Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-16 - PHARMACEUTICAL SERVICES
Section 560-X-16-.29 - Annual Report
Universal Citation: AL Admin Code R 560-X-16-.29
Current through Register Vol. 43, No. 02, November 27, 2024
(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:
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.
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