Ala. Admin. Code r. 560-X-16-.29

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-16-.29 - Annual Report

(1) The DUR Board must submit an annual report to the Medicaid Agency containing information specified by the state. The Agency must submit, annually, a report to the Secretary of Health and Human Services through the HCFA Regional Office that incorporates the DUR Board Report. It must Include:

(a) A description of the nature and scope of the prospective drug review program.

(b) A description of how pharmacies performing prospective DUR without computers are expected to comply with the statutory requirement for written criteria.

(c) Detailed information on the specific criteria and standards in use.

(d) A description of the steps taken by the State to include in the prospective and retrospective DUR program drugs dispensed to residents of a nursing facility that is not in compliance with approved drug regimen review procedures.

(e) A description of the actions taken by the State Medicaid agency and the DUR Board to ensure compliance with the requirements for predetermined standards and with the access to the predetermined standards requirement.

(f) A description of the nature and scope of the retrospective DUR program.

(g) A summary of the educational interventions used and an assessment of the effect of these educational interventions on the quality of care.

(h) A description of the steps taken by the State Agency to monitor compliance by pharmacies with the prospective DUR counseling requirements contained in Federal and State laws and regulations.

(i) Clear statements of purpose that delineate the respective goals, objectives, and scopes of responsibility of the DUR and surveillance and utilization review (SUR) functions.

(j) An estimate of the cost savings generated as a result of the DUR program. This report must identify costs of DUR and savings to the Medicaid drug program attributable to prospective and retrospective DUR.

Author:

Ala. Admin. Code r. 560-X-16-.29

Emergency rule: Effective July 1, 1993. Permanent rule effective October 14, 1993. Amended: Filed January 7, 1997; effective February 11, 1997.

Rule was previously 560-X-16-.27, and was renumbered 560-X-16-.29 as per refiling filed September 10, 2004.

Statutory Authority: State Plan, Page 74b; Title XIX, Social Security Act; 42 CFR Section 440.120; Public Law 101-508.