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

1. (1) Eligibility.

   1. (A) Only pharmacies that meet the criteria for an enrolled Missouri Medicaid pharmacy shall be eligible to participate in the program.

2. (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 division of an application and continues until there is an official written disposition of the request by the third-party administrator.
   2. (B) Participating pharmacies shall meet the conditions of eligibility set forth in 19 CSR 90-2.020(1), both at the time of initial application for participation and on an ongoing basis.
   3. (C) The applicant shall submit an enrollment application form to the third-party administrator. The third-party administrator shall develop and designate such form.
   4. (D) The applicant shall consent to a review of information on the application enrollment form and of the required documentation, with reasonable prior notice to the applicant, if selected for review. Program eligibility will be denied if the applicant refuses to cooperate with the request.
   5. (E) 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.
   6. (F) The applicant shall submit with the appropriate enrollment application a signed participating pharmacy agreement as developed by the third-party administrator.
   7. (G) A participating provider’s enrollment in the program shall be effective on the date when the signatures of the third-party administrator’s authorized representatives have been affixed to the provider agreement. No services rendered prior to that date shall be eligible for reimbursement.
   8. (H) A participating pharmacy’s enrollment shall cease to be effective on the date when the third-party administrator suspends or terminates the pharmacy’s provider agreement. Payment or reimbursements shall not be made for prescription drugs dispensed on any dates when a pharmacy’s enrollment is no longer effective.

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.