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42 U.S. Code § 1395w-133

State Pharmaceutical Assistance Programs

42 U.S. Code § 1395w-133. State Pharmaceutical Assistance Programs

(a) Requirements for benefit coordination
(1) In generalBefore July 1, 2005, the Secretary shall establish consistent with this section requirements for prescription drug plans to ensure the effective coordination between a part D plan (as defined in paragraph (5)) and a State Pharmaceutical Assistance Program (as defined in subsection (b)) with respect to—
(A)
payment of premiums and coverage; and
(B)
payment for supplemental prescription drug benefits,
for part D eligible individuals enrolled under both types of plans.
(2) Coordination elementsThe requirements under paragraph (1) shall include requirements relating to coordination of each of the following:
(A)
Enrollment file sharing.
(B)
The processing of claims, including electronic processing.
(C)
Claims payment.
(D)
Claims reconciliation reports.
(E)
Application of the protection against high out-of-pocket expenditures under section 1395w–102(b)(4) of this title.
(F)
Other administrative processes specified by the Secretary.
Such requirements shall be consistent with applicable law to safeguard the privacy of any individually identifiable beneficiary information.
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