Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-055 - State Plan Amendment #2005-005

Current through Register Vol. 49, No. 6, June, 2024
Agency
Citation (s)
Groups Covered
DCO
1935(a) and 1902(a)(66)
The agency provides for making Medicare prescription
						  drug Low Income Subsidy
42
						  CFR 423.774 and
						  423.904
determinations under Section 1935(a) of the Social
						  Security Act for those individuals who specifically request a state
						  determination.
1. The agency makes determinations of eligibility for
						  premium and cost-sharing subsidies under and in accordance with section
						  1860D-14 of the Social Security Act;
2. The agency provides for informing the Secretary of
						  such determinations in cases in which such eligibility is established or
						  redetermined;
3. The agency provides for screening of individuals for
						  Medicare cost-sharing described in Section 1905(p)(3) of the Act and offering
						  enrollment to eligible individuals under the State plan or under a waiver of
						  the State plan.
TN No.
05-05
Approval Date
11/17/05
Effective Date
November 1,
				2005
Supersedes
TNNo.
None, New Page
1935(d)(1)
Effective January 1, 2006, the Medicaid agency will not
						  cover any Part D drug for full-benefit dual eligible individuals who are
						  entitled to receive Medicare benefits under Part A or Part B.
Citation (s)
Provision (s)
1927(d)(2) and 1935(d)(2)
1. The Medicaid agency provides coverage, to the same
						  extent that it provides coverage for all Medicaid recipients, for the following
						  excluded or otherwise restricted drugs or classes of drugs, or their medical
						  uses - with the exception of those covered by Part D plans as supplemental
						  benefits through enhanced alternative coverage as provided in
						  42
						  CFR §
													423.104(f) (1) (ii)
						  (A) - to full benefit dual eligible
						  beneficiaries under the Medicare Prescription Drug Benefit -Part D.
42
						  CFR §
													423.104(f) (1) (ii)
						  (A)
__
The following excluded drugs are
						  covered:
HI
(a) agents when used for anorexia,
						  weight loss, weight gain (see specific drug categories below)
(b) agents when used to promote fertility (see specific
						  drug categories below)
(c) agents when used for cosmetic purposes or hair
						  growth (see specific drug categories below)
HI (d) agents when used for the symptomatic relief
						  cough and colds
HI (e) prescription vitamins and mineral products,
						  except prenatal vitamins and fluoride
HI (f) nonprescription drugs
1927(d)(2) and 1935(d)(2)
(g) covered outpatient drugs which the manufacturer
						  seeks to require as a condition of sale that associated tests or monitoring
						  services be purchased exclusively from the manufacturer or its designee (see
						  specific drug categories below)
HI (h) barbiturates
HI (i) benzodiazepines
(The Medicaid agency lists specific category of drugs
						  below)
__
No excluded drugs are covered.
1935(d)(1)
Effective January 1, 2006, the Medicaid agency will not
						  cover any Part D drug for full-benefit dual eligible individuals who are
						  entitled to receive Medicare benefits under Part A or Part B.
Citation (s)
Provision (s)
1927(d)(2) and 1935(d)(2)
1. The Medicaid agency provides coverage, to the same
						  extent that it provides coverage for all Medicaid recipients, for the following
						  excluded or otherwise restricted drugs or classes of drugs, or their medical
						  uses - with the exception of those covered by Part D plans as supplemental
						  benefits through enhanced alternative coverage as provided in
						  42
						  CFR §
													423.104(f) (1) (ii)
						  (A) - to full benefit dual eligible
						  beneficiaries under the Medicare Prescription Drug Benefit -Part D.
42
						  CFR §
													423.104(f) (1) (ii)
						  (A)
__
The following excluded drugs are
						  covered:
HI
(a) agents when used for anorexia,
						  weight loss, weight gain (see specific drug categories below)
(b) agents when used to promote fertility (see specific
						  drug categories below)
(c) agents when used for cosmetic purposes or hair
						  growth (see specific drug categories below)
HI (d) agents when used for the symptomatic relief
						  cough and colds
HI (e) prescription vitamins and mineral products,
						  except prenatal vitamins and fluoride
HI (f) nonprescription drugs
1927(d)(2) and 1935(d)(2)
(g) covered outpatient drugs which the manufacturer
						  seeks to require as a condition of sale that associated tests or monitoring
						  services be purchased exclusively from the manufacturer or its designee (see
						  specific drug categories below)
HI (h) barbiturates
HI (i) benzodiazepines
(The Medicaid agency lists specific category of drugs
						  below)
__
No excluded drugs are
				covered.