reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › General Provisions › Section 439.762 - "Medicare Advantage plan with prescription drug coverage" and "MA-PD" defined

Current through June 11, 2024
"Medicare Advantage plan with prescription drug coverage" or
				  "MA-PD" means health benefits coverage, including, without limitation,
				  qualified prescription drug coverage, offered pursuant to
				  42
				  C.F.R. §
										423.4 under a policy or
				  contract with Medicare by a Medicare Advantage organization as described in
				  42
				  C.F.R. §
										422.2.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › General Provisions › Section 439.763 - "Medicare Part D" defined

Current through June 11, 2024
"Medicare Part D" means the federal prescription drug benefit
				  established pursuant to Part 423 of Title 42 of the Code of Federal
				  Regulations.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › General Provisions › Section 439.764 - "Open enrollment" defined

Current through June 11, 2024
"Open enrollment" means a period prescribed by the Department
				  during which an application for a subsidy may be filed.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › General Provisions › Section 439.765 - "Prescription drug plan" and "PDP" defined

Current through June 11, 2024
"Prescription drug plan" or "PDP" means coverage for
				  prescription drugs that is offered under a policy, contract or plan which has
				  been approved as specified in
				  42
				  C.F.R. §
										423.272 and which is offered by
				  a sponsor that has a contract with the Centers for Medicare and Medicaid
				  Services of the United States Department of Health and Human Services that
				  meets the contract requirements under Subpart K of Part 423 of Title 42 of the
				  Code of Federal Regulations.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › General Provisions › Section 439.766 - "Subsidy" defined

Current through June 11, 2024
"Subsidy" means the amount of money that the Department may
				  pay to a contractor, prescription drug plan or Medicare Advantage plan with
				  prescription drug coverage or to the State Plan for Medicaid on behalf of a
				  person with a disability who meets the criteria for receiving a subsidy set
				  forth in NRS
				  NRS
				  439.745 for coverage for prescription drugs
				  and pharmaceutical services.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › General Provisions › Section 439.767 - "Traditional Disability Prescription Program" defined

Current through June 11, 2024
"Traditional Disability Prescription Program" means the
				  prescription drug benefits available to eligible applicants who are not also
				  eligible for Medicare Part D.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.768 - Eligibility for traditional benefits

Current through June 11, 2024
Persons with disabilities who are not eligible for Medicare
				  Part D may be eligible for traditional benefits under the Disability
				  Prescription Program, based on the availability of funding and contractual
				  agreements with a pharmacy benefit manager selected by the Department through a
				  formal bidding process.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.769 - Eligibility for coordination of benefits

Current through June 11, 2024
A person with a disability who is eligible for Medicare Part
				  D may be eligible for assistance with out-of-pocket expenses for prescription
				  drugs and pharmaceutical services. The availability of such coverage is subject
				  to the availability of funding and legislative approval of state subsidies that
				  are intended to maximize federal benefits and, to the extent possible, minimize
				  out-of-pocket expenses for prescription drugs and pharmaceutical services.
				  Eligibility for such coverage is subject to requirements that are similar, but
				  not identical, to the requirements for the Traditional Disability Prescription
				  Program, including, without limitation, all the following requirements:
1. An applicant must be at least 18 years of
				age but not more than 61 years of age.
2. An applicant must have a verifiable
				disability.
3. An applicant must
				have an annual income that is less than the amount set forth in NRS
				NRS
				439.745.
4. An applicant who is eligible for Medicare
				Part D must enroll in Medicare Part D and a prescription drug plan or Medicare
				Advantage plan with prescription drug coverage.
5. An applicant who is eligible for any
				federal subsidy under Medicare Part D must apply for and use any such subsidy
				before requesting such coverage through the Disability Prescription
				Program.
6. An applicant who is not
				eligible for full Medicaid in this State must meet a 1-year residency
				requirement as set forth in NRS
				NRS
				439.745.
7. An applicant who is enrolled in full
				Medicaid in this State is not required to meet the 1-year residency requirement
				for a subsidy approved by the Legislature. Depending upon the technical aspects
				of the coordination of benefits, the Department may allow such an applicant to
				receive such coverage without actually enrolling in the Disability Prescription
				Program.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.770 - Request for information

