Nevada Administrative Code

NAC 439.765 “Prescription drug plan” and “PDP” defined. (NRS 439.630) “Prescription drug plan” or “PDP” means coverage for prescription drugs that is offered under a policy, contract or plan which has been approved as specified in 42 C.F.R. § 423.272 and which is offered by a spo…

NAC 439.766 “Subsidy” defined. (NRS 439.630) “Subsidy” means the amount of money that the Department may pay to a contractor, prescription drug plan or Medicare Advantage plan with prescription drug coverage or to the State Plan for Medicaid on behalf of a person with a disabilit…

NAC 439.767 “Traditional Disability Prescription Program” defined. (NRS 439.630) “Traditional Disability Prescription Program” means the prescription drug benefits available to eligible applicants who are not also eligible for Medicare Part D. (Added to NAC by Dep’t of Health & H…

NAC 439.768 Eligibility for traditional benefits. (NRS 439.630) Persons with disabilities who are not eligible for Medicare Part D may be eligible for traditional benefits under the Disability Prescription Program, based on the availability of funding and contractual agreements w…

NAC 439.769 Eligibility for coordination of benefits. (NRS 439.630) A person with a disability who is eligible for Medicare Part D may be eligible for assistance with out-of-pocket expenses for prescription drugs and pharmaceutical services. The availability of such coverage is s…

NAC 439.770 Request for information. (NRS 439.630) Upon request, the Department will provide information to an applicant relating to the criteria for receiving a subsidy, including, without limitation, any documentation that the Department may require the applicant to provide to …

NAC 439.771 Requirements for application; request for waiver of eligibility requirement regarding household income. (NRS 439.630) 1. In addition to meeting the criteria for receiving a subsidy set forth in NRS 439.745, an applicant who wishes to receive a subsidy must file a prop…

NAC 439.772 Notice of approval or denial of application; notice of name of new enrollee. (NRS 439.630) 1. Within 45 days after receiving an application for a subsidy, the Department will provide written notice to the applicant of its approval or denial of the application. 2. If t…

NAC 439.773 Order of priority if there is insufficient money available; qualifying hardship; granting of subsidy to applicant on waiting list if sufficient money becomes available. (NRS 439.630) 1. Except as otherwise provided in subsections 2, 3 and 4, if there is insufficient m…

NAC 439.774 Calculation of household income; eligibility for subsidy if maximum household income exceeded. (NRS 439.630) 1. For the purposes of determining whether an applicant satisfies the eligibility requirement set forth in NRS 439.745 regarding household income, the Departme…

NAC 439.775 Information and documentation: Cooperation with Department; updating. (NRS 439.630) 1. An applicant or enrollee shall cooperate with the Department in securing all information and documentation necessary to determine or confirm the eligibility of the applicant or cont…

NAC 439.776 Continuing eligibility; annual review. (NRS 439.630) 1. If the Department approves an application for a subsidy, the enrollee remains eligible to receive the subsidy as long as he or she continues to meet the criteria for receiving a subsidy set forth in this chapter …

NAC 439.777 Discontinuation of subsidy to enrollee: Request by enrollee; ineligibility of enrollee; granting of subsidy to applicant on waiting list if enrollee determined ineligible. (NRS 439.630) 1. If an enrollee who is receiving a subsidy wishes to discontinue receiving the s…

NAC 439.778 Notice to enrollee of determination regarding ineligibility. (NRS 439.630) If the Department determines that an enrollee no longer meets the criteria for receiving a subsidy set forth in this chapter and chapter 439 of NRS, it will notify the enrollee in writing that …

NAC 439.779 Request for hearing; scheduling of hearing. (NRS 439.630) 1. An applicant or enrollee who is aggrieved by a decision of the Department concerning a subsidy and who wishes to have a hearing before the Department must file a written request for a hearing with the Depart…

NAC 439.780 Continuation of benefits pending outcome of hearing. (NRS 439.630) 1. Benefits of an existing enrollee may be continued pending the outcome of the hearing if the enrollee requests such continuation within 10 days after the date of the decision by the Department. 2. Th…

NAC 439.781 Denial of request for hearing; request for dismissal. (NRS 439.630) 1. The Department will deny a request for a hearing received pursuant to NAC 439.779 if: (a) The sole issue being contested is an issue that may only be resolved by amending the provisions of NRS 439.…

NAC 439.782 Testimony under oath. (NRS 439.630) All testimony to be considered in a hearing must be taken under oath. Except as otherwise provided in NAC 439.784, before testifying, a person must swear or affirm before the hearing officer to the truthfulness of the testimony he o…

NAC 439.783 Conducting hearing in person; representation; evidence. (NRS 439.630) 1. Except as otherwise provided in NAC 439.784, a hearing must be conducted in person by a hearing officer. 2. An applicant or enrollee may represent himself or herself or may, in writing, authorize…

NAC 439.784 Conducting hearing by telephone. (NRS 439.630) 1. The hearing officer may conduct the hearing over the telephone if he or she determines it is in the best interest of each party to the hearing to do so. 2. A hearing that is conducted over the telephone must be conduct…

NAC 439.785 Retention of record. (NRS 439.630) 1. The Department will produce a record of the hearing and retain it for 3 years after the date the decision of the hearing officer is issued or until the resolution of any judicial review of the decision, whichever occurs later. 2. …

NAC 439.786 Official recording of hearing; request for copy. (NRS 439.630) 1. The hearing officer presiding over a hearing conducted pursuant to NAC 439.779 to 439.787, inclusive, shall cause the hearing to be recorded on audiotape or any other means of sound reproduction. The De…

