NAC439.838. Discontinuation of subsidy to enrollee: Request by enrollee; ineligibility of enrollee; granting of subsidy to applicant on waiting list if enrollee determined ineligible.

     1. If an enrollee who is receiving a subsidy wishes to discontinue receiving the subsidy, he or she must submit a written request to that effect to the Department and notify the contractor in writing.

     2. If, based on information the Department receives, the Department reasonably believes that an enrollee no longer meets the criteria for receiving a subsidy because one of the circumstances set forth in subsection 3 applies to the enrollee, it shall provide the enrollee with notice as set forth in NAC 439.840 and an opportunity for a hearing.

     3. The circumstances in which an enrollee no longer meets the criteria for receiving a subsidy include, without limitation, that:

     (a) The enrollee is eligible for coverage for prescription drugs and pharmaceutical services through Medicare Part D, but the enrollee declines to enroll in that program or in a PDP or MA-PD, or the enrollee declines to apply for any federal subsidy available to him or her, or both;

     (b) The enrollee is eligible for coverage for prescription drugs and pharmaceutical services through Medicare Part D and qualifies for a federal low-income subsidy as a “very low-income beneficiary”;

     (c) The enrollee is eligible for coverage for prescription drugs and pharmaceutical services through Medicaid;

     (d) The household income of the enrollee exceeds the maximum household income set forth in NRS 439.665;

     (e) The enrollee knowingly provided incorrect information on the application that he or she filed with the Department pursuant to NAC 439.826 and failed to correct the information within a reasonable time as determined by the Department;

     (f) The enrollee failed to maintain residency in this State; or

     (g) The enrollee failed to respond timely to a request for verification of the income of the applicant or of any other annual eligibility requirement.

     4. The Department will deem an enrollee to be ineligible to receive a subsidy if the enrollee does not request a hearing within 30 days after the date of the notice provided to the enrollee pursuant to subsection 2.

     5. If an enrollee no longer meets the criteria for receiving a subsidy because one of the circumstances set forth in subsection 3 applies to the enrollee, the Department will grant a subsidy to an applicant on the waiting list, if any, in the order of priority described in NAC 439.830.

     (Added to NAC by Dep’t of Human Resources by R069-00, eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004; A by Dep’t of Health & Human Services by R157-05, 11-17-2005)