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| Sec. X-4. 22 MRSA §3174-M, sub-§3, as enacted by PL 1993, c. 410, Pt. I, | | §10, is repealed and the following enacted in its place: |
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| | | 3. Emergency supply.__The department shall adopt routine | | technical rules as necessary that provide for a pharmacy to | | dispense, in accordance with applicable licensing standards and | | professional judgment, a one-time supply for 10 days of the | | prescribed drug.__The rules must allow the department to | | authorize refills of the drug on a case-by-case basis at the end | | of the 10-day period if the prescribing provider has not | | submitted the required information at that time or the department | | determines that an additional refill is necessary. |
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| | | The rules must provide that receipt of a 10-day supply under this | | subsection does not relieve the prescribing provider of the duty | | to submit all required information. The provision of the 10-day | | supply does not entitle the MaineCare member to receive benefits | | pending appeal in the event that a request for prior | | authorization is ultimately denied, except when the member was | | receiving the drug for which the 10-day supply was provided | | immediately prior to the provision of that supply. |
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| | | Any drug provided under this emergency procedure is considered a | | Medicaid-covered service pending departmental actions. |
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| | | Sec. X-5. 22 MRSA §3174-M, sub-§5 is enacted to read: |
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| | | 5.__Expedited review process.__The department shall provide an | | independent review process whenever a MaineCare member has | | written certification from the member's physician that: |
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| | | A.__Delay in the provision of the requested drug may | | severely jeopardize the life or health of the MaineCare | | member or cause a severe functional decline in the member; | | or |
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| | | B.__A preferred drug, if provided, would impose a serious | | risk to the life or health of the MaineCare member. |
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| | | The independent review process must ensure a decision within 72 | | hours of the time that the request is filed, unless the parties | | otherwise agree that the 72-hour period may be extended. The | | independent review process must ensure that coverage decisions | | based upon lack of medical necessity are conducted by a physician | | or pharmacist.__The physician need not in all cases be of the | | same specialty or subspecialty as the prescribing physician. |
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| | | Sec. X-6. Impact analysis required. The Department of Health and Human | | Services shall institute a process to determine |
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