PURPOSE: This rule establishes eligibility and the application process for eligible seniors for the Missouri Senior Rx Program.

1. (1) Eligibility.

   1. (A) To be eligible to participate in the program, an applicant shall:

      1. 1. Meet the eligibility requirements in

sections 208.550 to 208.571, RSMo; and

1. 2. The commission shall determine the

income level necessary to be eligible for the program under sections 208.556.4(1), (2), and (3). The commission may restrict income eligibility limits as a last resort to obtain program cost control.

1. (B) Program eligibility is established for a fiscal year when a valid program application is approved, unless there is a cause for earlier termination.

1. (2) Application Process.

   1. (A) The application process includes all activity relating to a request for eligibility determination. It begins with the receipt by the commission of an application and continues until there is an official written disposition of the request by the third-party administrator.

   2. (B) The application shall require the applicant to attest to the following information:

      1. 1. Residence;
      2. 2. Any third-party health insurance cov-

erage;

1. 3. Previous year prescription drug costs;
2. 4. Annual household income for an indi-

vidual or couple, if married;

1. 5. Date of birth;
2. 6. Gender;
3. 7. Race (optional);
4. 8. Social Security number (optional);
5. 9. Self-certification of Missouri residen-

cy;

1. 10. Self-certification of household

income;

1. 11. Certification and authorization state-

ment; and

1. 12. Signature of applicant or authorized

agent.

1. (C) The applicant shall submit with the application the following documentation:

   1. 1. Documentation of residence shall

include one (1) of the following: a valid drivers license; a valid Missouri state identification card; certification of residency in a nursing home; or a completed and signed federal, state, or local income tax return with the applicant’s name and address preprinted on it. 19 CSR 90-1

1. 2. Documentation of age shall include

one (1) of the following: birth certificate; delayed birth certificate; certified hospital records; a valid drivers license or a valid Missouri state identification card.

1. 3. Documentation of income shall be in

the form required by the commission in the application and shall be substantially equivalent to the documentation required to determine income pursuant to sections 135.010 to 135.035, RSMo.

1. (D) The applicant shall certify and attest that the answers to questions on the application, the items on the application form and the required documentation are true and accurate to the best of the applicant’s knowledge. Before the application can be processed, the certification shall be dated and signed by the applicant or authorized agent and any other party whose signature is required in the instructions which accompany the application form.
2. (E) The applicant shall consent to a review of information on the application form and of the required documentation, with reasonable prior notice to the applicant, if selected for review. Program eligibility will be denied or terminated if the applicant refuses to cooperate with the request.
3. (F) The applicant shall assist the commission, division, or third-party administrator in securing corroboration of the applicant’s information on the application form and required documentation when necessary. Program eligibility will be denied or terminated if the applicant refuses to cooperate with the request.
4. (G) The applicant shall submit an enrollment fee in the amount as established by the commission on an annual basis.

1. (3) Denial of Application.

   1. (A) An application shall be denied if an applicant fails to comply with the provisions of sections 208.550 to 208.571, RSMo and the regulations promulgated thereunder.
   2. (B) An applicant may apply for a refund of the enrollment fee if the commission denies his or her eligibility because the commission restricted the income eligibility limits as a last resort to obtain program cost control pursuant to section 208.556.4(3), RSMo.

AUTHORITY: section 208.553.3(5), RSMo Supp. 2001.* Emergency rule filed Jan. 16, 2002, effective March 1, 2002, expired Aug. 27, 2002. Original rule filed Jan. 16, 2002, effective Aug. 30, 2002.

*Original authority: 208.553, RSMo 2001. ` SENIOR SERVICES