 490)
Regulation .07 repealed effective 42:3 Md. R. 316, eff.2/16/2015; amended effective 44:3 Md. R. 188, eff. 2/13/2017