37.81.318 PROCESSING BIG SKY RX PARTICIPANT APPLICATIONS
(1) The department will process applications on a first in first served basis using the date the application is received by the department.
(a) The program will not enroll or pay benefits retroactively.
(b) Benefits will only be paid to eligible and enrolled individuals as of the first month following enrollment.
(2) Applications will be processed by the department and individuals will be notified in writing of their eligibility status as:
(b) qualified but incomplete;
(d) eligible and enrolled; or
(e) eligible and on the waiting list for the Big Sky Rx Program.
(3) A completed application consists of:
(a) a signed Big Sky Rx application form with the following information:
(i) applicant's and spouse's (if applicable) name;
(ii) Social Security number;
(iii) Medicare number;
(iv) date of birth;
(vi) home phone number;
(vii) mailing address;
(viii) family size;
(ix) family income;
(x) gross wages;
(xi) family assets;
(xii) disability or blind related work expense;
(xiii) name of applicants' PDP; and
(xiv) payment option of direct deposit or mail if applicant wishes to be paid directly.
(4) An applicant must sign the application and self-declare Montana residency and application for Big Sky Rx.
(5) An applicant must provide documentation of Medicare Part D PDP or Medicare advantage plan enrollment including documentation of Part D name, group number, and premium payment portion amount.
(6) An applicant who meets the eligibility requirements for Social Security Extra Help and is missing no other program requirement will receive a three month temporary enrollment. Within three months a temporary enrollee must provide documentation of a Social Security Extra Help determination. If no documentation is provided, the temporary enrollee will be disenrolled.
(7) An application is incomplete if it is missing any item listed in (3) through (6).
(8) Individuals not meeting the eligibility criteria in ARM 37.81.307 will be considered ineligible and mailed a program notice containing the reason for ineligibility. An individual may request an appeal, as provided in ARM 37.81.330. An individual may reapply for the program at any time.
(9) Qualified but incomplete applications will be marked "pending" until the applicant provides the PDP information and any missing application material.
(a) The applicant will be mailed a notice that the application is pending. The application will be held for 60 days from the application date. Following the 61st day, a notice will be mailed to the applicant as a reminder of the missing information.
(b) The application will remain "pended" until the information can be processed. If the information is still missing on the 91st day following the application date, the department will consider the applicant ineligible and the individual will be mailed a notice. The department will take no further action.
(10) Incomplete applications that are not otherwise qualified are considered "pending" by the department. These individuals will be mailed a notice of the missing information.
(a) A pended application will be held for 30 days waiting for missing information. If the missing information is received within the 30 days from the application date, the application will be processed.
(b) Following the 31st day the department will consider the application incomplete. The applicant becomes ineligible, and will be mailed a notice. The department will take no further action.
(11) Eligible individuals must meet all of the eligibility criteria in ARM 37.81.307. An eligible applicant will be enrolled in the program on a first in first served basis using the date the completed application is received by the department.
(12) Program enrollment starts the first day of the following month. Enrollees will be mailed an enrolled notice, including the approved premium benefit amount. The premium benefit amount will be paid to the PDP or the individual for the following month.
(13) If no premium assistance is available because of funding, eligible individuals will be placed on the department's waiting list. If funds become available, a notice will be sent and the applicant will be enrolled.
History: 53-2-201, 53-6-1004, MCA; IMP, 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA; NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2378, Eff. 1/1/10.