Current through June 11, 2024
Upon request, the Department will provide information to an
				  applicant relating to the criteria for receiving a subsidy, including, without
				  limitation, any documentation that the Department may require the applicant to
				  provide to the Department to verify that the applicant is eligible to receive a
				  subsidy.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.771 - Requirements for application; request for waiver of eligibility requirement regarding household income

Current through June 11, 2024
1. In addition to
				meeting the criteria for receiving a subsidy set forth in NRS
				NRS
				439.745, an applicant who wishes to receive a
				subsidy must file a properly completed application for a subsidy with the
				Department during a period of open enrollment.
2. The application must be made:
(a) On a form prescribed by the Department;
				and
(b) Under oath as required
				pursuant to NRS
				NRS
				439.755.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.772 - Notice of approval or denial of application; notice of name of new enrollee

Current through June 11, 2024
1. Within 45 days
				after receiving an application for a subsidy, the Department will provide
				written notice to the applicant of its approval or denial of the
				application.
2. If the application
				is approved, the notice must state:
(a) The
				amount of the subsidy that the Department will pay to a contractor, PDP or
				MA-PD, or to the State Plan for Medicaid on behalf of the applicant;
(b) The amount of the annual household income
				on which the eligibility was based; and
(c) If the applicant is deemed eligible but
				there is insufficient money available from the amount allocated for subsidies
				by the Department, that the applicant has been placed on a waiting list in the
				order of priority described in NAC 439.773.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.773 - Order of priority if there is insufficient money available; qualifying hardship; granting of subsidy to applicant on waiting list if sufficient money becomes available

Current through June 11, 2024
1. Except as
				otherwise provided in subsections 2, 3 and 4, if there is insufficient money
				available for each applicant from the amount allocated for subsidies by the
				Department, the Department will rank the applicants whose applications are
				approved based on their household income. The applicant with the lowest
				household income will receive priority over the other applicants. If the
				household income of two applicants is exactly the same amount, the applicant
				whose application was received earlier by the Department will receive priority
				over the other applicant.
2. If an
				applicant documents a medical condition that will deteriorate rapidly if
				prescribed medications are not taken, the applicant will receive priority over
				other applicants on the waiting list, regardless of income level. If two
				applicants document such emergent medical conditions, the applicant whose
				application was received earlier by the Department will receive priority over
				the other applicant.
3. If the
				Department determines that an applicant whose income exceeds the established
				limits has a qualifying financial hardship, the applicant will be ranked on the
				priority list at his or her adjusted income level, which is the applicant's
				actual income minus medical costs or the cost of another qualifying
				hardship.
4. If, at any time, the
				Department determines that there is sufficient money available from the amount
				allocated for subsidies by the Department for more applicants, the Department
				may grant a subsidy to an applicant on the waiting list in the order of
				priority described in this section. If the Department grants a subsidy pursuant
				to this subsection, the Department will provide written notice to the applicant
				in the manner set forth in NAC 439.772.
5. For the purposes of this section, an
				applicant shall be deemed to have a qualifying hardship if the applicant
				submits to the Department:
(a) Documentation
				satisfactory to the Department that verifies that the monthly cost of
				prescription drugs, pharmaceutical services or out-of-pocket medical expenses,
				or any combination thereof, for the applicant's household is causing a
				hardship; or
(b) Documentation
				satisfactory to the Department that verifies any other hardship of the
				applicant that the Department determines is a qualifying hardship.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.774 - Calculation of household income; eligibility for subsidy if maximum household income exceeded

