439.665 - Contracts to subsidize cost of prescription drugs, pharmaceutical services and other benefits; eligibility for and amount of subsidies; copayments; waiver of eligibility requirements; covera
439.665 Contracts to subsidize cost of prescription drugs, pharmaceutical services and other benefits; eligibility for and amount of subsidies; copayments; waiver of eligibility requirements; coverage provided by Federal Government; authority of Department to change programs; eligibility of veterans for subsidies.
1. The Department may:
(a) Enter into contracts with private insurers who transact health insurance in this State to subsidize the cost of prescription drugs, pharmaceutical services and, to the extent money is available, other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear, for senior citizens by arranging for the availability, at a reasonable cost, of policies of health insurance that provide coverage to senior citizens for prescription drugs, pharmaceutical services and, to the extent money is available, other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear; or
(b) Subsidize the cost of prescription drugs, pharmaceutical services and, to the extent money is available, other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear, for senior citizens in any other manner.
2. Within the limits of the money available for this purpose in the Fund for a Healthy Nevada, a senior citizen who is not eligible for Medicaid and who is eligible for a subsidy that is made available pursuant to subsection 1 is entitled to an annual grant from the Fund to subsidize the cost of prescription drugs, pharmaceutical services and, to the extent money is available, other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear, if the senior citizen has been domiciled in this State for at least 1 year immediately preceding the date of application and except as otherwise provided in subsection 5:
(a) If the senior citizen is single, his or her income is not over $21,500; or
(b) If the senior citizen is married, his or her household income is not over $28,660.
Ê The monetary amounts set forth in this subsection must be adjusted for each fiscal year by adding to each amount the product of the amount shown multiplied by the percentage increase in the Consumer Price Index from December 2002 to the December preceding the fiscal year for which the adjustment is calculated.
3. The subsidy granted pursuant to this section must not exceed the annual cost of prescription drugs, pharmaceutical services and to the extent money is available, other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear, provided to the senior citizen.
4. A subsidy that is made available pursuant to subsection 1 must provide for:
(a) A copayment of not more than $10 per prescription drug or pharmaceutical service that is generic as set forth in the formulary of the insurer or as set forth by the Department; and
(b) A copayment of not more than $25 per prescription drug or pharmaceutical service that is preferred as set forth in the formulary of the insurer or as set forth by the Department.
5. The Department may waive the eligibility requirement set forth in subsection 2 regarding household income upon written request of the applicant or enrollee based on one or more of the following circumstances:
(a) Illness;
(b) Disability; or
(c) Extreme financial hardship, when considering the current financial circumstances of the applicant or enrollee.
Ê An applicant or enrollee who requests such a waiver shall include with that request all medical and financial documents that support the request.
6. If the Federal Government provides any coverage for:
(a) Prescription drugs and pharmaceutical services; or
(b) Other benefits, including, without limitation, dental or vision benefits or hearing aids or other devices that enhance the ability to hear,
Ê for senior citizens who are eligible for a subsidy pursuant to subsections 1 to 5, inclusive, the Department may, upon approval of the Legislature, or the Interim Finance Committee if the Legislature is not in session, change any program established pursuant to NRS 439.635 to 439.690, inclusive, and otherwise provide assistance with prescription drugs, pharmaceutical services and, to the extent money is available, other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear, for senior citizens within the limits of the money available for this purpose in the Fund.
7. The provisions of subsections 1 to 5, inclusive, do not apply to the extent that the Department provides assistance with prescription drugs, pharmaceutical services and other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear, for senior citizens pursuant to subsection 6.
8. A veteran may receive assistance with prescription drugs, pharmaceutical services and other benefits, including, without limitation, dental and vision benefits and hearing aids or other devices that enhance the ability to hear, pursuant to this section to the extent that the veteran does not receive other services or benefits provided to veterans for the same purpose if the veteran qualifies for the assistance as a senior citizen.
(Added to NRS by 1999, 2760; A 2001, 2675; 2003, 1751, 3493; 2005, 1259, 1573; 2007, 2342)