NAC 439.787 Decision of hearing officer. (NRS 439.630) 1. The decision of a hearing officer must be in writing and be based exclusively on evidence presented at the hearing or, if requested by the hearing officer pursuant to NAC 439.783, after the hearing. 2. Within 30 days after…

NAC 439.788 Duties of Department if decision of Department is overturned by hearing officer. (NRS 439.630) 1. If a hearing officer overturns a decision of the Department to deny a subsidy or a decision that an enrollee is ineligible to receive a subsidy, the Department will: (a) …

NAC 439.789 Recoupment of subsidy paid in error; request by enrollee for waiver or reduction of amount required to be returned. (NRS 439.630) 1. Except as otherwise provided in subsections 4 and 5, the Department will pursue all legal remedies for the collection of debt, includin…

NAC 439.790 Confidentiality of records. (NRS 439.630) The records of the Department relating to an applicant or enrollee are confidential and are considered protected health information under the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIP…

NAC 439.800 Short title. (NRS 439.655) NAC 439.800 to 439.862, inclusive, may be referred to as the Senior Prescription Program. (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001; A by Dep’t of Health & Human Services by R157-05, 11-17-…

NAC 439.802 Definitions. (NRS 439.655) As used in NAC 439.800 to 439.862, inclusive, unless the context otherwise requires, the words and terms defined in NAC 439.804 to 439.8225, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Dep’t of Human Res…

NAC 439.804 “Applicant” defined. (NRS 439.655) “Applicant” means a person who applies to the Department to receive a subsidy for coverage for prescription drugs and pharmaceutical services pursuant to NRS 439.670. (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-200…

NAC 439.806 “Contractor” defined. (NRS 439.655) “Contractor” means: 1. A private insurer with whom the Department has entered into a contract pursuant to NRS 439.665 to make available, at a reasonable cost, policies of health insurance that provide coverage to senior citizens for…

NAC 439.807 “Coordination of benefits” defined. (NRS 439.630) “Coordination of benefits” means the coordination of the Senior Prescription Program with Medicare Part D in a manner that: 1. Maximizes coverage for prescription drugs and pharmaceutical services for persons in this S…

NAC 439.808 “Department” defined. (NRS 439.655) “Department” means the Department of Health and Human Services. (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-2001; A by Dep’t of Health & Human Services by R157-05, 11-17-2005)

NAC 439.810 “Enrollee” defined. (NRS 439.655) “Enrollee” means a person who the Department has determined is eligible to receive a subsidy for coverage for prescription drugs and pharmaceutical services pursuant to NRS 439.665. (Added to NAC by Dep’t of Human Resources by R069-00…

NAC 439.812 “Hearing officer” defined. (NRS 439.630) “Hearing officer” means a person who: 1. Did not participate in the decision of the Department that is the subject of the hearing; and 2. Is appointed by the Director or a designee thereof to preside at a hearing conducted purs…

NAC 439.813 “Household” defined. (NRS 439.655) “Household” means an applicant and the spouse of the applicant. (Added to NAC by Dep’t of Human Resources by R143-01, eff. 12-17-2001)

NAC 439.814 “Household income” defined. (NRS 439.655) “Household income” has the meaning ascribed to it in NRS 439.640. (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-2001)

NAC 439.816 “Income” defined. (NRS 439.655) “Income” has the meaning ascribed to it in NRS 439.645. (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-2001)

NAC 439.817 “Medicare Advantage plan with prescription drug coverage” and “MA-PD” defined. (NRS 439.630) “Medicare Advantage plan with prescription drug coverage” or “MA-PD” means health benefits coverage, including, without limitation, qualified prescription drug coverage, offer…

NAC 439.8175 “Medicare Part D” defined. (NRS 439.630) “Medicare Part D” means the federal prescription drug benefit established pursuant to Part 423 of Title 42 of the Code of Federal Regulations. (Added to NAC by Dep’t of Health & Human Services by R157-05, eff. 11-17-2005)

NAC 439.818 “Open enrollment” defined. (NRS 439.655) “Open enrollment” means a period prescribed by the Department during which an application for a subsidy may be filed. (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001)

NAC 439.819 “Prescription drug plan” and “PDP” defined. (NRS 439.630) “Prescription drug plan” or “PDP” means coverage for prescription drugs that is offered under a policy, contract or plan which has been approved as specified in 42 C.F.R. § 423.272 and which is offered by a spo…

NAC 439.820 “Senior citizen” defined. (NRS 439.655) “Senior citizen” has the meaning ascribed to it in NRS 439.650. (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-2001)

NAC 439.822 “Subsidy” defined. (NRS 439.655) “Subsidy” means the amount of money that the Department may pay to a contractor on behalf of a senior citizen who meets the criteria for receiving a subsidy set forth in NRS 439.665 for coverage for prescription drugs and pharmaceutica…

NAC 439.8225 “Traditional Senior Prescription Program” defined. (NRS 439.630) “Traditional Senior Prescription Program” means the prescription drug benefits available to eligible applicants who are not also eligible for Medicare Part D. (Added to NAC by Dep’t of Health & Human Se…

NAC 439.823 Eligibility for traditional benefits. (NRS 439.630) Senior citizens who are not eligible for Medicare Part D may be eligible for traditional benefits under the Senior Prescription Program, based on the availability of funding and contractual agreements with a pharmacy…

NAC 439.8235 Eligibility for coordination of benefits. (NRS 439.630) A senior citizen who is eligible for Medicare Part D may be eligible for assistance with out-of-pocket expenses for prescription drugs and pharmaceutical services. The availability of such coverage is subject to…

NAC 439.824 Request for information. (NRS 439.655) Upon request, the Department will provide information to an applicant relating to the criteria for receiving a subsidy, including, without limitation, any documentation that the Department may require the applicant to provide to …