Current through June 11, 2024
1. For the purposes
				of determining whether an applicant satisfies the eligibility requirement set
				forth in NRS
				NRS
				439.745 regarding household income, the
				Department:
(a) Will calculate the monthly
				household income for the month in which an application is filed with the
				Department pursuant to NAC 439.771 and multiply that number by 12; or
(b) May, if the household income fluctuates
				from month to month:
(1) Add the monthly
				household income over a period of at least 2 months;
(2) Divide the sum calculated pursuant to
				subparagraph (1) by the number of months within the period described in
				subparagraph (1); and
(3) Multiply
				the quotient calculated pursuant to subparagraph (2) by 12.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.775 - Information and documentation: Cooperation with Department; updating

Current through June 11, 2024
1. An applicant or enrollee shall cooperate
				with the Department in securing all information and documentation necessary to
				determine or confirm the eligibility of the applicant or continued eligibility
				of the enrollee to receive a subsidy. If the applicant or enrollee fails to
				cooperate, the Department will deny the application or will deem the enrollee
				ineligible to receive a subsidy.
2.
				An enrollee shall update the information contained in the application filed
				with the Department pursuant to NAC 439.771 that relates to his or her
				eligibility to receive a subsidy, including, without limitation, a change in
				his or her:
(a) Name;
(b) Address;
(c) Telephone number;
(d) Household income;
(e) Marital status;
(f) Eligibility for Medicare Part
				D;
(g) Enrollment in a PDP or MA-PD
				or the selection of a different PDP or MA-PD;
(h) Eligibility for Medicaid; or
(i) Eligibility for supplemental security
				income, by notifying the Department in writing within 20 days after the
				information becomes available to him or her.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.776 - Continuing eligibility; annual review

Current through June 11, 2024
1. If the
				Department approves an application for a subsidy, the enrollee remains eligible
				to receive the subsidy as long as he or she continues to meet the criteria for
				receiving a subsidy set forth in this chapter and chapter 439 of NRS.
2. The Department will review the eligibility
				of each enrollee at least annually. In conducting this review, the Department
				will compare the information it has received from the enrollee with information
				concerning the enrollee that is maintained by other federal, state, county and
				local agencies, as well as other organizations that administer programs for
				low-income persons or persons with disabilities.
3. If the Department is unable to determine
				the continuing eligibility of the enrollee in the manner set forth in
				subsection 2, the Department may require the enrollee to provide additional
				documentation, including, without limitation, a copy of the income tax returns
				of the enrollee.
4. If the
				Department is unable to obtain the additional documentation required pursuant
				to subsection 3, the Department will deem the enrollee ineligible to receive a
				subsidy.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.777 - Discontinuation of subsidy to enrollee: Request by enrollee; ineligibility of enrollee; granting of subsidy to applicant on waiting list if enrollee determined ineligible

Current through June 11, 2024
1. If an enrollee
				who is receiving a subsidy wishes to discontinue receiving the subsidy, the
				enrollee must submit a written request to that effect to the Department and
				notify the contractor in writing.
2. If, based on information the Department
				receives, the Department reasonably believes that an enrollee no longer meets
				the criteria for receiving a subsidy because one of the circumstances set forth
				in subsection 3 applies to the enrollee, the Department shall provide the
				enrollee with notice as set forth in NAC 439.778 and an opportunity for a
				hearing.
3. The circumstances in
				which an enrollee no longer meets the criteria for receiving a subsidy include,
				without limitation, that:
(a) The enrollee is
				eligible for coverage for prescription drugs and pharmaceutical services
				through Medicare Part D, but the enrollee declines to enroll in that program or
				in a PDP or MA-PD, or the enrollee declines to apply for any federal subsidy
				available to him or her, or both;
(b) The enrollee is eligible for coverage for
				prescription drugs and pharmaceutical services through Medicare Part D and
				qualifies for a federal low-income subsidy as a "very low-income
				beneficiary";
(c) The household
				income of the enrollee exceeds the maximum household income set forth in NRS
				NRS
				439.745;
(d) The enrollee knowingly provided incorrect
				information on the application that he or she filed with the Department
				pursuant to NAC 439.771 and failed to correct the information within a
				reasonable time as determined by the Department;
(e) The enrollee failed to maintain residency
				in this State; or
(f) The enrollee
				failed to respond timely to a request for verification of the income of the
				enrollee or of any other annual eligibility requirement.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.778 - Notice to enrollee of determination regarding ineligibility

