DAR File No. 41175

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-60A-2

DUR Board Composition and Membership Requirements

Notice of Proposed Rule

(Amendment)

DAR File No.: 41175
Filed: 01/17/2017 09:30:28 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to update Drug Utilization Review (DUR) Board membership to include a pharmacist who will represent Accountable Care Organizations (ACOs).

Summary of the rule or change:

This amendment updates DUR Board membership to include a pharmacist who will represent ACOs. It also makes other technical changes.

Statutory or constitutional authorization for this rule:

• Title 26, Chapter 18, Part 2
• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this amendment only updates DUR Board composition and implements new membership requirements. It neither affects services to Medicaid clients nor reimbursement to Medicaid providers.

local governments:

There is no impact to local governments because they neither fund the DUR Board nor make administrative decisions regarding its composition.

small businesses:

There is no impact to small businesses because this amendment only updates DUR Board composition and implements new membership requirements. It neither affects services to Medicaid clients nor reimbursement to Medicaid providers.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to Medicaid providers and to Medicaid clients because this amendment only updates DUR Board composition and implements new membership requirements. It neither affects Medicaid services nor provider reimbursement.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid client because this amendment only updates DUR Board composition and implements new membership requirements. It neither affects Medicaid services nor provider reimbursement.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no fiscal impact to business because membership changes to the DUR Board do not affect the operation of any businesses.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/17/2017

This rule may become effective on:

04/01/2017

Authorized by:

Joseph Miner, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-60A. Drug Utilization Review Board.

R414-60A-2. DUR Board Composition and Membership Requirements.

(1) The Director of the Division of [Health Care]Medicaid and Health Financing ([DHCF]DMHF) shall act on behalf of the Executive Director of the Utah Department of Health regarding all DUR Board issues, and shall appoint the following groups of individuals to four-year terms on the DUR Board:

(a) Four physicians from recommendations received from the Utah Medical Association.

(b) One physician engaged in Academic Medicine.

(c) Three pharmacists from recommendations received from the Utah Pharmacy Association.

(d) One pharmacist engaged in Academic Pharmacy.

(e) One dentist from recommendations received from the Utah Dental Association.

(f) One individual from recommendations received from the Pharmaceutical Manufacturers Association (PhRMA).

(g) One consumer representative.

(h) One pharmacist from recommendations received from the Accountable Care Organizations (ACOs).

(2) Membership Requirements.

(a) An appointee may not serve more than two consecutive terms in one of the 12 board positions listed in Subsection R414-60A-2(1). Terms separated by more than an interruption of two months are not consecutive.

(b) If [the Division]DMHF does not receive recommendations to fill a vacant position within 30 days of a request, [the Division]DMHF may [submit for consideration a list of potential candidates to an organization listed in Subsection R414-60A-2(1)]appoint a qualified individual to fill the vacancy.

(c) If there are no willing nominees for appointment when an appointed term has expired, the [DHCF]DMHF Director may reappoint[:

(i) physician] members on the board to additional non-consecutive terms as needed[;

(ii) pharmacist members on the board to additional non-consecutive terms as needed; and

(iii) a dentist, PhRMA member, or consumer member to additional non-consecutive one-year terms as needed].

(3) Notwithstanding the requirements in Subsection R414-60A-2(1), the Director shall adjust the length of terms upon appointment so that one-half of the DUR Board is appointed every two years.

(4) The DUR Board shall elect a chairperson to a one-year term from among its members. The chairperson may serve consecutive terms if reelected by the board.

(5) When a vacancy occurs on the board, the Director shall appoint a replacement for the unexpired term of the vacating member.

(6) The DUR Board shall be managed by a non-voting board manager appointed from the pharmacy group within [DHCF]DMHF.

(7) Other individuals of the [DHCF]DMHF pharmacy group are non-voting ex-officio advisory members of the DUR Board.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [September 7, 2007]2017

Notice of Continuation: June 25, 2012

Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5 ; 26-18 Part 2