Sec. 206. T–MSIS drug data analytics reports
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/bill/116/hr/19/ih/section-206A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Not later than May 1 of each calendar year beginning with calendar year 2021, the Secretary of Health and Human Services (in this section referred to as the Secretary ) shall publish on a website of the Centers for Medicare & Medicaid Services that is accessible to the public a report of the most recently available data on provider prescribing patterns under the Medicaid program. Each report required under subsection
(a)for a calendar year shall include the following information with respect to each State (and, to the extent available, with respect to Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa): A comparison of covered outpatient drug (as defined in section 1927(k)(2) of the Social Security Act ( 42 U.S.C. 1396r–8(k)(2) )) prescribing patterns under the State Medicaid plan or waiver of such plan (including drugs prescribed on a fee-for-service basis and drugs prescribed under managed care arrangements under such plan or waiver)— across all forms or models of reimbursement used under the plan or waiver; within specialties and subspecialties, as defined by the Secretary; by episodes of care for— each chronic disease category, as defined by the Secretary, that is represented in the 10 conditions that accounted for the greatest share of total spending under the plan or waiver during the year that is the subject of the report; procedural groupings; and rare disease diagnosis codes; by patient demographic characteristics, including race (to the extent that the Secretary determines that there is sufficient data available with respect to such characteristic in a majority of States), gender, and age; by patient high-utilizer or risk status; and by high and low resource settings by facility and place of service categories, as determined by the Secretary. In the case of medical assistance for covered outpatient drugs (as so defined) provided under a State Medicaid plan or waiver of such plan in a managed care setting, an analysis of the differences in managed care prescribing patterns when a covered outpatient drug is prescribed in a managed care setting as compared to when the drug is prescribed in a fee-for-service setting. A report required under subsection
(a)for a calendar year may include State-specific information about prescription utilization management tools under State Medicaid plans or waivers of such plans, including— a description of prescription utilization management tools under State programs to provide long-term services and supports under a State Medicaid plan or a waiver of such plan; a comparison of prescription utilization management tools applicable to populations covered under a State Medicaid plan waiver under section 1115 of the Social Security Act ( 42 U.S.C. 1315 ) and the models applicable to populations that are not covered under the waiver; a comparison of the prescription utilization management tools employed by different Medicaid managed care organizations, pharmacy benefit managers, and related entities within the State; a comparison of the prescription utilization management tools applicable to each enrollment category under a State Medicaid plan or waiver; and a comparison of the prescription utilization management tools applicable under the State Medicaid plan or waiver by patient high-utilizer or risk status. To the extent practicable, the Secretary shall include in each report published under subsection (a)— analyses of national, State, and local patterns of Medicaid population-based prescribing behaviors; and recommendations for administrative or legislative action to improve the effectiveness of, and reduce costs for, covered outpatient drugs under Medicaid while ensuring timely beneficiary access to medically necessary covered outpatient drugs. T–MSIS data Each report required under subsection
(a)shall— be prepared using data and definitions from the Transformed Medicaid Statistical Information System (T–MSIS) data set (or a successor data set) that is not more than 24 months old on the date that the report is published; and as appropriate, include a description with respect to each State of the quality and completeness of the data, as well as any necessary caveats describing the limitations of the data reported to the Secretary by the State that are sufficient to communicate the appropriate uses for the information. Each report required under subsection
(a)shall be prepared by the Administrator for the Centers for Medicare & Medicaid Services. For fiscal year 2020 and each fiscal year thereafter, there is appropriated to the Secretary $2,000,000 to carry out this section.
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U.S. Code
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- 42 USC 1396r–8(k)(2)
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