Current through June 11, 2024
If the Department determines that an enrollee no longer meets
				  the criteria for receiving a subsidy set forth in this chapter and chapter 439
				  of NRS, it will notify the enrollee in writing that the enrollee is ineligible
				  to receive a subsidy. The notice must inform the enrollee:
1. Of the reason that the enrollee is
				ineligible to receive a subsidy;
2.
				Of the procedures set forth in NAC 439.779 for requesting a hearing to review
				the decision of the Department; and
3. Of any free or inexpensive legal services
				available in the area and must provide telephone numbers of the organizations
				providing those services.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.779 - Request for hearing; scheduling of hearing

Current through June 11, 2024
1. An
				applicant or enrollee who is aggrieved by a decision of the Department
				concerning a subsidy and who wishes to have a hearing before the Department
				must file a written request for a hearing with the Department within 30 days
				after the date of the notice of the decision from the Department.
2. The Department will schedule a hearing
				within 45 days after it receives the request for a hearing.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.780 - Continuation of benefits pending outcome of hearing

Current through June 11, 2024
1.
				Benefits of an existing enrollee may be continued pending the outcome of the
				hearing if the enrollee requests such continuation within 10 days after the
				date of the decision by the Department.
2. The Department will deny a request for
				continuation of benefits if the request for a hearing is also denied pursuant
				to NAC 439.781.
3. If benefits are
				continued and the decision of the hearing officer upholds the decision of the
				Department, the Department may require the enrollee to reimburse the Department
				for benefits paid on behalf of the enrollee.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.781 - Denial of request for hearing; request for dismissal

Current through June 11, 2024
1. The Department will deny a request for a
				hearing received pursuant to NAC 439.779 if:
(a) The sole issue being contested is an
				issue that may only be resolved by amending the provisions of NRS
				NRS 439.705 to
				439.795,
				inclusive;
(b) The sole issue being
				contested is that the Department denied an application for a subsidy,
				discontinued paying a subsidy or reduced the amount of a subsidy, if that
				action by the Department was based only upon the limits of the money available
				from the amount allocated for subsidies by the Department;
(c) The sole issue being contested is an
				issue that relates to a determination of the coverage of a policy of health
				insurance under which an enrollee is covered and the enrollee has failed to
				complete a process for resolving disputes established by the contractor;
				or
(d) The request is not received
				by the Department within the limit on time set forth in NAC 439.779.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.782 - Testimony under oath

Current through June 11, 2024
All testimony to be considered in a hearing must be taken
				  under oath. Except as otherwise provided in NAC 439.784, before testifying, a
				  person must swear or affirm before the hearing officer to the truthfulness of
				  the testimony he or she is about to give in the hearing.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.783 - Conducting hearing in person; representation; evidence

Current through June 11, 2024
1. Except as otherwise provided in NAC
				439.784, a hearing must be conducted in person by a hearing officer.
2. An applicant or enrollee may represent
				himself or herself or may, in writing, authorize a person to represent him or
				her at the hearing, including, without limitation, an attorney.
3. Upon request, each party to the hearing
				shall submit to the hearing officer before the hearing copies of any evidence
				or exhibit that the party will present during the hearing. The provisions of
				this subsection do not preclude:
(a) A party
				from presenting additional evidence during the hearing; or
(b) An applicant or enrollee from presenting
				additional evidence after the hearing if requested by the hearing
				officer.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.784 - Conducting hearing by telephone

