SF 1401

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:20am

A bill for an act
relating to human services; establishing an e-prescribing demonstration project;
requiring fee-for-service drug coverage; establishing a utilization review program
for ADHD and ADD medications; requiring a report; amending Minnesota
Statutes 2008, sections 256B.0625, subdivision 13, by adding a subdivision;
256B.69, subdivision 6; proposing coding for new law in Minnesota Statutes,
chapter 256.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [256.9652] E-PRESCRIBING INITIATIVE.
new text end

new text begin (a) The commissioner shall implement a demonstration project that incorporates
e-prescribing applications with a clinical information database in order to increase
patient safety and efficiencies and reduce medication errors, duplication of therapies,
and eliminate waste.
new text end

new text begin (b) The commissioner shall identify providers who are currently using e-prescribing
and who are high-volume prescribers. The commissioner shall ensure that each provider
identified has the ability through e-prescribing software to receive the following:
new text end

new text begin (1) a patient's specific medication history for the last 100 days;
new text end

new text begin (2) the preferred drug list and formulary verification;
new text end

new text begin (3) prescription details; and
new text end

new text begin (4) drug interaction alerts.
new text end

new text begin (c) Beginning January 1, 2010, each provider identified by the commissioner shall
use the e-prescribing applications for each prescription.
new text end

new text begin (d) The commissioner shall evaluate the project in terms of the number of
prescriptions written by the providers participating in the demonstration project.
The evaluation shall include a comparison between participating providers and
nonparticipating providers in terms of:
new text end

new text begin (1) number of prescriptions written per patient; and
new text end

new text begin (2) average cost of the prescriptions written per patient.
new text end

new text begin The results of the evaluations shall be submitted to the legislature by March 15, 2011.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0625, subdivision 13, is amended to
read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs
when specifically used to enhance fertility, if prescribed by a licensed practitioner and
dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance
program as a dispensing physician, or by a physician or a nurse practitioner employed
by or under contract with a community health board as defined in section 145A.02,
subdivision 5, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.

(c) Medical assistance covers the following over-the-counter drugs when prescribed
by a licensed practitioner or by a licensed pharmacist who meets standards established by
the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen,
family planning products, aspirin, insulin, products for the treatment of lice, vitamins for
adults with documented vitamin deficiencies, vitamins for children under the age of seven
and pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the formulary committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions,
or disorders, and this determination shall not be subject to the requirements of chapter
14. A pharmacist may prescribe over-the-counter medications as provided under this
paragraph for purposes of receiving reimbursement under Medicaid. When prescribing
over-the-counter drugs under this paragraph, licensed pharmacists must consult with the
recipient to determine necessity, provide drug counseling, review drug therapy for potential
adverse interactions, and make referrals as needed to other health care professionals.

(d) Effective January 1, 2006, medical assistance shall not cover drugs that
are coverable under Medicare Part D as defined in the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e),
for individuals eligible for drug coverage as defined in the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section
1860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the
drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this
subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code,
title 42, section 1396r-8(d)(2)(E), shall not be covered.

new text begin (e) Effective January 1, 2010, prescription drug coverage shall be covered on a
fee-for-service basis according to subdivisions 13 to 13h, except as specified in section
256B.69, subdivision 6, paragraph (c).
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 13i. new text end

new text begin Utilization drug review for children. new text end

new text begin (a) The commissioner shall
establish a utilization review program for attention deficit/hyperactivity disorder (ADHD)
and attention deficit disorder (ADD) medication and psychotropic medication prescribed
to children.
new text end

new text begin (b) The program shall require prior authorization for ADHD medication prescribed
to children under five years of age and a second opinion from a commissioner-approved
provider.
new text end

new text begin (c) The program shall require a second opinion from a commissioner-approved
provider for children five years of age and under 18 years of age for ADHD medications
that exceed the following dosages:
new text end

new text begin (1) methylphenidates 120 mg/day;
new text end

new text begin (2) dexmethylphenidates 60 mg/day;
new text end

new text begin (3) amphetamines 60 mg/day; and
new text end

new text begin (4) Strattera 120 mg/day.
new text end

new text begin (d) The commissioner shall require prior authorization and a second opinion from a
commissioner-approved provider when a child under 18 years of age is prescribed more
than one type of medication identified in paragraph (c) at one time.
new text end

new text begin (e) The commissioner shall require a second opinion from a commissioner-approved
provider if any of the following conditions apply:
new text end

new text begin (1) the absence of a DSM-IV diagnosis in the child's claim record;
new text end

new text begin (2) five or more psychotropic medications prescribed concomitantly after 60 days;
new text end

new text begin (3) two or more concomitant antipsychotic medications after 60 days;
new text end

new text begin (4) three or more concomitant mood stabilizer medications for a mental health
diagnosis after 60 days;
new text end

new text begin (5) the prescribed psychotropic medication is not consistent with appropriate care
for the child's diagnosed mental disorder or with documented target symptoms associated
with a therapeutic response to the medication prescribed; and
new text end

new text begin (6) psychotropic medications prescribed for children under five years of age.
new text end

new text begin (f) The commissioner may establish threshold amounts for identified
psychotropic medications that, if exceeded, may require a second opinion from a
commissioner-approved provider.
new text end

Sec. 4.

Minnesota Statutes 2008, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) new text begin Except as provided in paragraph (c), new text end each
demonstration provider shall be responsible for the health care coordination for eligible
individuals. Demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections 256B.02,
subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered to
enrollees. Notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section shall provide relocation
service coordination to enrolled persons age 65 and over;

(2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated health care services for eligible
individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide
services to enrollees; and

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.

(b) Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
care and social service practitioners to provide services to enrollees. A demonstration
provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the claim.

new text begin (c) Effective January 1, 2010, a demonstration provider shall not authorize or arrange
prescription drug coverage described under section 256B.0625; 256D.03, subdivision 4; or
256L.03 as part of the comprehensive health care services that are required to be provided
by the demonstration provider under this section. Prescription drug coverage shall be
provided on a fee-for-service basis according to section 256B.0625. This paragraph does
not apply to integrated Medicare and Medicaid programs operating under subdivisions 23
and 28. This paragraph does not apply to physician-administered drugs. A demonstration
provider shall continue to provide the commissioner with clinic information.
new text end