| Old | New | Differences | |
|---|---|---|---|
| 1 | - | General Assembly Substitute Bill No. 6360 | |
| 2 | - | January Session, 2011 *_____HB06360HS____031111____* | |
| 1 | + | General Assembly Raised Bill No. 6360 | |
| 2 | + | January Session, 2011 LCO No. 2956 | |
| 3 | + | *02956_______HS_* | |
| 4 | + | Referred to Committee on Human Services | |
| 5 | + | Introduced by: | |
| 6 | + | (HS) | |
| 3 | 7 | ||
| 4 | 8 | General Assembly | |
| 5 | 9 | ||
| 6 | - | ||
| 10 | + | Raised Bill No. 6360 | |
| 7 | 11 | ||
| 8 | 12 | January Session, 2011 | |
| 9 | 13 | ||
| 10 | - | *_____HB06360HS____031111____* | |
| 14 | + | LCO No. 2956 | |
| 15 | + | ||
| 16 | + | *02956_______HS_* | |
| 17 | + | ||
| 18 | + | Referred to Committee on Human Services | |
| 19 | + | ||
| 20 | + | Introduced by: | |
| 21 | + | ||
| 22 | + | (HS) | |
| 11 | 23 | ||
| 12 | 24 | AN ACT CONCERNING NOTICE BY THE DEPARTMENT OF SOCIAL SERVICES OF A DECISION TO DENY PAYMENT FOR A PRESCRIPTION DRUG UNDER THE MEDICAID PROGRAM. | |
| 13 | 25 | ||
| 14 | 26 | Be it enacted by the Senate and House of Representatives in General Assembly convened: | |
| 15 | 27 | ||
| 16 | 28 | Section 1. Section 17b-274 of the general statutes is amended by adding subsections (e) and (f) as follows (Effective October 1, 2011): | |
| 17 | 29 | ||
| 18 | 30 | (NEW) (e) The Commissioner of Social Services or any independent pharmacy consultant acting on behalf of the Department of Social Services shall provide written notice to a Medicaid recipient whenever the commissioner or such consultant electronically denies payment, in whole or in part, for a prescribed drug. The commissioner or such consultant shall provide such notice to the Medicaid recipient at the time the recipient is at the pharmacy to obtain the drug or shall give notice by regular or electronic mail to the Medicaid recipient not later than twenty-four hours after the commissioner or such consultant denies payment for the drug. Such notice shall be individually tailored to describe the circumstances under which the commissioner or such consultant denied payment for the drug prescribed to the Medicaid recipient and shall: (1) Identify the drug for which payment was denied; (2) explain the reason for the denial of full or partial payment; (3) state the regulatory basis for the denial; (4) describe the process to request a hearing to review the denial; and (5) describe additional actions, if any, that the Medicaid recipient may take to obtain a supply of the drug for which payment was denied or a supply of a substitute drug. | |
| 19 | 31 | ||
| 20 | - | (NEW) (f) The Commissioner of Social Services or independent pharmacy consultant acting on behalf of the Department of Social Services shall notify, in writing by regular or electronic mail, the medical practitioner who issued the prescription for the drug for which payment was denied not later than two business days after the denial to advise the practitioner of such denial and whether the denial was due to the practitioner's failure to obtain prior authorization for the drug. If such denial was due to the practitioner's failure to obtain prior authorization for the drug, the commissioner or such consultant shall explain to the practitioner the need to obtain prior authorization in accordance with the provisions of subsection ( | |
| 32 | + | (NEW) (f) The Commissioner of Social Services or independent pharmacy consultant acting on behalf of the Department of Social Services shall notify, in writing by regular or electronic mail, the medical practitioner who issued the prescription for the drug for which payment was denied not later than two business days after the denial to advise the practitioner of such denial and whether the denial was due to the practitioner's failure to obtain prior authorization for the drug. If such denial was due to the practitioner's failure to obtain prior authorization for the drug, the commissioner or such consultant shall explain to the practitioner the need to obtain prior authorization in accordance with the provisions of subsection (e) of this section and shall provide the practitioner with the names of equally effective drugs that do not require prior authorization. If the practitioner fails to submit a request for prior authorization for the drug originally prescribed for the Medicaid recipient and an equally effective drug not requiring prior authorization is not dispensed to the Medicaid recipient within twelve calendar days from the date of the commissioner's or such consultant's initial denial, the commissioner or such consultant shall contact the practitioner to again notify the practitioner of the practitioner's ability to submit a request for prior authorization for the drug originally prescribed or to prescribe an equally effective drug not requiring prior authorization. | |
| 21 | 33 | ||
| 22 | 34 | ||
| 23 | 35 | ||
| 24 | 36 | ||
| 25 | 37 | This act shall take effect as follows and shall amend the following sections: | |
| 26 | 38 | Section 1 October 1, 2011 17b-274 | |
| 27 | 39 | ||
| 28 | 40 | This act shall take effect as follows and shall amend the following sections: | |
| 29 | 41 | ||
| 30 | 42 | Section 1 | |
| 31 | 43 | ||
| 32 | 44 | October 1, 2011 | |
| 33 | 45 | ||
| 34 | 46 | 17b-274 | |
| 35 | 47 | ||
| 36 | - | Statement of | |
| 48 | + | Statement of Purpose: | |
| 37 | 49 | ||
| 38 | - | ||
| 50 | + | To require the Department of Social Services and independent pharmacy consultants acting on behalf of the department to notify Medicaid recipients and medical practitioners when the department denies payment, in whole or in part, for a prescription drug that is prescribed to the Medicaid recipient. | |
| 39 | 51 | ||
| 40 | - | ||
| 41 | - | ||
| 42 | - | HS Joint Favorable Subst.-LCO | |
| 43 | - | ||
| 44 | - | HS | |
| 45 | - | ||
| 46 | - | Joint Favorable Subst.-LCO | |
| 52 | + | [Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.] |