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REGS : 10.18.05—10.18.07 Maryland AIDS Drug Assistance Program: Eligibility, Services; and Health Insurance (MADAP-PLUS)

 

 Content Editor

 
PROPOSAL
Maryland Register
Issue Date:  January 24, 2014
Volume 41 • Issue 2 • Pages 133—135
 
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 18 HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
Notice of Proposed Action
[14-036-P]
The Secretary of Health and Mental Hygiene proposes to:
(1) Repeal Regulation .07 and amend Regulation .08 under COMAR10.18.05 Maryland AIDS Drug Assistance Program: Eligibility;
(2) Amend Regulations .04-2 and .05 under COMAR 10.18.06 Maryland AIDS Drug Assistance Program: Services; and
(3) Amend Regulation .04 under COMAR 10.18.07 Maryland AIDS Drug Assistance Program: Health Insurance (MADAP-PLUS).
Statement of Purpose
The purpose of this action is to:
(1) Remove restrictions in current regulations that prevent the provision of allowable services under the Affordable Care Act as outlined in Health Resources and Services Administration (HRSA) policy guidance;
(2) Eliminate the participant cost-sharing fee; and
(3) Clarify the MADAP Advisory Board member selection process and member term limits to allow for smoother operations.
Comparison to Federal Standards
There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through February 24, 2014. A public hearing has not been scheduled.
 
10.18.05 Maryland AIDS Drug Assistance Program: Eligibility
Authority: Health-General Article, §§2-104(b) and (i) and 2-105(a) and (b), Annotated Code of Maryland
.08 Income.
A. The Department shall consider earned and unearned gross income of the household in determining financial eligibility under this chapter[:
(1) Financial eligibility; and
(2) Calculation of the fee].
B.—E. (text unchanged)
 
10.18.06 Maryland AIDS Drug Assistance Program: Services
Authority: Health-General Article, §§2-104(b) and (i), 2-105(a) and (b), and 18-102, Annotated Code of Maryland
.04-2 Advisory Board.
A. (text unchanged)
B. The Board shall consist of a maximum of 11 members as follows:
(1) Up to 7 members shall be clinicians including physicians, physician assistants, certified nurse practitioners, and pharmacists; and
(2) Up to 4 members shall be community representatives including representatives from community-based organizations, community advocates, and individuals living with HIV.
[B.] C. [The] Each Board [members] member shall:
(1) Be appointed by the [Department] Secretary;
(2) Have [1-year] 2-year terms; and
(3) Be allowed to serve [more than one term] one or more additional terms after being off the Board for a 1-year minimum period between terms.
[C.] D. The Board shall:
(1) Meet at least [quarterly] twice per year;
(2) Develop recommendations for the formulary for MADAP by considering the:
(a) (text unchanged)
(b) Cost effectiveness of the drug[, including any supplemental rebates from manufacturers]; and
(c) Needs of MADAP recipients, such as the:
(i) Ease of drug therapy administration; and
[(ii) Rate of compliance with drug therapy instructions; and]
[(iii)] (ii) Frequency of prior authorization] Availability of other drugs on the MADAP formulary to treat the same condition; and
(3) (text unchanged)
[D.] E. The Department shall:
(1) Decide if the recommendations of the Board will be accepted;
[(1)] (2) (text unchanged)
[(2)] (3) Post the times of meetings and allow the public to submit written comment for consideration by the [Advisory] Board.
.05 Limitations on Covered Services.
A. (text unchanged)
B. MADAP may not pay for:
(1) A drug prescribed as part of a recipient's care in an inpatient hospital, nursing home, or long-term care setting; or
(2) The drug peginterferon alfa-2b, peginterferon alfa-2a, ribavirin, epoetin alpha, filgrastim, or oxandrolone, unless the recipient has submitted to MADAP a written statement as specified in COMAR 10.18.05.05[; or]
[(3) Treatment of hepatitis C except as specified in COMAR 10.18.05.05].
 
10.18.07 Maryland AIDS Drug Assistance Program: Health Insurance (MADAP-PLUS)
Authority: Health-General Article, §§2-104(b) and (i) and 2-105(a) and (b), Annotated Code of Maryland
.04 Eligibility.
A.—B. (text unchanged)
C. Insurance Criteria. To be eligible for MADAP-Plus an applicant shall be[:
(1) Receiving[ receiving or eligible to receive health insurance benefits under:
[(a)] (1)[(e)] (5) (text unchanged)
[(2) Responsible for paying 50 percent or more of the applicant's own total monthly health insurance costs.]
D. (text unchanged)
E. Employer Sponsored Insurance Plans. An individual is not eligible for MADAP-Plus if the individual has or is eligible for employer sponsored health insurance, unless the applicant is responsible for paying 50 percent or more of the individual’s total monthly health insurance premiums.
[E.] F. (text unchanged)
JOSHUA M. SHARFSTEIN, M.D.
Secretary of Health and Mental Hygiene