TITLE 89: SOCIAL SERVICES
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AUTHORITY: Implementing and authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (PL 108-173) and Section 12-13 of the Illinois Public Aid Code [305 ILCS 5/12-13].
SOURCE: Adopted by emergency rulemaking at 29 Ill. Reg. 10254, effective July 1, 2005, for a maximum of 150 days; adopted at 29 Ill. Reg. 19968, effective November 23, 2005.
Section 127.10 Federal Legislative Base
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (PL 108-173) establishes a voluntary prescription drug benefit for Medicare beneficiaries under a new Medicare Part D that begins January 1, 2006. Medicare Part D provides medical coverage of prescription drugs to Medicaid eligible individuals who are also eligible for Medicare Part A or enrolled in Medicare Part B. It also provides for extra help with premiums, deductibles and co-payments under a low-income subsidy (LIS) for individuals who meet an income and asset test as described at 42 CFR 423.773.
Section 127.20 Scope of Department Responsibility
a) The federal Centers for Medicare and Medicaid Services (CMS) have overall responsibility for implementing Medicare Part D. Under Medicare Part D, the federal Social Security Administration (SSA) has responsibility for eligibility determinations and redeterminations for the LIS, and for appeals of those eligibility determinations and redeterminations.
b) As described at 42 CFR 423, Subpart S, the State has certain responsibilities related to Medicare Part D. As the agency responsible for administering Medicaid in Illinois, the Department shall make eligibility determinations and redeterminations for the LIS, and hear appeals of eligibility determinations and redeterminations, only for individuals who specifically request a State determination (see 89 Ill. Adm. Code 110.10). The Department is also required to notify CMS of LIS eligibility determinations.