Current through June 11, 2024
1. The hearing
				officer may conduct the hearing over the telephone if he or she determines it
				is in the best interest of each party to the hearing to do so.
2. A hearing that is conducted over the
				telephone must be conducted at the office of a state agency or another location
				approved by the hearing officer in advance of the hearing, at which a
				representative of the Department will:
(a) Be
				available to answer the telephone call the hearing officer places to begin the
				hearing;
(b) Administer the oath
				required pursuant to NAC 439.782 to the applicant or enrollee; and
(c) Receive any additional evidence that the
				applicant or enrollee wishes to submit and transmit it to the hearing officer
				by facsimile machine.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.785 - Retention of record

Current through June 11, 2024
1. The Department
				will produce a record of the hearing and retain it for 3 years after the date
				the decision of the hearing officer is issued or until the resolution of any
				judicial review of the decision, whichever occurs later.
2. As used in this section, "record of the
				hearing" means:
(a) All the documents filed
				with the Department concerning the hearing;
(b) The official recording of the hearing or
				a summary of the hearing prepared by a person designated by the Director of the
				Department;
(c) All the evidence
				presented at the hearing and, if requested by the hearing officer pursuant to
				NAC 439.783, after the hearing; and
(d) The decision of the hearing
				officer.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.786 - Official recording of hearing; request for copy

Current through June 11, 2024
1. The
				hearing officer presiding over a hearing conducted pursuant to NAC 439.779 to
				439.787, inclusive, shall cause the hearing to be recorded on audiotape or any
				other means of sound reproduction. The Department will consider that recording
				to be the official recording of the hearing.
2. A person may obtain a copy of the official
				recording of a hearing in which the person was a party if he or she submits to
				the Department:
(a) A written request;
				and
(b) The fee charged by the
				Department for an official recording.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.787 - Decision of hearing officer

Current through June 11, 2024
1. The decision of
				a hearing officer must be in writing and be based exclusively on evidence
				presented at the hearing or, if requested by the hearing officer pursuant to
				NAC 439.783, after the hearing.
2.
				Within 30 days after the date of the hearing, the Department will send the
				decision of the hearing officer by certified mail to the applicant or enrollee
				and to his or her authorized representative, if any.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Hearings › Section 439.788 - Duties of Department if decision of Department is overturned by hearing officer

Current through June 11, 2024
1. If a hearing
				officer overturns a decision of the Department to deny a subsidy or a decision
				that an enrollee is ineligible to receive a subsidy, the Department will:
(a) Reimburse the applicant or the enrollee
				for the actual out-of-pocket expenses for prescription drugs or pharmaceutical
				services incurred from the date that the applicant or the enrollee appealed the
				decision of the Department to the date that the decision of the hearing officer
				was issued;
(b) Pay the amount of
				the subsidy due a contractor from the date that the applicant or the enrollee
				appealed the decision of the Department to the date that the decision of the
				hearing officer was issued; and
(c)
				Reimburse the applicant or the enrollee, upon receipt of proof of payment for
				any premium paid to a contractor for a policy of health insurance from the date
				that the applicant or the enrollee appealed the decision of the Department to
				the date that the decision of the hearing officer was issued.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Miscellaneous Provisions › Section 439.789 - Recoupment of subsidy paid in error; request by enrollee for waiver or reduction of amount required to be returned

Current through June 11, 2024
1. Except as
				otherwise provided in subsections 4 and 5, the Department will pursue all legal
				remedies for the collection of debt, including, without limitation, those
				remedies set forth in chapter 353C of NRS, to recoup a subsidy that was paid in
				error from the contractor or enrollee determined by the Department to be
				responsible for the error, including, without limitation, a subsidy that was
				paid:
(a) To a contractor who was not
				entitled to receive payment of the subsidy;
(b) For an enrollee whose application for a
				subsidy was submitted with fraudulent intent; or
(c) For an enrollee who was otherwise not
				qualified to receive the subsidy.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › DISABILITY PRESCRIPTION PROGRAM › Miscellaneous Provisions › Section 439.790 - Confidentiality of records

