117 STAT. 2158
PUBLIC LAW 108–173—DEC. 8, 2003
‘‘(A) IN GENERAL.—For purposes of this section, the term ‘full-benefit dual eligible individual’ means for a State for a month an individual who— ‘‘(i) has coverage for the month for covered part D drugs under a prescription drug plan under part D of title XVIII, or under an MA–PD plan under part C of such title; and ‘‘(ii) is determined eligible by the State for medical assistance for full benefits under this title for such month under section 1902(a)(10)(A) or 1902(a)(10)(C), by reason of section 1902(f), or under any other category of eligibility for medical assistance for full benefits under this title, as determined by the Secretary. ‘‘(B) TREATMENT OF MEDICALLY NEEDY AND OTHER INDIVIDUALS REQUIRED TO SPEND DOWN.—In applying subparagraph (A) in the case of an individual determined to be eligible by the State for medical assistance under section 1902(a)(10)(C) or by reason of section 1902(f), the individual shall be treated as meeting the requirement of subparagraph (A)(ii) for any month if such medical assistance is provided for in any part of the month.’’. (c) MEDICAID COORDINATION WITH MEDICARE PRESCRIPTION DRUG BENEFITS.—Section 1935, as so inserted and amended, is further amended by adding at the end the following new subsection: ‘‘(d) COORDINATION OF PRESCRIPTION DRUG BENEFITS.— ‘‘(1) MEDICARE AS PRIMARY PAYOR.—In the case of a part D eligible individual (as defined in section 1860D–1(a)(3)(A)) who is described in subsection (c)(6)(A)(ii), notwithstanding any other provision of this title, medical assistance is not available under this title for such drugs (or for any cost-sharing respecting such drugs), and the rules under this title relating to the provision of medical assistance for such drugs shall not apply. The provision of benefits with respect to such drugs shall not be considered as the provision of care or services under the plan under this title. No payment may be made under section 1903(a) for prescribed drugs for which medical assistance is not available pursuant to this paragraph. ‘‘(2) COVERAGE OF CERTAIN EXCLUDABLE DRUGS.—In the case of medical assistance under this title with respect to a covered outpatient drug (other than a covered part D drug) furnished to an individual who is enrolled in a prescription drug plan under part D of title XVIII or an MA–PD plan under part C of such title, the State may elect to provide such medical assistance in the manner otherwise provided in the case of individuals who are not full-benefit dual eligible individuals or through an arrangement with such plan.’’. (d) TREATMENT OF TERRITORIES.— (1) IN GENERAL.—Section 1935, as so inserted and amended, is further amended— (A) in subsection (a) in the matter preceding paragraph (1), by inserting ‘‘subject to subsection (e)’’ after ‘‘section 1903(a)’’; (B) in subsection (c)(1), by inserting ‘‘subject to subsection (e)’’ after ‘‘1903(a)(1)’’; and (C) by adding at the end the following new subsection: ‘‘(e) TREATMENT OF TERRITORIES.—
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