PRINTER'S NO. 1334
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1260
Session of
2021
INTRODUCED BY THOMAS, SAMUELSON, BENHAM, BROOKS, CONKLIN,
SCHLEGEL CULVER, FREEMAN, HENNESSEY, HILL-EVANS, JOZWIAK,
KOSIEROWSKI, LONGIETTI, McNEILL, MIZGORSKI, O'MARA, OTTEN,
PARKER, PICKETT, POLINCHOCK, SANCHEZ, SAPPEY, SCHLOSSBERG,
SHUSTERMAN, STEPHENS, WEBSTER AND D. WILLIAMS, APRIL 21, 2021
REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES,
APRIL 21, 2021
AN ACT
Amending the act of August 26, 1971 (P.L.351, No.91), entitled
"An act providing for a State Lottery and administration
thereof; authorizing the creation of a State Lottery
Commission; prescribing its powers and duties; disposition of
funds; violations and penalties therefor; exemption of prizes
from State and local taxation and making an appropriation,"
in Pharmaceutical Assistance for the Elderly, further
providing for the pharmaceutical assistance contract for the
elderly needs enhancement tier, for board, for powers of the
department and for coordination of benefits.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 519(b) and (c.1) of the act of August 26,
1971 (P.L.351, No.91), known as the State Lottery Law, are
amended to read:
Section 519. The Pharmaceutical Assistance Contract for the
Elderly Needs Enhancement Tier.
* * *
(b) PACENET eligibility.--A person with an annual income of
not less than $14,500 and not more than [$27,500] $33,500 in the
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case of a single person and of not less than $17,700 and not
more than [$35,500] $41,500 in the case of the combined income
of persons married to each other shall be eligible for enhanced
pharmaceutical assistance under this section. A person may, in
reporting income to the department, round the amount of each
source of income and the income total to the nearest whole
dollar, whereby any amount which is less than 50ยข is eliminated.
[(c.1) Premium.--In those instances in which a PACENET
claimant is not enrolled in Part D pursuant to section 533, the
claimant shall be required to pay a monthly premium equivalent
to the regional benchmark premium.]
* * *
Section 2. Section 520(c.1) of the act is amended by adding
a paragraph to read:
Section 520. Board.
* * *
(c.1) Powers and duties.--The board shall advise on the
following:
* * *
(4) The development and modernization of the program, as
necessary, to ensure that the program is providing and
continues to provide the assistance intended in a fiscally
responsible manner without excessively hampering the
pharmaceutical industry.
* * *
Section 3. Sections 533 and 534(b)(3) and (4) of the act are
amended to read:
Section 533. Powers of the department.
The department [shall]:
(1) [Identify] Shall identify the Part D plan or plans
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with which the department has entered into a contract under
section 534 that meet the prescription drug needs and
pharmacy preferences of a claimant.
(2) [Recommend] May require that the claimant enroll in
the Part D plan or program that meets the prescription drug
needs and pharmacy preferences of the claimant in the most
cost-effective manner for the Commonwealth.
(3) [Initiate] Shall initiate enrollment on behalf of
the claimant in the Part D plan recommended by the department
unless the claimant notifies the department that the claimant
wishes to enroll in another Part D plan.
(4) [File] Shall file and pursue appeals in accordance
with CMS regulations with a claimant's Part D plan on the
claimant's behalf to request exceptions to the plan's tiered
cost-sharing structure or to request a nonformulary Part D
drug.
(5) [Assist] Shall assist claimants the department
believes to be eligible for the LIS in making an application
to the Social Security Administration.
(6) [Provide] Shall provide at least ten days for the
claimant to decline enrollment in the recommended plan.
(7) [Develop] Shall develop and distribute language,
when recommending enrollment, notifying claimants of:
(i) The ability to decline enrollment in the
recommended Part D plan.
(ii) The ability to file and pursue appeals to the
recommended Part D plan on their own behalf.
(iii) The possibility that their choice of plan may
affect their medical coverage if they are enrolled in a
Medicare advantage plan, if applicable.
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Section 534. Coordination of benefits.
* * *
(b) Specific coordination provisions.--The following
provisions shall apply to claimants who are also Part D
enrollees:
* * *
(3) The program shall pay the premium assessed by a PACE
or PACENET enrollee's PDP or, with respect to the
prescription drug plan, Medicare Advantage Prescription Drug
Plan in an amount not to exceed the regional benchmark
premium and any copayments in excess of those set forth in
section 509.
[(4) Part D enrollees enrolled in PACENET shall pay the
Part D premiums charged by their PDP or, with respect to the
prescription drug plan, Medicare Advantage Prescription Drug
Plan and the program shall pay any copayments in excess of
those set forth in section 519.]
* * *
Section 4. This act shall take effect in 60 days.
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