Current through June 11, 2024
The records of the Department relating to an applicant or
				  enrollee are confidential and are considered protected health information under
				  the Health Insurance Portability and Accountability Act of 1996,
				  Public Law
				  104-191 (HIPAA). Any use or release of protected
				  health information must comply with the
HIPAA Privacy Manual
established by the Department, which reflects the provisions of Part 164 of
				  Title 45 of the Code of Federal Regulations.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.800 - Short title

Current through June 11, 2024
NAC 439.800 to 439.862, inclusive, may be referred to as the
				  Senior Prescription Program.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001; A by
				  Dep't of Health & Human Services by R157-05,
				  11-17-2005
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.802 - Definitions

Current through June 11, 2024
As used in NAC 439.800 to 439.862, inclusive, unless the
				  context otherwise requires, the words and terms defined in NAC 439.804 to
				  439.8225, inclusive, have the meanings ascribed to them in those
				  sections.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001; A by
				  Dep't of Health & Human Services by R157-05,
				  11-17-2005
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.804 - "Applicant" defined

Current through June 11, 2024
"Applicant" means a person who applies to the Department to
				  receive a subsidy for coverage for prescription drugs and pharmaceutical
				  services pursuant to
				  NRS
				  439.670.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001;
				  R200-03, 9-17-2004
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.806 - "Contractor" defined

Current through June 11, 2024
"Contractor" means:
1. A private insurer with whom the Department
				has entered into a contract pursuant to NRS
				NRS
				439.665 to make available, at a reasonable
				cost, policies of health insurance that provide coverage to senior citizens for
				prescription drugs and pharmaceutical services; or
2. An entity with which the Department has
				entered into a contract to manage pharmaceutical benefits, including, without
				limitation, processing and paying claims for pharmaceutical benefits on behalf
				of the Department.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by Dep't of Health & Human
				  Services by R157-05, 11-17-2005
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.807 - "Coordination of benefits" defined

Current through June 11, 2024
"Coordination of benefits" means the coordination of the
				  Senior Prescription Program with Medicare Part D in a manner that:
1. Maximizes coverage for prescription drugs
				and pharmaceutical services for persons in this State;
2. Minimizes disruptions in the enrollment of
				persons in this State in state and federal programs that provide coverage for
				prescription drugs and pharmaceutical services;
3. Minimizes disruptions in the eligibility
				of persons in this State for state and federal programs that provide coverage
				for prescription drugs and pharmaceutical services;
4. Minimizes out-of-pocket expenses for
				prescription drugs and pharmaceutical services for Medicare beneficiaries in
				this State; and
5. Maximizes
				federal funding for coverage for prescription drugs and pharmaceutical services
				for persons in this State.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.808 - "Department" defined

Current through June 11, 2024
"Department" means the Department of Health and Human
				  Services.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by Dep't of Health & Human
				  Services by R157-05, 11-17-2005
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.810 - "Enrollee" defined

Current through June 11, 2024
"Enrollee" means a person who the Department has determined
				  is eligible to receive a subsidy for coverage for prescription drugs and
				  pharmaceutical services pursuant to NRS
				  NRS
				  439.665.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001;
				  R200-03, 9-17-2004
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.812 - "Hearing officer" defined

Current through June 11, 2024
"Hearing officer" means a person who:
1. Did not participate in the decision of the
				Department that is the subject of the hearing; and
2. Is appointed by the Director of the
				Department or a designee thereof to preside at a hearing conducted pursuant to
				NAC 439.842 to 439.856, inclusive.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by R200-03,
				  9-17-2004
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.813 - "Household" defined

Current through June 11, 2024
"Household" means an applicant and the spouse of the
				  applicant.
Added to NAC by Dep't
				  of Human Resources by R143-01, eff. 12-17-2001
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.814 - "Household income" defined

Current through June 11, 2024
"Household income" has the meaning ascribed to it in NRS
				  NRS
				  439.640.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.816 - "Income" defined

