N.J. Admin. Code § 10:167-4.5

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:167-4.5 - Medicare Part D Prescription Drug Plan premium payments

(a) The Department shall pay Medicare Part D premiums to the PDP on behalf of PAAD beneficiaries in accordance with the Fiscal Year 2016 Appropriations Act, P.L. 2015, c. 63, approved June 26, 2015, as amended and supplemented by subsequent State appropriations acts.

1. If the PDP is a Medicare-authorized prescription drug plan associated with a Medicare-managed care plan (MA-PD), the PAAD program shall pay an amount towards the prescription portion of the premium up to and including the benchmark amount set for New Jersey by CMS for the current benefit year pursuant to 42 CFR 423.780(b)(2), as amended and supplemented, which is incorporated herein by reference.

2. If the PDP is an MA-PD and the premium cost is above the benchmark amount set for New Jersey by CMS, the PAAD beneficiary shall be responsible for any premium costs that are above the benchmark amount.

N.J. Admin. Code § 10:167-4.5

New Rule, R.2009 d.16, effective 1/5/2009.
See: 40 N.J.R. 4479(a), 41 N.J.R. 221(a).

Amended by 48 N.J.R. 1366(b), effective 7/5/2016