Source: https://www.law.cornell.edu/cfr/text/42/403.816
Timestamp: 2017-04-27 14:59:01
Document Index: 130369161

Matched Legal Cases: ['art 403', '§ 403', '§ 403', '§ 403', '§ 403', '§ 403', '§ 403', '§ 403']

42 CFR 403.816 - Special rules concerning long-term care and I/T/U pharmacies. | US Law | LII / Legal Information Institute
CFR › Title 42 › Chapter IV › Subchapter A › Part 403 › Subpart H › Section 403.816 42 CFR 403.816 - Special rules concerning long-term care and I/T/U pharmacies.
§ 403.816 Special rules concerning long-term care and I/T/U pharmacies.
(1) An applicant for endorsement may submit an application to become a special endorsed sponsor for long-term care and/or for I/T/U pharmacies.
(b)Long-term care. A special endorsed sponsor for long-term care must - (1) Apply transitional assistance toward the cost of covered discount card drugs obtained by transitional assistance enrollees who reside in long-term care facilities and who receive such prescription drugs through long-term care pharmacies;
(4) Include special terms and conditions in its contracts with network pharmacies that are long-term care pharmacies to facilitate access to and the administration of transitional assistance to transitional assistance enrollees residing in long-term care facilities, including, but not limited to the following - (i) Waiving penalties against long-term care pharmacies for submitting late claims to the special endorsed sponsor due to the pharmacy's coordination of benefits activities; and
(5) Except as noted in paragraph (c) of this section, comply with all requirements for endorsed sponsors noted in §§ 403.804 and 403.806.
(c)Waiver of requirements.
(1) The following requirements will not apply to or will be waived for special endorsed sponsors providing transitional assistance to long-term care residents:
(i) As the Secretary determines appropriate on a case-by-case basis, any additional requirements discussed in §§ 403.804 and 403.806, except for the requirements in §§ 403.812 and 403.813, may be waived or modified on behalf of a special endorsed sponsor for long-term care if the waiver or modification is - (A) Necessary to enable the applicant to either initiate enrollment activities under the special endorsement within 6 months of enactment of section 1860D-31 of the Act, or accommodate the unique needs of long-term care pharmacies; or
(d)I/T/U pharmacies. A special endorsed sponsor for I/T/U pharmacies must - (1) Apply transitional assistance toward the cost of covered discount card drugs obtained by transitional assistance enrollees who are American Indians and Alaska Natives and who receive prescription drugs through I/T/U pharmacies as allowed under paragraph (d)(2) of this section;
(4) Except as noted in paragraph (e) of this section, comply with all requirements for endorsed sponsors noted in §§ 403.804 and 403.806.
(e)Waiver of requirements.
(1) The following requirements will not apply to or will be waived for special endorsed sponsors providing transitional assistance through I/T/U pharmacies:
(i) As the Secretary determines appropriate on a case-by-case basis, any additional requirements discussed in §§ 403.804 and 403.806, except for the requirements in §§ 403.812 and 403.813, may be waived or modified on behalf of a special endorsed sponsor for I/T/U pharmacies if the waiver or modification is - (A) Necessary to enable the applicant to either initiate enrollment activities under the special endorsement within 6 months of enactment of section 1860D-31 of the Act, or accommodate the unique needs of I/T/U pharmacies; or