Current through June 11, 2024
"Income" has the meaning ascribed to it in NRS
				  NRS
				  439.645.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.817 - "Medicare Advantage plan with prescription drug coverage" and "MA-PD" defined

Current through June 11, 2024
"Medicare Advantage plan with prescription drug coverage" or
				  "MA-PD" means health benefits coverage, including, without limitation,
				  qualified prescription drug coverage, offered pursuant to
				  42
				  C.F.R. §
										423.4 under a policy or
				  contract with Medicare by a Medicare Advantage organization as described in
				  42
				  C.F.R. §
										422.2.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.8175 - "Medicare Part D" defined

Current through June 11, 2024
"Medicare Part D" means the federal prescription drug benefit
				  established pursuant to Part 423 of Title 42 of the Code of Federal
				  Regulations.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.818 - "Open enrollment" defined

Current through June 11, 2024
"Open enrollment" means a period prescribed by the Department
				  during which an application for a subsidy may be filed.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by R143-01,
				  12-17-2001
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.819 - "Prescription drug plan" and "PDP" defined

Current through June 11, 2024
"Prescription drug plan" or "PDP" means coverage for
				  prescription drugs that is offered under a policy, contract or plan which has
				  been approved as specified in
				  42
				  C.F.R. §
										423.272 and which is offered by
				  a sponsor that has a contract with the Centers for Medicare and Medicaid
				  Services of the United States Department of Health and Human Services that
				  meets the contract requirements under Subpart K of Part 423 of Title 42 of the
				  Code of Federal Regulations.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.820 - "Senior citizen" defined

Current through June 11, 2024
"Senior citizen" has the meaning ascribed to it in NRS
				  NRS
				  439.650.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.822 - "Subsidy" defined

Current through June 11, 2024
"Subsidy" means the amount of money that the Department may
				  pay to a contractor on behalf of a senior citizen who meets the criteria for
				  receiving a subsidy set forth in NRS
				  NRS
				  439.665 for coverage for prescription drugs
				  and pharmaceutical services.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001;
				  R200-03, 9-17-2004
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › General Provisions › Section 439.8225 - "Traditional Senior Prescription Program" defined

Current through June 11, 2024
"Traditional Senior Prescription Program" means the
				  prescription drug benefits available to eligible applicants who are not also
				  eligible for Medicare Part D.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.823 - Eligibility for traditional benefits

Current through June 11, 2024
Senior citizens who are not eligible for Medicare Part D may
				  be eligible for traditional benefits under the Senior Prescription Program,
				  based on the availability of funding and contractual agreements with a pharmacy
				  benefit manager selected by the Department through a formal bidding
				  process.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.8235 - Eligibility for coordination of benefits

Current through June 11, 2024
A senior citizen who is eligible for Medicare Part D may be
				  eligible for assistance with out-of-pocket expenses for prescription drugs and
				  pharmaceutical services. The availability of such coverage is subject to the
				  availability of funding and legislative approval of state subsidies that are
				  intended to maximize federal benefits and, to the extent possible, minimize
				  out-of-pocket expenses for prescription drugs and pharmaceutical services.
				  Eligibility for such coverage is subject to requirements that are similar, but
				  not identical, to the requirements for the Traditional Senior Prescription
				  Program, including, without limitation, all the following requirements:
1. An applicant must be 62 years of age or
				older.
2. An applicant must have an
				annual income that is less than the amount set forth in NRS
				NRS
				439.665.
3. An applicant who is eligible for Medicare
				Part D must enroll in Medicare Part D and a prescription drug plan or Medicare
				Advantage plan with prescription drug coverage.
4. An applicant who is eligible for any
				federal subsidy under Medicare Part D must apply for and use any such subsidy
				before requesting such coverage through the Senior Prescription
				Program.
5. An applicant who is not
				eligible for full Medicaid in this State must meet a 1-year residency
				requirement as set forth in NRS
				NRS
				439.665.
6. An applicant who is enrolled in full
				Medicaid in this State is not required to meet the 1-year residency requirement
				for a subsidy approved by the Legislature. Depending upon the technical aspects
				of the coordination of benefits, the Department may allow such an applicant to
				receive such coverage without actually enrolling in the Senior Prescription
				Program.
Added to NAC by Dep't
				  of Health & Human Services by R157-05, eff.
				  11-17-2005
NRS
					 439.735
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.824 - Request for information

