Sec. 202. Improving reporting requirements and developing standards for the use of drug use review boards in State Medicaid programs
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Section 1927(g)(3) of the Social Security Act ( 42 U.S.C. 1396r–8(g)(3) ) is amended— by amending subparagraph
(B)to read as follows: The membership of the DUR Board shall include health care professionals who have recognized knowledge and expertise in one or more of the following: The clinically appropriate prescribing of covered outpatient drugs. The clinically appropriate dispensing and monitoring of covered outpatient drugs. Drug use review, evaluation, and intervention. Medical quality assurance. The membership of the DUR Board shall— be made up of at least 1/3 but no more than 51 percent members who are licensed and actively practicing physicians and at least 1/3 members who are licensed and actively practicing pharmacists; and include at least 1 licensed and actively practicing physician and at least 1 licensed and actively practicing pharmacist, each of whom— is independent and free of any conflict, including with respect to manufacturers, medicaid managed care entities, or pharmacy benefit managers; and has expertise in the care of 1 or more categories of individuals who are likely to be eligible for benefits under this title, including elderly or disabled individuals, children with complex medical needs, or low-income individuals with chronic illnesses; and be made publicly available. The State shall establish and implement a conflict of interest policy for the DUR Board that— is publicly accessible; requires all board members to complete, on at least an annual basis, a disclosure of relationships, associations, and financial dealings that may affect their independence of judgement in board matters; and contains clear processes, such as recusal from voting or discussion, for those members who report a conflict of interest, along with appropriate processes to address any instance where a member fails to report a conflict of interest. ; and by adding at the end the following new subparagraph: Each State shall require the DUR Board to prepare and submit to the State an annual report on the DUR Board membership. Each such report shall include any conflicts of interest with respect to members of the DUR Board that the DUR Board recorded or was aware of during the period that is the subject of the report, and the process applied to address such conflicts of interest, in addition to any other information required by the State. Each annual State report to the Secretary required under subparagraph
(D)shall include— the number of individuals serving on the State's DUR Board; the names and professions of the individuals serving on such DUR Board; any conflicts of interest or recusals with respect to members of such DUR Board reported by the DUR Board or that the State was aware of during the period that is the subject of the report; and whether the State has elected for such DUR Board to serve as the committee responsible for developing a State formulary under subsection (d)(4)(A). . Section 1932(i) of the Social Security Act ( 42 U.S.C. 1396u–2(i) ) is amended— by striking section 483.3(s)(4) and inserting section 438.3(s)(4) ; by striking 483.3(s)(5) and inserting 438.3(s)(5) ; and by adding at the end the following: Such a managed care entity shall not be considered to be in compliance with the requirement of such section 438.3(s)(5) that the entity provide a detailed description of its drug utilization review activities unless the entity includes a description of the prospective drug review activities described in paragraph (2)(A) of section 1927(g) and the activities listed in paragraph (3)(C) of section 1927(g), makes the underlying drug utilization review data available to the State and the Secretary, and provides such other information as deemed appropriate by the Secretary. . The Secretary of Health and Human Services may promulgate regulations or guidance establishing national standards for Medicaid drug use review programs under section 1927(g) of the Social Security Act ( 42 U.S.C. 1396r–8 ) and drug utilization review activities and requirements under section 1932(i) of such Act ( 42 U.S.C. 1396u–2(i) ), for the purpose of aligning review criteria for prospective and retrospective drug use review across all State Medicaid programs. Not later than 18 months after the date of enactment of this Act, the Secretary of Health and Human Services shall issue guidance— outlining steps that States must take to come into compliance with statutory and regulatory requirements for prospective and retrospective drug use review under section 1927(g) of the Social Security Act ( 42 U.S.C. 1396r–8(g) ) and drug utilization review activities and requirements under section 1932(i) of such Act ( 42 U.S.C. 1396u–2(i) ) (including with respect to requirements that were in effect before the date of enactment of this Act); and describing the actions that the Secretary will take to enforce such requirements. The amendments made by this section shall take effect on the date that is 1 year after the date of enactment of this Act.
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- 42 USC 1396r–8(g)(3)
- 42 USC 1396u–2(i)
- 42 USC 1396r–8
- 42 USC 1396r–8(g)
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Sec. 202
Improving reporting requirements and developing standards for the use of drug use review boards in State Medicaid programs
Cite42 USC 1396r–8(g)(3)
Cite42 USC 1396u–2(i)
Cite42 USC 1396r–8
Cite42 USC 1396r–8(g)
Cites 4Cited by 0 across 0 sources