36-2972. Rights, authority and responsibilities of the director and the administration
A. Subject to continued federal financial participation as provided in sections 36-2919 and 36-2958, the director shall plan for and take all steps necessary to implement the qualified medicare beneficiary program under title XIX of the social security act, as amended.
B. The administration and the director have full operational responsibility for this article. Except as provided in this article or required by federal law or the section 1115 waiver, the provisions of articles 1 and 2 of this chapter are fully applicable to this article and the director and administration have all the rights, powers, duties and responsibilities accorded to the system under articles 1 and 2 of this chapter. Services shall be delivered in accordance with federal law and the section 1115 waiver for articles 1 and 2 of this chapter.
C. The administration shall coordinate benefits provided under this article to members so that costs for services payable by the system are costs avoided or recovered from a third party payor. The director may require that program contractors, contractors and noncontracting providers are responsible for the coordination of benefits for services provided pursuant to this article. Benefit coordination requirements for noncontracting providers are limited to coordination of benefits with standard health insurance and disability or medicare supplemental health insurance policies and similar programs for health coverage. The director shall require members to assign to the system rights to all types of medical benefits to which the member is entitled.
D. Notwithstanding section 36-2911, the program contractors or contractors shall pay all premiums, deductibles and coinsurance amounts for the member to obtain coverage or secure services as required by the administration. For members not enrolled with a contractor or program contractor the administration may pay the premiums, deductibles and coinsurance amounts.
Section: Previous 36-2955 36-2956 36-2957 36-2958 36-2959 36-2960 36-2971 36-2972 36-2973 36-2974 36-2975 36-2976 36-2981 36-2982 36-2983 NextLast modified: October 13, 2016