| | | Sec. FFF-4. Subcommittee of MaineCare Advisory Committee to review prior | | authorization process. The MaineCare Advisory Committee shall | | establish a standing subcommittee to review the prior | | authorization process used in MaineCare and the Drugs for the | | Elderly benefit programs and to make recommendations to the | | Department of Human Services related to their operation. | | Membership on the subcommittee consists of members of the | | MaineCare Advisory Committee, providers and experts in prior | | authorization from private insurance and private purchasers and | | any additional experts considered necessary by the committee to | | achieve the purposes of this section. The subcommittee may not | | exceed 15 members. |
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| | | The department shall work with the subcommittee to examine the | | following issues. |
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| | | 1. Consumer education. The subcommittee shall determine the | | most effective means of providing educational information to | | members of MaineCare and Drugs for the Elderly, both | | electronically and otherwise, related to the prior authorization | | process, including but not limited to: |
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| | | A. Provision for accessing drugs requiring prior | | authorization in an emergency or on a one-time basis before | | a prior authorization request has been approved; |
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| | | B. The right to request an administrative hearing when the | | Department of Human Services fails to act on a request for | | prior authorization or prior authorization has been denied, | | including the right to receive benefits pending the hearing | | under certain circumstances; |
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| | | C. Procedural requirements of the prior authorization | | process, including the Department of Human Services' | | responsibility to process a completed prior authorization | | request within at least 24 hours; |
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| | | D. An easily accessible, understandable, complete and up- | | to-date list of drugs subject to prior authorization | | together with all information related to preferred drugs, | | dosage requirements and step therapies; and |
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| | | E. Refill policies, including early refill policies and any | | exceptions to those policies. |
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| | | 2. Prior authorization process. The subcommittee shall | | review the current prior authorization process and make | | recommendations to the Department of Human Services as to how it | | can be simplified or improved. In particular, the subcommittee | | shall review: |
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