Current through June 11, 2024
Upon request, the Department will provide information to an
				  applicant relating to the criteria for receiving a subsidy, including, without
				  limitation, any documentation that the Department may require the applicant to
				  provide to the Department to verify that the applicant is eligible to receive a
				  subsidy.
Added to NAC by Dep't
				  of Human Resources by R069-00, eff. 3-2-2001
NRS
					 439.655
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.826 - Requirements for application; open enrollment; request for waiver of eligibility requirement regarding household income

Current through June 11, 2024
1. In addition
				to meeting the criteria for receiving a subsidy set forth in NRS
				NRS
				439.665, an applicant who wishes to receive a
				subsidy must file a properly completed application for a subsidy with the
				Department during a period of open enrollment.
2. The application must be made:
(a) On a form prescribed by the Department;
				and
(b) Under oath as required by
				NRS
				NRS
				439.670.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.828 - Notice of approval or denial of application; notice of name of new enrollee

Current through June 11, 2024
1. Within 45 days
				after receiving an application for a subsidy, the Department will provide
				written notice to the applicant of its approval or denial of the
				application.
2. If the application
				is approved, the notice must state:
(a) The
				amount of the subsidy that the Department will pay to a contractor, PDP or
				MA-PD, or to the State Plan for Medicaid on behalf of the applicant;
(b) The amount of the annual household income
				on which the eligibility was based; and
(c) If the applicant is deemed eligible but
				there is insufficient money available from the amount allocated for subsidies
				by the Department, that the applicant has been placed on a waiting list in the
				order of priority described in NAC 439.830.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.831 - Calculation of household income; eligibility for subsidy if maximum household income exceeded

Current through June 11, 2024
1. For the purposes
				of determining whether an applicant satisfies the eligibility requirement set
				forth in NRS
				NRS
				439.665 regarding household income, the
				Department:
(a) Will calculate the monthly
				household income for the month in which an application is filed with the
				Department pursuant to NAC 439.826 and multiply that number by 12; or
(b) May, if the household income fluctuates
				from month to month:
(1) Add the monthly
				household income over a period of at least 2 months;
(2) Divide the sum calculated pursuant to
				subparagraph (1) by the number of months within the period described in
				subparagraph (1); and
(3) Multiply
				the quotient calculated pursuant to subparagraph (2) by 12.
Nevada Administrative Code › Chapter 439 - Administration of Public Health › SENIOR PRESCRIPTION PROGRAM › Application and Eligibility › Section 439.834 - Information and documentation: Cooperation with Department; updating

Current through June 11, 2024
1. An applicant or enrollee shall cooperate
				with the Department in securing all information and documentation necessary to
				determine or confirm the eligibility of the applicant or continued eligibility
				of the enrollee to receive a subsidy. If the applicant or enrollee fails to
				cooperate, the Department will deny the application or will deem the enrollee
				ineligible to receive a subsidy.
2.
				An enrollee shall update the information contained in the application filed
				with the Department pursuant to NAC 439.826 that relates to his or her
				eligibility to receive a subsidy, including, without limitation, a change in
				his or her:
(a) Name;
(b) Address;
(c) Telephone number;
(d) Household income;
(e) Marital status;
(f) Eligibility for Medicare Part
				D;
(g) Enrollment in a PDP or MA-PD
				or selection of a different PDP or MA-PD;
(h) Eligibility for Medicaid; or
(i) Eligibility for supplemental security
				income, by notifying the Department in writing within 20 days after the
				information becomes available to him or her.